The institutional dynamics perspective of ICT for health initiatives in India

Abstract

As there has been a considerable investment in ICT for development (ICT4D) initiatives, policymakers, practitioners and academics are calling for a more comprehensive and meaningful assessment of the impact of such initiatives. While the impact assessment of ICT4D can be carried out from multiple perspectives, the institutional lens is opportune in examining the softer aspects of the impact such as the behavioural, cultural, and social dimensions. ICT4D interventions juxtapose two institutional logics, that of designer and of the users, which may or may not align with each other. The impact of the initiative depends on how the interplay between the logics unfolds. We exemplify the importance of institutional context in impact assessment of ICT4D initiatives by examining the interplay of the institutional logics in the healthcare system. We conceptualise healthcare system in terms of the logic of choice, perpetuated by the ICT for health initiative, and the logic of care which is embedded in the core of the health system. The interaction between the two logics, in turn, determines how the intervention evolves. We arrive at a framework outlining the tensions arising from the interplay of the logic of choice and logic of care in the healthcare system when an ICT4D intervention is introduced.