Integrating mobile and web health infrastructures in low resource contexts

Abstract

Trustworthy and accessible health information is a key success factor for health management at all levels of the health system in any country. There is a rapid growth in mobile penetration in Less-developed countries (LDC). This has lead to many projects that want to exploit this new infrastructure to collect health data from remote and rural areas in LDC. This thesis addresses the dynamics of integrating mobile Short Message Service (SMS) infrastructures and web infrastructures in low resource contexts. The method chosen in this project is Action Design Research (ADR). Information infrastructure theory was utilized by strategies such as bootstrapping and cultivation of the existing installed base. These strategies were chosen to make the project sustainable. The project focuses on the use of existing mobile infrastructures, including private low-end phones of health workers, to collect health information in LDC. This ADR project consists of four phases, which includes two field trips to Uganda and Rwanda. Accordingly, background studies and analyzes of relevant installed bases in both countries have also been conducted. This ADR project has resulted in the development of a software artifact used to integrate the web-based system the District Health Information Software 2 (DHIS2) with the SMS infrastructure. This artifact has enabled remote data collection using SMS messages in the DHIS2. During this ADR project, we observed different kinds of dynamics when integrating the web and mobile infrastructures. We observed differences in flexibility in these two infrastructures. We also found that political and organizational processes increased the complexity involved in the process of integrating the two infrastructures. Further, we observed that some users have experienced difficulties using SMS messaging for remote data collection in rural Uganda. Most importantly, we found that creation of a generative software artifact stimulates innovation. We also looked at how the process of integrating the two infrastructures can be interpreted in the terms of digital convergence. Overall, this project has shown that it is possible to extend the boundaries of the web-based infrastructures by the integration with low resource mobile infrastructures. Hopefully, this project will contribute to the collection of more accurate health data from both remote and rural areas in low resource contexts.