Machina ex deos. Successes and challenges of implementing mobile computing technologies for development. The experience of nine Indian village health projects using a project-issued mobile application

As mobile computing technologies become increasingly functional and affordable, global donor and local development organizations find ways to justify and fund their use in grassroots development work. This dissertation asks two questions: (1) In resource-constrained social sector settings, what project features govern and structure use of work-issued mobile devices? And: (2) How do decision-makers adjust to maximize the benefit of newly-introduced devices while minimizing new burdens to the project and project staff? More simply, what variables under social sector projects’ control might promote successful use of information and communication technologies in development (ICTD) projects? This research represents systematic, qualitative comparison of nine extended deployments of a popular mobile health application, CommCare. Each studied project deployed devices loaded with CommCare to health workers in India as a supportive job aid and/or a data collection tool to help monitor beneficiary populations’ health status and frontline workers’ work. This dissertation examines the conditions under which these health workers were able and willing to use CommCare devices in their jobs, and whether and how they deviated from the use of those devices prescribed by their supervisors. Primary data for this study come from 62 in-depth, semi-structured interviews, extensive review of project documents, and personal observations from field study in India over six months in 2013. Employing a sociotechnical lens and a principal agent model, my data support expectations that use of CommCare devices would help align community health workers’ behavior with their supervisors’ organization and mission-related priorities. Use of the devices improved health workers’ professional competence and improved communications, data quality, and data access. These improvements facilitated project supervisors’ monitoring of health workers and beneficiaries, and funders’ monitoring of projects. Contradicting expectations, use of CommCare devices also weakened organizational oversight and control through new data challenges and increased health worker autonomy in their personal and professional lives. These dual benefits and challenges ultimately served the overall projects’ missions.