The Map and the Territory: An Ethnographic Study of the Low Utilisation of a Global eHealth Network

Abstract

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.

Situating mobile health: a qualitative study of mHealth expectations in the rural health district of Nouna, Burkina Faso

“…that constitute the lifeworld of participants. Neglecting this may lead to a misinterpretation of the challenges at hand, and ultimately to poor project design and disappointing results [ 34 , 40 , 71 ]. To take the example of gender relations, a review of literature on the influence of mHealth interventions on gender relations in developing countries shows that, while projects can increase women’s autonomy in seeking health services, projects that are not carefully designed may also reinforce existing power imbalances.…”

“…Positive responses to mHealth do not necessarily lead to high uptake, as receptiveness is inseparable from various conditions, including socioeconomic factors, geographic barriers and quality of care [ 6 , 23 ]. More importantly, to reduce local mHealth expectations to issues of acceptance and feasibility is to neglect the complexity inherent to both health-seeking behaviours [ 35 – 37 ] and processes of technology adoption [ 38 – 40 ]. This may sometimes border on technological determinism, with local contexts portrayed as blank slates upon which mHealth should be introduced without any great difficulty [ 41 ].…”

Equal Relations and Appropriate Expertise in India’s South-South Co-operation? Discourse and Practice of the Pan-African e-Network

“…Most academic publications merely repeat the intended outputs and objectives of the project. Notable exceptions include in depth reports and assessments of the health component of the PAEN made by independent researchers in specific countries, notably Ghana and Senegal (Afarikumah and Kwankam 2013, Cairó-i-Céspedes and Colom-Jaén 2014, Duclos 2012, 2013, 2014, 2015, 2016). Especially the work of Vincent Duclos providing deeper insight into the origins and modalities of the PAEN, deserves a special mention.…”

“…The case studies in Senegal, Ethiopia and Ghana report the underutilisation of the Pan-African e-network (Afarikumah and Kwankam 2013, Cairó-i-Céspedes and Colom-Jaén 2014, Duclos 2012, 2013, 2014, 2015, 2016, Michael and Baumann 2016). Michael & Baumann refer to implementation problems in Ethiopia and assert that ‘the different projects envisaged within the PAEN only exist in theory, and the project itself has been marred with technical problems’.…”

Inhabiting Media: An Anthropology of Life in Digital Speed

“…This remote engendering of the human is deeply enmeshed with living and technical systems, at the articulation of networking and clinical practice, modeling patterns, and chaotic forces. Specifically, I have shown how things like technical glitches, failures to communicate, boredom, wasted time, political passions, and absent users are not external to, but rather constitutive of network connectivity and speed (Duclos ). All in all, ethnographical inquiry can contribute to mapping a “rich seam of conjunctions” in which the speed of computation “meets with its ostensible outside” (Fuller , 5).…”