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ICT4D initiatives hold the potential to transform health service delivery in settings of poverty, yet, in practice, they face many of the same implementation complexities and coordination challenges as the global health and development programs that they aim to streamline or strengthen. Researchers and practitioners alike are now quick to observe that “context matters”, but such an observation does not amount to a coherent alternative vision of more appropriate ICT4D design and implementation. In this paper, we draw on the metaphor of imbrication to elucidate the iterative process by which ICTs become entangled with particular contexts of use. Our longitudinal ethnographic study examines the implementation and iterative redesign of an Internet of things (IoT) technology that collects real-time data and alerts health workers of disruptions in the cold storage of vaccines in Kenya. Extending recent work on imbrication, we show that technologies imbricate not only with the social context but also with local material infrastructure and that designers play a limited yet clearly consequential role in this process. To explain these findings, we highlight instances of material “back talk” and concomitant practice breakdown in which initial attempts to shape a situation yield puzzling or unappreciated consequences, which lead designers to accommodate material realities and, ultimately, pursue unanticipated courses of action. Drawing on these conceptual tools, we reveal six overlapping activities through which designers may guide the emergence of sociomaterial practices. We say that they design for the emergence of sociomaterial practices to underscore that designers cannot predict or control all contextual complexities, though they can adapt to them when they arise. Based on our insights about this process, we develop three contributions. First, we offer fresh perspective on the longstanding concern with local context in ICT4D research. Second, we suggest that our notion of designing for the emergence of sociomaterial practices is relevant for and adds to contextually aware design research frameworks such as action design research. Finally, we propose that ICT4D practitioners should attend to practice breakdowns and material back talk as they grapple with the complexities of the implementation bottleneck in global health and development.

Insights from an ICT4D Initiative in Kenya’s Immunization Program: Designing for the Emergence of Sociomaterial Practices