National e-health innovation : conduct of international e-health technology transfers in Africa

The sociology and economics of the conduct of international e-health technology transfers (IeTTs) is examined. Most African countries are perennial recipients with variations in their domestic e-health utilisation, development and implementation. We identify, explore, and demonstrate how complex and interlinked global, continental, national and subnational actions and institutions condition their national e-health implementations. Multidisciplinary literatures are from national e-health implementations, national innovation system (NIS) interactive learning, international technology transfers, global development and globalisation. Methodically, a unique combination of middle-range and moderate Science and Technology Studies constructivism, NIS institutionalism and Deleuzian poststructuralist narrative is employed. The conduct of IeTTs is characterised by technological path dependency, history, complexity, power, politics, multiple identities, self-interests and contestations in complex global and transnational interactions. Recipients‘ exercises of National Agency mirror their varied domestic technology acquisition dynamics and trajectories. Successful transfers are institutionally conditioned by interactions of global geopolitics, fragmented continental governance and national reticence. Agential asymmetry that results, accounts for why most recipients are variably struggling in their technology acquisitions. The exercise of National Agency is paramount. National economic size and maturity of extant national innovation capacity can determine if a recipient can acquire domestic e-health innovation and industrial competences. Actions taken by National governments, can strategically determine if technologies are accumulated and technical knowledge assimilated, for addressing the challenges of technology inappropriateness, incompatibilities and obsolescence encountered during subnational utilisations. We contend that implementing a national e-health infrastructure is a long-term and large-scale institutional engineering endeavour. Cumulative advantage explains difference between Schumpeter and Schumacher on e-health technology design and production. A Schumpeterian domestic industrial model of hi-tech e-health technology development, rather than a cosmopolitan Schumacher consumerist one, is proposed. Whilst, appreciating that Schumacher on incremental accumulation and assimilation from small-scale technological implementations can be instrumental. Uniquely, we identify that global geopolitical contention between global west and east economies and competitive global markets and global technoeconomic changes can either condition scale and depth of domestic acquisition. Nevertheless, these conditions and events have historically and contemporaneously shaped global e-health innovations. In a Schumpeterian evolutionary sense, Satcom technologies that powered e-health services in the past are now being substituted by mobile ones. This technological transition is bringing about a convergence of consumer electronics (i.e. Smartphones) and lifesciences industries, driven by a combinatorial biomedical, telecommunication and computing e-health innovations. With these findings, an innovation-based macro-societal perspective is proposed for studying e-health implementation, as opposed to the prevalent information based microbehavioural studies. Further contributions to academia and policy are made to ICT4D, Global Health and m-health practices. Policy recommendations are made to national, continental and global institutions on how to foster national technology acquisitions. Recipients are encouraged to learn from incremental domestic e-health implementations in global technology frontiers. Their share in intellectual property rights accruing from global-subnational e-health coinnovations must be repatriated. We conclude by proposing a global collaboration framework to guide and to foster cooperation amongst those involved in the conduct of IeTTs. Symmetry – an alignment of vertical hierarchical and diffuse horizontal complex sociotechnical interactions, though, not as the implied flat, circumscribed and cyclical dynamics of actor network theory, is proposed. So, an alignment of the constitutive diverse and competing interests and identities, is deemed strategic, to foster domestic accumulations and assimilations.