Paper short abstract:

We introduce the notion of coordinative artefacts in the study of digital transformation for development. We do so with a study of community health in Malawi, where scannable barcodes act as coordinative artefacts that facilitate exchanges between health staff and electronic patient records (EPRs).

Paper long abstract:

Digital transformation is being leveraged in low- and middle-income countries (LMICs) to address issues of data quality and accessibility in the health sector. In community health clinics in Malawi, the first point of contact with the patient is the Health Surveillance Assistant (HSA), a worker who documents health data and updates patient records. With the digitisation of patients’ records, HSAs need to also update the Electronic Patient Record (EPR), which requires training and reliance on sporadic connectivity whose lack impairs data retrieval operations. If a patient’s EPR is not found, this commonly results in the HSA creating a new patient record, generating incomplete patient histories and duplications that affect the production of aggregate health data.

Drawing on an action case study in four health facilities in rural Malawi, we present a digital solution centred on low-cost printers that provide scannable codes for identifying patients, as an alternative to typing in names. HSAs report that typing names can lead to several issues, including misspellings leading to time consuming searching in the database and accessing the wrong record for patients with similar names. Attributing a unique barcode to each patient, the battery-powered printers seek to reduce data duplication. Tested and developed during three research visits, scannable codes operate as coordinative artefacts that facilitate exchanges of information between HSAs and the patient database. Our paper introduces the notion of coordinative artefacts in the study of digital transformation for development, also offering a usable alternative to tackle the constraints of the present EPR system.