Discourse, Materiality, and the Users of Mobile Health Technologies: A Nigerian Case Study

mHealth, which is the use of mobile phones and other handheld information and communication technologies (ICTs), has been increasingly advocated as the solution to the problems, primarily infrastructure and personnel, facing the healthcare sector of many low-to-lower-middle-income countries (LMICs). Following a series of United Nations Foundation research and advisory publications (in 2012, 2014 and 2016) arguing that mobile phones are approaching ubiquity in Nigeria and across the world, the UN strongly recommended that LMICs undertake mHealth initiatives. Subsequently, Nigeria’s Federal Ministry of Health (FMOH) published a National Health ICT Strategic Framework (Strategic Framework), 2015-2020; the rallying call of this document is that “Health ICTs will deliver universal healthcare [in Nigeria] by 2020.” The document takes a techno-optimistic position that celebrates and advocates for the creation of mHealth technologies, yet it fails to acknowledge the dire lack of the basic, necessary infrastructures for such electronic health systems, particularly in rural areas, including a scarcity of reliable electrical systems or the trained personnel who would understand how to use such technologies. This creates and sustains a healthcare precarity for poor and rural Nigerians. The rhetoric of health and medicine has taken up precarity as a framework for understanding how modern discourses contribute to the material positioning of humans with respect to technological systems. Using material-discursive critique and precarity as analytical frameworks, I tie the history of western medicine in Nigeria to the prevailing top-down approach which created widespread healthcare deserts. Using Critical (Policy) Discourse Analysis, I also examine discursive positioning of agents, e.g., “stakeholders” in the Strategic Framework and “heroes” in an mHealth technology developed and advertised locally in Nigeria, to reveal how policy documents and popular advertisements around mHealth are manipulated to camouflage these healthcare deserts with techno-optimistic rhetoric. Only when we address both the actual material conditions and the rhetorical and linguistic silencing of the people in these rural or poor areas will we be able to approach the promised benefits of mHealth systems in universal healthcare

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries