The Evolving Braid: An Ethnography of Technology Change in Uganda

If there's one thing one can expect from developing countries–it’s the unexpected. From 2007-2010, I combined my skills as a software developer with ethnographic methods to observe the use of information technology in a non-governmental organization (NGO) in Southwest Uganda. This NGO subsidizes health facilities by paying for sexually transmitted infection treatment on the basis of claims submitted after the patient consultation, targeting treatment of 99,000 clients between 2006-2011. The program addresses a real need - in the program area, a household survey found that while 39% of the population reported STI symptoms, only 1/3 sought care. However, management of this program is information intensive. As part of my studies, I implemented and tested Claim Mobile, a smartphone-based data collection application intended to reduce claims processing delays and improve health facility engagement. I successfully tested Claim Mobile in Summer 2008, processing 35 claims for two health facilities, and then discontinued its deployment six months later, when I decided that integration and scale-up of the technology would be problematic for the changing context the NGO. New priorities and new program management practices revealed ‘invisible constraints’ that a redesign of Claim Mobile would not accommodate.

This dissertation addresses the ways in which I as a researcher, an NGO, and their beneficiary health service providers deal with and understand social and technological change. I discuss how the NGO program staff ’braided’ communications together to address their communications needs, the ways in which choices in design can affect stakeholder relationships, and reflect on the reasons for Claim Mobile’s ’failure’. I find that 1) designs must account for all stakeholders, not just users, 2) ICTs are used in co-evolving and codependent braided ways, 3) affordances and constraints change over time, as well as in relation to the different user contexts, and as a result 4) designs are subject to changing context.