Activity theory perspective to the scale-up and sustainability of mhealth in armed conflict zones of developing countries

Mobile Health (mHealth) presents the potential to facilitate healthcare and improve the quality of life if successful pilot projects are scaled up and sustainable. However, the persistent termination of mHealth at the pilot phase challenges its potential in developing countries. Existing research suggests an absence of understanding of these phenomena for two reasons. First, literature is scarce in the broad context of armed conflict zones in developing countries, particularly in the IS domain. Second, extant literature emphasizes mHealth implementation, while neglecting the scale-up and sustainability of these technologies. Therefore, this study employs activity theory as a holistic lens to explore how contradictions shape the scale-up and sustainability of mHealth in the armed conflict zone of developing countries. In this study, rather than viewing contradiction as a challenge, it serves as a driver for effecting changes that can foster scale-up and sustainability. The Algorithm for the Management of Acute Childhood Illnesses (ALMANACH), provides an empirical basis for this study. The research employs the interpretivism philosophy and the case study method. In-depth interviews, participatory observations, and document reviews were used to collect data. Purposive and snowball sampling techniques were used to select the study's participants. The study reveals a lack of professional expertise among the CHWs, the non-involvement of the users and beneficiaries in designing ALMANACH, and the lack of financial compensation for using ALMANACH in practice as contradictions. The study further exposes how community volunteer groups and the ALMANACH scientific board were established to steer demand.