Self-Reinforcing Linkages Between Value and Local Ownership: Rethinking Sustainability of ICT4D Project

The paper addresses the wicked problem of unsustainable health information systems in the context of low and middle income countries (LMICs), specifically using a case study from India in the public health sector. The paper makes the argument that current analysis of sustainability tends to be largely "supply-driven" focusing on the provision of external resources and technical assistance needed to sustain a project. But since these external injections are self multiplying, requiring more and more over time, they tend to not lead to satisfactory and sustainable solutions. The paper argues for a more "demand-driven" approach, where the focus is on the user and the use context. Taken from this perspective, the paper identifies two sets of processes evolving local ownership and enhancing use as being key to establish sustainability. Further, these processes are seen to be mutually self-reinforcing, and supported by an enabling context of use.