Posted to the Ethnos Project by on June 2nd, 2012

Thanks to Melissa for allowing me to share her recently published dissertation!


If there’s one thing one can expect from information technology deployments in developing countries–it’s the unexpected. From 2007-2010, I combined my skills as a software developer with ethnographic methods to observe the use of information technology in a non-governmental organization (NGO) in Southwest Uganda. This NGO subsidizes health facilities by paying for sexually transmitted infection treatment on the basis of claims submitted after the patient consultation, targeting treatment of 99,000 clients between 2006-2011. The program addresses a real need – in the program area, a household survey found that while 39% of the population reported STI symptoms, only 1/3 sought care. However, management of this program is information intensive. As part of my studies, I implemented and tested Claim Mobile, a smartphone-based data collection application intended to reduce claims processing delays and improve health facility engagement. I successfully tested Claim Mobile in Summer 2008, processing 35 claims for two health facilities, and then discontinued its deployment six months later, when I decided that integration and scale-up of the technology would be problematic for the changing context the NGO. New priorities and new program management practices revealed ‘invisible constraints’ that a redesign of Claim Mobile would not accommodate.

This dissertation addresses the ways in which I as a researcher, an NGO, and their beneficiary health service providers deal with and understand social and technological change. I discuss how the NGO program staff ’braided’ communications together to address their communications needs, the ways in which choices in design can affect stakeholder relationships, and reflect on the reasons for Claim Mobile’s ’failure’. I find that 1) designs must account for all stakeholders, not just users, 2) ICTs are used in co-evolving and codependent braided ways, 3) affordances and constraints change over time, as well as in relation to the different user contexts, and as a result 4) designs are subject to changing context.

The Author

From Melissa Densmore’s website:


Melissa Densmore (formerly Melissa Ho) is a PhD candidate in the University of California, Berkeley School of Information, and holds a BA in Computer Science from Cornell University, and an MSc in Data Communications, Networks and Distributed Systems from University College London. Recipient of the 2008 Yamashita Foundations for Change Prize, she now leverages her Silicon Valley experience in design and development of user interfaces and web-based applications in developing regions. Since 2004, she has been actively conducting research (ethnographic fieldwork and systems design and deployment) with the Technology and Infrastructure for Emerging Regions research group (, an inter-disciplinary project funded in part by the National Science Foundation. As part of this group, she has participated in numerous deployments, including the setup of long distance wireless communications networks for hospitals and universities in Africa and India.

Her project in Ghana is an open source tele-medicine application enabling doctor-to-doctor consultation between rural doctors and urban specialists, as well as between doctors in Ghana and their colleagues who have moved abroad ( In Uganda, she is working on the use of mobile devices for information management in the Uganda OBA project ( Her research focuses on healthcare and telecommunications infrastructure in Africa, and is funded by the Blum Center for Developing Economies.

For more information about Melissa Densmore please explore these sites:

Melissa Densmore’s personal page
Melissa Densmore’s blog
Follow her on Twitter

This dissertation is presented here with kind permission from the author.

© 2012 Melissa Ho Densmore

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