This article is based on the introduction of a telemedicine system in the jungles of northeastern Peru. The system was designed by a European consortium led by a Spanish polytechnic in cooperation with two universities in Lima and the Peruvian Ministry of Health. The purpose of the system was to improve health conditions by extending science-based medicine into a region with well-established traditional healing practices. The central analytical focus of this article is on the interplay between the public health care system, which used the telemedicine system, and local health care practices. The manner in which scientific medicine was delivered through information technology and public health care services is analyzed in terms of the health personnel's activity, the local population's conceptions of health, and the trajectories followed by patients seeking recovery. The author participated in the design of the second evaluation of the telemedicine system and acted as a participant observer in the regional hospital and peripheral clinics. In addition to interviewing health care staff from the study area, the author 1 Sundeep Sahay was the accepting senior editor for this paper. Lucy Suchman was the associate editor. Maggie Mort and Dixi Louise Strand served as reviewers. also met with traditional healers, and patients in the districts whether or not they were involved in the telemedicine project. New institutional theory provided the analytical framework for the interpretation of the observed behavior of the public health care staff, traditional healers, and potential patients. Empirically, this study describes the informal aspects of the functioning of the telemedicine system, and its partial mismatch with the definitions of health and illness employed by local communities and healers.An argument is made that people's construction of their health, which is embedded in their normal patterns of action, should be identified, and then considered in the design, implementation, and evaluation of future telemedicine projects. This article problematizes an approach to telemedicine-based health development that is weakly accountable to local social contexts and their diversity.

Blockchain technology comes with the promise of being a disruptive technology with the potential for novel ways of interaction in a wide range of applications. Following broader application, scholarly interest in the technology is growing, though an extensive analysis of blockchain applications from a governance perspective is lacking to date. This research pays special attention to the governance of blockchain systems and illustrates decision problems in 14 blockchain systems from four application domains. Based on academic literature, semi-structured interviews with representatives from those organizations, and content analysis of grey literature, common problems in blockchain governance have been singled out and contextualized. Studying their enactment revealed their relevance to major organizational theories in what we labelled "Patrolling the borders", "External Legitimation", "Reduction of Discretionality", and "Temporal Management". The identification of these problems enriches the scarce body of knowledge on the governance of blockchain systems, resulting in a better understanding of how blockchain governance links to existing concepts and how it is enacted in practice.

This chapter examines how trust can emerge and be sustained in the context of mobile transactions. It focuses on M-PESA, a mobile banking system in Kenya, using data from an ethnographic study that was deployed in Kibera-one of Africa's largest slums. We present research in progress and discuss two main findings. Firstly, interpersonal trust relations between the customers and agents are weak. Customers do not trust the agents with their money. Secondly, the institutional trust relations between the customer and Safaricom, the mobile service provider offering M-PESA, are strong. This means that customers use the M-PESA service because they believe that their money will be kept safe by Safaricom. After providing empirical evidence to substantiate these claims, this study concludes by suggesting questions for future research.

The

The blockchain comes with the promise of being a disruptive technology with the potential for novel ways of interaction in a wide range of applications. Although scholarly interest in the technology is growing, a broad analysis of blockchain applications from a governance perspective lacks to date. This research pays special attention to the governance of blockchain systems and illustrates core governance decisions on 15 blockchain systems from four application domains. Based on academic literature, semi-structured interviews with representatives from those companies, and content analysis of grey literature, different blockchain governance decisions have been derived and their enactment described. The identification of them enriches the scarce body of knowledge on blockchain systems with a better understanding of how key governance decisions are enacted in practice.

No abstract

No abstract

BackgroundIn Geographical Information Systems issues of scale are of an increasing interest in storing health data and using these in policy support. National and international policies on treating HIV (Human Immunodeficiency Virus) positive women in India are based on case counts at Voluntary Counseling and Testing Centers (VCTCs). In this study, carried out in the Indian state of Andhra Pradesh, these centers are located in subdistricts called mandals, serving for both registration and health facility policies. This study hypothesizes that people may move to a mandal different than their place of residence for being tested for reasons of stigma. Counts of a single mandal therefore may include cases from inside and outside a mandal. HIV counts were analyzed on the presence of outside cases and the most likely explanations for movement. Counts of women being tested on a practitioners' referral (REFs) and those directly walking-in at testing centers (DWs) were compared and with counts of pregnant women.ResultsAt the mandal level incidence among REFs is on the average higher than among DWs. For both groups incidence is higher in the South-Eastern coastal zones, being an area with a dense highway network and active port business. A pattern on the incidence maps was statistically confirmed by a cluster analysis. A spatial regression analysis to explain the differences in incidence among pregnant women and REFs shows a negative relation with the number of facilities and a positive relation with the number of roads in a mandal. Differences in incidence among pregnant women and DWs are explained by the same variables, and by a negative relation with the number of neighboring mandals. Based on the assumption that pregnant women are tested in their home mandal, this provides a clear indication that women move for testing as well as clues for explanations why.ConclusionsThe spatial analysis shows that women in India move towards a different mandal for getting tested on HIV. Given the scale of study and different types of movements involved, it is difficult to say where they move to and what the precise effect is on HIV registration. Better recording the addresses of tested women may help to relate HIV incidence to population present within a mandal. This in turn may lead to a better incidence count and therefore add to more reliable policy making, e.g. for locating or expanding health facilities.