Technology, diversity and health worker empowerment:: A human capability approach
Mukherjee, Arunima Sehgal (2016). 'Technology, diversity and health worker empowerment:: A human capability approach' Paper presented at the annual conference of the HDCA, Tokyo 2016.
abstract The theme of diversity is often ignored in discussions around ICT4D (Information and Communications Technology for Development) research and practice. On the contrary, a dominant theme in this domain remains of standardization in order to achieve efficiencies and scale. A major reason for this is that the dominant focus is on the technical artefact, on the belief that more modern technologies can help solve existing developmental problems, such as in health, education and social security. Technologies can be relatively easily standardized than human beings and their behavior, and the argument is more it can be standardized, the greater would be the potential for it to scale geographically and functionally. In this process, however, the potential that arises from the diversity amongst individuals, their learning, experiences, skills and aspirations, tends to get marginalized, to the larger harm of the ICT initiative and its ability to address developmental problems. Geoff Walsham in his book “Making a world of difference” (2001) is one of the few scholars in the information systems and ICT4D areas who have called to celebrate rather than ignore diversity. He argues that while ITs have become an essential component of contemporary society, many issues concerned with the human aspects of the IT remain problematic despite technological advances. He argues that we should be using IT to support a world in which diversity and difference are respected. However, his call has gone largely unheard amongst ICT4D researchers, and the dominant theme is to the reverse. However, Sen’s Capability Approach with its primary focus on the individual and the individual choices they value provides a rich avenue to understand and celebrate diversity, and to also design and develop information systems that can bring diversity to the fore. At the same time, there have been tremendous advances in technology, such as with the Internet, Social Media, Mobile technologies which provide the tools and methodologies to design for systems that seek diversity. The combination of theoretical advances and technological tools thus provide an exciting platform to address the long-neglected issue of diversity. In this paper, I try to take these two sets of conceptual and technical tools to study the issue of diversity, drawing upon the lens of “empowerment” of health workers within the public health space in developing countries, looking specifically at the case of India. The public health space in developing countries is characterized by diversity. Firstly, population profiles vary significantly in terms of gender balance, language, culture, geography and various others. Disease profiles vary significantly across countries and even within the same countries across regions, districts and villages. Budgets and funding for public health systems strengthening vary with donor interests, political priorities, attention given to particular diseases, and the level of efficiencies among existing facilities. The technical infrastructure is another variant, especially relevant to consider whilst considering ICT initiatives, when we look at coverage of internet, mobile networks, power and water supply, and even parameters of roads, water bodies and climatic conditions. Trying to deeply and intimately understand “what choices individuals value” can provide useful inputs for the designer in building systems that respect diversity. Choices provide a lens to understand an individual’s aspirations, the problems they are engaging with, the constraints or unfreedoms they experience in terms of existing structures, and the capabilities and potential they have to address existing challenges reflecting their level of human agency. ICTs, appropriately designed and used, provide the potential to meet and expand these individual choices, their agency, and if converted from capabilities to functionings can ultimately contribute to help achieve desired developmental outcomes. This approach can not only take in diversity seriously in the process of design, but also have diversity embedded in the outcomes pursued. I take this approach in the empirical examination of two cases of ICT introduction in the public health system of two Indian states. In the first case, I study the introduction of a patient based hospital information system within the district hospital systems in the state of Himachal Pradesh in North India. There are different departments, work flows, patients, staff, and the technology is to help bring in efficiencies of work and also improve quality of care. I study the processes of health worker empowerment and how these contribute or not to desired outcomes. In the second case, I study a Mother and Child tracking system introduced nationally, within the state of Punjab. From the perspective of the field level nurses, I examine their processes of empowerment. An interesting aspect of my analysis was to understand the different affordances the same technology provides to different health functionaries, and their implications on empowerment. In conclusion, my paper draws upon the human capability approach to understand diversity, studied through the lens of empowerment. I develop implications for design, which can forefront diversity, in a manner in which it is celebrated rather than being marginalized.