The Production of Indicators: Enumeration Labor, Information Technology, and the Project-Based Practice of HIV Data Governance in Malawi

• In Event: The Will to Improve, The Vision of Future-Making, and Innovations for Development - II

Abstract

Quantified health indicators play a crucial role in most global health initiatives. Health indicators, which are conceptualized as numeric representations that smooth out the messiness of everyday life, are mobilized to justify the choice of specific development actions and interventions and to hold both donors and recipients accountable to pre-agreed measurable outcomes. With the increasing demand for timely and reliable health indicators from the Global South for monitoring and evaluation, development projects increasingly build in a component to strengthen data management capacity in health facilities that serve as sites of intervention. Following Merry’s (2016) call to examine contemporary global governance through investigating the social and political processes of indicator production, this paper examines the making and consequence of electronic medical record system (EMR) as a transnationally introduced technology that enables ‘enumeration labor’. This paper is based on five months of ethnographic fieldwork in two HIV clinics in Malawi where EMR is introduced by an international NGO to improve the management of HIV data. Research indicates that EMR does ease the workload for health workers tasked with collecting patient data and calculating indicators. However, the concept of quality health data framed by these global health development projects is contested locally. The top-down and project-based nature of the intervention results in a partially dislocated EMR design, which further destabilizes an already unstable clinical environment. It also exploits first-line health workers, pulling them away from patient care activities to focus on the production of externally demanded indicators.

Author

• Chia-Shuo Tang, Amsterdam Institute for Social Science Research, University of Amsterdam