Mobile Health and the Social Organization of Care in the Global South: Beyond Technological Fixes

Thesis (Ph.D.)--University of Washington, 2022The notion of a global “care crisis” has recently loomed large in public consciousness, drawing attention to the longstanding problem of how our care infrastructures are increasingly overburdened and unsupported. The chronic underinvestment in paidand unpaid healthcare work has been made especially clear in light of the shocks of the COVID-19 pandemic. In response to this crisis, transnational agencies, national governments, hospitals, and non-governmental organizations (NGOs) have sought to leverage increasing smartphone and mobile internet use globally to create “technological fixes” that restructure work, time, and space with the aim of meeting care needs with limited resources—this in contrast to investments that could increase resources but ultimately compromise on capitalistic aims of profit and efficiency. In this dissertation, I examine multiple types of fixes that have gotten significant traction in global health, including digital payments, personal chat apps, and semi-automated chatbots, focusing on contexts within India and Kenya. I describe care workers’ and health organizations’ experiences with these technologies and how they integrate with larger health infrastructures. Drawing on feminist social reproduction theory, I tease out ways that these technologies meet real and urgent care needs, while also belying the mere redistribution, short-term valuation, and narrowing of care work that takes place by and through technological fixes (often most affecting those with the least power in a given context). Taking this dilemma seriously, I argue for the responsibility of researchers and practitioners to combat dominant narratives of technological fixes for the care crisis, even as we seek to support care work through design. Thus, this work considers how we might center futures of care work in which societies make concrete investments in care workers and care infrastructures, not for efficiency’s sake but for the needs and aspirations of care workers and the sustainability of our care infrastructures