Journal of Information Technology

Recent years were marked by the implementation of many eHealth projects using information and communication technologies to provide health services in developing countries. While generating great expectations, these projects remain poorly documented and available data suggest high failure rates. This raises a practical question: How are such eHealth networks to be effectively designed and implemented? This paper addresses this question. Specifically, it presents an ethnographic study of the Pan-African e-Network, a project which connects many hospitals all across India and Africa, providing medical teleconsultations and distance learning services. The study investigates the low utilisation of the network, an issue undermining its potential and efficiency. Factors contributing to this situation include communication barriers, the presumed ego of doctors, poor awareness of the project, and a lack of flexibility to work with the specificities of the connected sites. Above all, these factors point towards a dichotomous approach across the project's design and implementation, and taking two distinct yet related forms: (a) an ontological divide between technical and ‘non-technical’ domains; (b) a political sorting out of what is and what is not the project, aimed at neutralising and accounting for heterogeneous processes and practices. In both cases, low utilisation reveals tensions between processes of closure and control, and the openness of a life that will not be contained. Ultimately, this paper intends to destabilise binary modes of thinking as they crystallise oppositions between design and implementation, project and context, technical and social worlds, efficacy and improvisation, mastery and unruliness, map and territory.

In this paper, we draw upon Goffman's symbolic interactionism to analyze the ways in which new users in developing countries have adopted ICT to present and manage contradictory self-images to different groups of the public. In particular, we show that the Acapú, an indigenous group in the Amazon, present themselves through online videos and websites as ideal Indians: innate forest stewards aiming to mitigate climate change and ensure the planet's environmental sustainability. At the same time, the Acapú are also represented through a complex computer simulation model as destructive “cowboys”: farmers and ranchers who are willing to develop by clearing their forests in the absence of financial compensation. This research shows that these two opposing self-images, while contradictory, are necessary for the implementation of REDD projects (a payment mechanism for reducing greenhouse emissions from deforestation). In order to obtain carbon credits from avoided deforestation, the project relies on the difference between deforestation measurements and high levels of predicted deforestation, which in turn, depend on the presentation of destructive self-images through the use of a complex computer simulation. But to sell these credits on a voluntary carbon market, it is necessary for the Acapú to openly market a self-image through the Internet which is attractive to corporate buyers willing to boost their eco-friendly profile. Based on this analysis, the paper challenges the narrative whereby Southern ICT users are passive receivers of technological black boxes. In contrast, it shows that in some cases these new users may participate in the creation of ICT artifacts to manage the impressions of distant audiences. Furthermore, the paper calls attention to the role of computer simulations and other ICT applications in concealing the paradoxes of neoliberal environmental management practices.

While the uptake of online communities toward development purposes continues to grow, many are characterized by an unresolved tension. On the one hand, they benefit from participation of heterogeneous stakeholders in their efforts to strengthen their expertise. On the other hand, these stakeholders represent highly diverging interests, which makes collective strategic action very challenging. To understand how online communities cope with this tension, we conducted a longitudinal, mixed method case study of an online community focused on development transportation. We argue that online communities are uniquely equipped, through their fluidity and open-endedness, to enable knowledge creation and agenda-setting. In so doing, online communities afford an ‘intermediary space’ that simultaneously accommodates both convergence and divergence of interests. Our study strengthens the bridge between information systems research and development studies, by highlighting the potential of ICT uptake toward ‘remaking participation’ in development debate, while including the perspectives of heterogeneous interest groups.

Information and communication technologies are known to be instrumental in the enhancement of healthcare management capabilities in developing countries. Turkey - a developing country - has undergone a major healthcare transformation marked by the redesign of primary care delivery and the implementation of a nation-wide Electronic Health Records (EHR) system. In this research, presenting Turkey's case, we investigate the consequences of EHR implementation in developing countries. We argue that to better understand the consequences, we need to link macro-level healthcare goals with micro-level system usage behaviors that actualize the macro-level goals or alternatively result in unintended negative health outcomes. We posit that this linkage is achieved through the meso-level structures, namely the EHR and the organizational context, in which it is embedded. Hence, we examine the EHR's role in this relationship. Our findings indicate that EHR usage both enables and constrains the achievement of clinicians' professional goals in the context of primary care delivery. Moreover, goal alignment between the government agency as the designer of the system and the clinicians influence the outcomes of the EHR-enabled transformation. When the healthcare goals are aligned, the system enables the clinicians to achieve their professional goals and their system usage behaviors converge, contributing to improvements in health outcomes. Contrarily, when the goals are misaligned, the system constrains goal achievement and the clinicians show divergent usage behaviors, including goal abandonment. In turn, goal abandonment may lead to negative consequences and even adversely affect the achievement of population-level healthcare goals in the long run.