Ted Saarikko

Here Today, Here Tomorrow: Considering Options Theory in Digital Platform Development

Keywords: Digital platform, digital options, options value, real options, ecosystem

Past decades have seen business platforms proliferate not only as a means to collaborate, but also decrease time-to-market and promote innovation. However, extant literature tends to dichotomise platforms, perceiving them as either strategic resources or technical systems. Applied to digital platforms, we argue that options theory offers a potential means to reconcile the operand and operant perspectives of platform artefacts. We illustrate our point via a case study of a firm that has gradually developed a product that enables mobile communication into a digital platform that provides a wide range of customers with services from several different suppliers. This study contributes to our understanding of digital platforms as it describes how design choices by a provider can affect flexibility and continued development of new services.

Introduction

In light of increased complexity and competition, firms are increasingly becoming aware of the impracticality of developing the technology to solve all of their problems on a case-by-case basis. One means to manage complexity as well as economise on development is through the use of platforms. The platform concept lends itself to several perspectives that may be broadly dichotomised into the platform as a modular core that permits variations on a theme [START_REF] Baldwin | The Architecture of Platforms: A Unified View[END_REF] on the one hand, and the platform as a shared structure that facilitates connectivity between parties [START_REF] Eisenmann | Strategies for Two-sided Markets[END_REF][START_REF] Eisenmann | Platform Envelopment[END_REF].

As different streams of research tend to pursue their own agenda, they leave in their wake a conceptualisation of platforms that is unclear at best and polysemic at worst. Business literature describes how transactions between actors can be facilitated via multi-sided platforms (e.g. [START_REF] Eisenmann | Opening Platforms: How, When, and Why?[END_REF][START_REF] Bodreau | Platform Rules: Multi-sided Platforms as Regulators[END_REF]). However, these studies tend to pay little attention to the artefacts we need to enact connectivity. Conversely, IS literature tends to focus on development or governance of the artefact, stopping short of the manner in which they are applied in a business context (e.g. [START_REF] Eisenmann | Opening Platforms: How, When, and Why?[END_REF], [START_REF] Wareham | Technology Ecosystem Governance[END_REF]). In essence, there is a tangible divide between studying platforms as operant resources that enable activities, and operand resources as objects of study [START_REF] Vargo | Evolving to a New Dominant Logic for Marketing[END_REF][START_REF] Nambisan | Information Technology and Product/Service Innovation: A Brief Assessment and Some Suggestions for Future Research[END_REF]. As artefacts, platforms are physical (or digital) composite objects of significant complexity. Viewed as operand resources, one is concerned with the prerequisites for creating a platform, e.g. technical requirements, design choices, or affordances. However, as platforms are intended to serve as a basis for other applications and uses, it is equally viable to view them as operant resources, i.e. resources that interact with other resources in order to further some ultimate aim. It is therefore not sufficient to study them as either designed artefacts or strategic enablers, but to adopt a composite view whereby both perspectives are equally germane.

We argue that options theory, subdivided into real options and digital options, offers a potentially fruitful means to study the development of platform as an operand resource as well as its appeal for potential users as an operant resource. Although options theory has frequently been applied to information technology (e.g. [START_REF] Santos | Justifying Investment in New Information Technologies[END_REF][START_REF] Benaroch | Justifying Electronic Banking Network Expansion Using Real Options Analysis[END_REF][START_REF] Benaroch | Option-based Risk Management: A Field Study of Sequential Information Technology Investment Decisions[END_REF][START_REF] Ghosh | A Real Options Model for Generalized Meta-Staged Projects-Valuing the Migration to SOA[END_REF]) and to some extent internal IT platforms (e.g. [START_REF] Taudes | Options Analysis of Software Platform Decisions: A Case Study[END_REF][START_REF] Fichman | Real Options and IT Platform Adoption: Implications for Theory and Practice[END_REF][START_REF] Sandberg | Digital Options Theory for IT Capability Investment[END_REF]), it has to the author's knowledge not received any significant attention as a framework for studying the design and diffusion of a platform qua commercial offering. In an effort to address operand as well as operant perspectives, we seek to explore how options drive the evolution of a digital platform and enable flexibility in application. We illustrate our reasoning using a case study of a SME located in Northern Europe that has developed and marketed a digital platform in several industries over the past 13 years.

The paper opens with an outline of platform literature with particular emphasis on digital platforms. Following that, we outline the two streams of options theory: Real options and digital options. We then account for the methodological approach and the case studied before moving on to present the results. The paper concludes with a discussion related to our findings.

Related research

The following chapter briefly outlines related research in platforms literature.

The platform concept

The platform concept first came into wide usage in large-scale manufacturing industries where the seemingly incongruent pursuits of mass production and consumer customisation bought about modularisation and the use of standardised components [START_REF] Suarez | The Role of Services in Platform Markets[END_REF]. In a broader sense, the platform concept has attained "wide usage in management literature as a term meaning foundation of components around which an organization [sic] might create a related but differentiated set of products or services" [17, p.36]. Although originally applied predominantly to physical products [START_REF] Baldwin | The Architecture of Platforms: A Unified View[END_REF], the discourse has expanded to include distinctly non-material components such as software [START_REF] Tiwana | Research Commentary-Platform Evolution: Coevolution of Platform Architecture, Governance, and Environmental Dynamics[END_REF]. Another quality of platforms is their potential to bring multiple actors together around a common structure and thus facilitate connectivity and foster exchange where this would be costly or otherwise impractical [START_REF] Eisenmann | Strategies for Two-sided Markets[END_REF]. We may distinguish between four platform types depending on their scope: Internal platforms that are used within a firm, supply chain platforms that follow a specific value-added process among several firms, industry platforms that serve as a hub for related or unrelated actors, and multisided platforms that are essentially open marketplaces that facilitate transactions [START_REF] Gawer | Platform Dynamics and Strategies: From Products to Services[END_REF]. The two latter types, industry platforms and multi-sided platforms, have garnered special attention in relation to novel business models as they are typically accompanied by an ecosystem of backing firms that supply modules or complements that are specific to that platform [START_REF] Tiwana | Research Commentary-Platform Evolution: Coevolution of Platform Architecture, Governance, and Environmental Dynamics[END_REF].

A key feature of platforms is their relative stability over time. They have a fixed set of attributes that allows users to interact with the platform and utilise its functionality [START_REF] Le Masson | Platforms for the Creation of Platforms: Collaborating in the Unknown[END_REF]. Should the manner in which we interact with the platform change on a regular basis, the utility of the platform would diminish as we would no longer have a stable, long-term baseline for which to develop complements [START_REF] Baldwin | The Architecture of Platforms: A Unified View[END_REF]. The temporal dimension is also relevant in differentiating between products and platforms. Products are typically isolated entities oriented towards short-term profits and limited life spans, whereas platforms are motivated by the long-term benefit of facilitating the continuous development of new products or services. The distinction between platforms and products has however become increasingly blurry as a physical product may serve as a platform for digital content or services, making the product a stable foundation for complements. This phenomenon has grown increasingly prevalent over the past few years and serves as a basis for a new kind of platform -the digital platform.

Digital platforms

The advent of digital technologies has opened up several new possibilities as they allow us to operate upon digital objects that are considerably more pliant than their physical counterparts [START_REF] Kallinikos | The Ambivalent Ontology of Digital Artifacts[END_REF]. The flexibility of digital technologies allows content and services to converge so that we may transmit them using the same standardised channels [START_REF] Tilson | Research Commentary-Digital Infrastructures: The Missing IS Research Agenda[END_REF]. Furthermore, devices enabled by digital technologies are no longer limited to a single configuration, but malleable in the sense that their applicability can be altered without interfering with their material properties [START_REF] Yoo | Organizing for Innovation in the Digitized World[END_REF].

Our growing understanding of digital materiality carries with it several corollaries, one of which is that platforms are no longer dependent upon the modularity of physical components. A fixed technical architecture could well be dynamic with regards to the ability to add or replace digital components over time. Hence, artefacts that are static in a physical sense may at the same time be digitally modular, permitting us to consider them digital platforms [START_REF] Yoo | Research Commentary-The New Organizing Logic of Digital Innovation: An Agenda for Information Systems Research[END_REF]. While the basic tenets of platform modularity still hold true (i.e. a stable core and interchangeable components), properties such as independence from specific channels of delivery as well as post hoc versatility do have profound bearing on how we can approach digital platforms. Yoo et al. [START_REF] Yoo | Research Commentary-The New Organizing Logic of Digital Innovation: An Agenda for Information Systems Research[END_REF] suggest a conception whereby the digital platform encompasses four layers: Device, network, service, and content. The ability to disaggregate the platform into these separate, largely independent layers offers us some idea of the potential afforded by combining digital and physical components. Any one of the four layers of a digital platform could be replaced or upgraded without the necessity to amend or replace the remaining three layers, allowing different aspects of the platform to develop at a different pace. Hence, the platform may be perceived as a stable structure upon which to build common services or business processes while it is at the same time offers significant potential for customisation to suit individual needs and preferences.

The ability of digital platforms to remain stable yet concurrently flexible brings about tremendous potential for different types of innovation [START_REF] Tilson | Research Commentary-Digital Infrastructures: The Missing IS Research Agenda[END_REF]. More importantly, they offer favourable conditions for continuous development and complements as digital objects are not dependent upon physical manufacturing facilities or cumbersome logistics. In some cases complements can even be created without involvement from the proprietor of the platform [START_REF] Tilson | Platform Complexity: Lessons from the Music Industry[END_REF]. As such, the owner could conceivably appropriate significant rents in permitting access whilst at the same time incurring moderate expenditures in maintenance and development, as is the case with applications for smartphones or software for computers. The combination of high profit margins for proprietors and easy access to solutions for adopters makes platforms an appealing commodity [START_REF] Eisenmann | Opening Platforms: How, When, and Why?[END_REF], [START_REF] Cusumano | Platforms Versus Products: Observations from the Literature and History[END_REF], [START_REF] Yoo | Organizing for Innovation in the Digitized World[END_REF], but it also exposes all concerned to increased complexity as contexts and technologies interact in ways that neither party may be able to predict. In essence, the choices made by providers and adopters affect the viability of a platform as a whole, yet they are made with a limited view of available choices and ensuing consequences. It therefore stands to reason that there is much to gain from elucidating options in a manner that is germane to providers as well as adopters.

Options theory

While options theory represents a diverse field in its own right, we will limit ourselves to the areas of real options and digital options.

Real options

Options theory is rooted in financial literature and outlines how firms may pursue investments whilst still minimising risk. Simply put, financial options state that a firm first makes a limited investment which creates an option to acquire an asset. The option grants preferential access to the object of interest and can be activated through a second, larger, investment [START_REF] Black | The Pricing of Options and Corporate Liabilities[END_REF]. Management literature expands upon financial options under the guise of real options, a broader construct that provides insight into how tangible as well as intangible resources can enable options for strategic action [START_REF] Adner | What is Not a Real Option: Considering Boundaries for the Application of Real Options to Business Strategy[END_REF]. Bowman and Hurry [START_REF] Bowman | Strategy through the Option Lens: An Integrated View of Resource Investments and the Incremental-choice Process[END_REF] describe the activation of options as a form of incremental decision-making on investments that originate with what they refer to as shadow options -options that are present but not recognised -that only become real options following a process of sense-making [START_REF] Weick | Organizing and the Process of Sensemaking[END_REF] or exploration [START_REF] March | Exploration and Exploitation in Organizational Learning[END_REF]. The identification of real options is to a significant extent subject to contingencies such as technological frames [START_REF] Orlikowski | Technological Frames: Making Sense of Information Technology in Organizations[END_REF], experience [START_REF] Ciborra | The Platform Organization: Recombining Strategies, Structures, and Surprises[END_REF] and absorptive capacity [START_REF] Cohen | Absorptive Capacity: A New Perspective on Learning and Innovation[END_REF] established by past investments, making the identification of real options virtually unique to every firm. After recognising an option as such, the real option may then be acted upon immediately or left unattended for a considerable amount of time depending upon the situation [START_REF] Bowman | Strategy through the Option Lens: An Integrated View of Resource Investments and the Incremental-choice Process[END_REF], [START_REF] Fichman | Real Options and IT Platform Adoption: Implications for Theory and Practice[END_REF]. Once the holder decides to act, the choices are to either abandon (sell) it or adopt (buy) it. The act of adopting an option may be further subdivided depending upon whether the option represents a continuation of existing strategies or whether it offers flexibility to modify organisational means or ends. Adopted options then give rise to new shadow options that will have to be identified as the cycle begins again. Real options theory may be transposed onto technology investments insofar as shadow options represent possible avenues of pursuit, real options correspond to developed technologies, and exercising an option equals commercialising or implementing a technology [START_REF] Mcgrath | A Real Options Logic for Initiating Technology Positioning Investments[END_REF]. It is vital to exercise good judgment as moving through this sequence of event cycle too quickly or out of step with technology trends can incur significant liabilities such as infrastructure costs and co-specialised components. The difficulty of evaluation is a perennial feature in IT-investments [START_REF] Brynjolfsson | The Productivity Paradox of Information Technology[END_REF] with particular salience for platforms [START_REF] Taudes | Options Analysis of Software Platform Decisions: A Case Study[END_REF][START_REF] Fichman | Real Options and IT Platform Adoption: Implications for Theory and Practice[END_REF] that primarily serve to enable other functions or services. Under these circumstances, flexibility options may be described as technology positioning investments that represent the cost of attaining a subsequent set of attractive growth options that generate additional options rather than serve current operational needs [START_REF] Mcgrath | A Real Options Logic for Initiating Technology Positioning Investments[END_REF], [START_REF] Fichman | Beyond Valuation: "Option Thinking" in IT Project Management[END_REF]. While single-purpose artefacts or technologies may be rela-tively easy to perceive (and evaluate) as a real option, investments in platforms are problematic as they represent significant costs yet only provide vicarious benefits as an infrastructure for further options [START_REF] Taudes | Options Analysis of Software Platform Decisions: A Case Study[END_REF]. The malleable nature of digital technologies may be an additional source of concern as they are ubiquitous yet often require special skills in order to progress beyond unrealised shadow options. With this in mind, we turn our attention to managing options related to digital technologies.

Digital options

Information technology is not only a significant factor in overall firm performance, but also a generator of options that help organisations leverage internal and external resources to their advantage. Sambamurthy, Bharadwaj and Grover [START_REF] Sambamurthy | Shaping Agility Through Digital Options: Reconceptualizing the Role of Information Technology in Contemporary Firms[END_REF] followed by Overby, Bharadwaj and Sambamurthy [START_REF] Overby | Enterprise Agility and the Enabling Role of Information Technology[END_REF] offer a novel perspective on real options in the form of digital options which they operationalize as the impact of IT upon the reach and richness of organisational processes and knowledge. Sambamurthy et al. argue that accessing digital options is commensurate to cultivating inimitable resources [START_REF] Barney | Firm Resources and Sustained Competitive Advantage[END_REF], describing it "a set of IT-enabled capabilities in the form of digitized [sic] enterprise work processes and knowledge work" [37, p.247]. While the concept of digital options has been applied in studies on ERP-systems (e.g. [START_REF] Karimi | The Role of ERP Implementation in Enabling Digital Options: A Theoretical and Empirical Analysis[END_REF]), it has also received criticism for its apparent lack of detail on certain key aspects. Sandberg, Mathiassen and Napier [START_REF] Sandberg | Digital Options Theory for IT Capability Investment[END_REF] argue that restricting digital options to reach and richness limits the concept's generative potential as well as its relevance to IT capabilities. A preferable alternative would be to conceptualise digital options in a manner more closely related to real options theory. Woodard, Ramasubbu, Tschang and Sambamurthy [START_REF] Woodard | Design Capital and Design Moves: The Logic of Digital Business Strategy[END_REF] adapt digital options to an environment where firm strategy is dependent upon co-development of physical and digital components in forming appealing products and/or services. A salient challenge in operating under these conditions is the ability to promote long-term stability and evolution whilst concurrently extracting short-term profits. The authors argue that the locus for digital options is design capital, which in turn is formed of two qualities: Option value and technical debt. Option value describes the possibilities enabled by the composition of the product or service, encompassing a wide span of features ranging from underlying technical architecture to software-enabled interface. The authors relate option value to generativity [START_REF] Zittrain | The Generative Internet[END_REF] in that it permits relatively inexpensive alterations to the original design, e.g. in the form of new product models by the producer or customisation by the consumer. Conversely, technical debt describes limitations in the design that restrict the ability to modify the product or service without incurring significant costs. While restricting the design ultimately serves to limit future development of a product or service, it may be necessary in light of practical considerations such as product cost or R&D expenditures. Options value and technical debt are not opposites, but rather orthogonal qualities that may be envisioned as a matrix which the firm traverses via design moves. It is possible to alter the options value without incurring or decreasing technical debt -and vice versa. While ostensibly simple, the underlying actions are by no means straightforward as digital business strategies are dependent upon composite physical-digital goods. Each type of materiality offer their own set of possibilities and limitations [START_REF] Kallinikos | The Ambivalent Ontology of Digital Artifacts[END_REF], some of which are emergent and only appear when combined. It is also worth considering that design moves are not necessarily perfectly rational or optimal, but are frequently influenced by external contingencies like availability of resources, influences from partners, or demands from customers.

Research method

The objective of the present study is to address the question of how platform evolution relates to the provision of options for application as well as further development.

We have pursued this line of inquiry using a single case study [START_REF] Yin | Case Study Research -Design and Methods, 4th edn. Sage Publications[END_REF] centred on a firm that provides a platform for secure communication. As the scope of the study is limited to suggesting means to study a particular phenomenon, the study can be categorised as an explorative study, which is also in keeping with the single-case approach.

A qualitative study based on interviews was motivated by the retrospective nature of the study and the unfamiliarity of the researchers with the specific business context. Interviews permit informed answers and access to the expertise of informants, permitting "in-depth studies […] in plain and everyday terms" [43, p.6]. The object of the study is to garner insight into the actions taken by a firm to meet changing business priorities and technological opportunities. Hence, case study allowed appeared the most viable option as it "studies a phenomenon […] in its real-world context" [43, p.17].

Empirical data was gathered primarily through five separate interviews with employees, with additional contextual information provided by documentation pertaining to the platform and attention in three meetings with representatives from the firm. Given that the provider is a small firm consisting of some twenty employees, five interviews with high-level staff were deemed sufficient to grasp the aim and scope of the platform. All interviews were conducted at the offices of the firm and ranged from 45 to 70 minutes in length. The interviews may be considered semi-structured [START_REF] Creswell | Qualitative Inquiry & Research Design -Choosing among Five Approaches[END_REF] as the interviewer prepared a number of questions beforehand, but also followed up on a priori unexpected or unknown avenues of inquiry that presented themselves.

Following transcription, the empirical material was compiled and disassembled guided by the theoretical framework used in this paper. The material was then reassembled thematically using the categories of the framework in an iterative fashion. Analysis was conducted using a bricolage approach where patterns and themes were sought based on a theoretically informed reading of the empirical material [START_REF] Kvale | Interviews: Learning the Craft of Qualitative Research Interviewing[END_REF] with the aim of deducing what aspects of the situated context is amenable to abstraction and contribution to a wider body of knowledge. As the number of interviews conducted is relatively small, no particular software or similar tool was used in the coding and analysis of the empirical material.

5

Case study

Our study centres on PlatformCo, an enterprise founded in 2000 located in northern Europe that currently houses a staff of 20+ employees. PlatformCo is a branch of a larger firm that is in the business of inventing, developing and selling wired communications systems for emergency use. In its particular niche, the aggregate firm has managed to establish a small yet firm foothold, but profit-margins are relatively low and the competition fierce. With that in mind, PlatformCo pursued an alternative business model and started branching out in the early 2000's by seeking to apply technical skills pertaining to communication in other areas. They sought diversification by developing a communication platform, PlatformCoMobile, which marked two distinct points of departure from the existing business model. First, the platform was designed to facilitate machine-to-machine communication rather than vocal communication between people or interaction between human and system. Second, the idea was to use the platform to sell services as opposed to off-the-shelf products to customers in an effort to increase profit margins. While this upward mobility in the value chain was desirable from a business perspective, it also represented a significant increase in the level of complexity as service-orientation forced closer ties to customers.

In practical terms, PlatformCoMobile is composed of a communications platform that is physically installed into the user's system where it serves as a link to backoffice system(s) where services are hosted. The communications platform is composed of a highly customised router and Linux-based software that is intended to provide security and stability. The platform may be integrated into user systems using several means; including common interfaces like Ethernet and Universal Serial Bus (USB) as well as the more specialised Controller Area Network (CAN) Bus which is widely used in automotive applications. PlatformCoMobile also supports a range of wireless communication protocols and is equipped to make use of the Global Positioning System. After installation, the platform allows the customer to access the unit (e.g. vehicle) remotely and gather data from its sensory devices or issue instructions to any onboard control systems. Marketed to business customers, PlatformCoMobile has been adopted in a wide range of industries, including private security, forestry machinery, public transportation and logistics. The majority of application contexts involve supervising vehicles, but there are also customers that prioritise resilience and utilise the platform in situations where physical access is a concern, e.g. for monitoring highvoltage electrical wiring. As customers rely on PlatformCoMobile to continuously transmit data even under extreme conditions, the platform hardware has been certified to comply with several international standards, including those set by the International Electrotechnical Commission (IEC) regarding heat, cold, vibration, shock and humidity.

In addition to services developed by PlatformCo themselves, other suppliers are also able to deliver their services via the platform following a process of certification and testing. PlatformCo typically form partnerships with these external suppliers that utilise their platform, making sure that the partners are able to deliver their service in exchange for a monthly fee. PlatformCo has made it an explicit policy to not develop any services that imitate or infringe upon partner services, instead prioritising the continued existence of the partner and availability of their expertise. While this may limit profits in the short run, it ensures that PlatformCo is able to attract complementors and offer a diverse portfolio of services via its platform.

Results

The following chapter presents the results of the study and relates them to theoretical constructs.

Digital options in platform design

PlatformCoMobile qua device has been redesigned in three major steps; the original iteration developed in 1997 and brought to market in 2000. The original intent was not to construct a platform for services, but rather to offer a robust, versatile and secure product for wireless communications. As such, PlatformCoMobile was marketed as a communications device that was sufficiently durable to withstand active service for many years in virtually any environment.

"…if you look back at the first generation…the reason that it looked the way it did is because of the tools and technology that were available at the time. We didn't have 3G-networks and the like. It was limited by the technical possibilities available back then. […] You could say that it was largely a prototype or proof-of-concept that everything could work together." -COO, PlatformCo

The platform was initially a stand-alone solution for communication that offered a highly limited range of functionality and limited prospects for improvements or additions. However, PlatformCo soon began to see the advantages of expanding upon the functionality of the product. The first major step was taken in 2001 when remote access was enabled. The impetus for this move was not a matter of strategy, but rather convenience. Service and configuration of PlatformCoMobile involved significant amount of travelling to remote locations or even neighbouring countries for technical staff. As maintenance is a continuous process, streamlining this activity translates into significant savings, which is particularly important for a relatively small enterprise like PlatformCo. Hence, economising on maintenance was the primary driver for early development of PlatformCoMobile. The following years saw development of platform functionality that was more related to adding value for users, such as the introduction of "managed services" in 2003, which was a basic form of what is commonly referred to as could services today.

Since the first generation of PlatformCoMobile was not intended as a platform for services, it was neither scalable nor expandable. Hence, the transition to the second generation entailed scrapping the entire architecture and starting from scratch with new hardware and software. While costly in terms of time and resources, it was necessary in order to accommodate new components, e.g. an improved GPS transponder and new I/O-ports that were sought by customers. As the second generation of Plat-formCoMobile was technically more advanced, PlatformCo took steps to ensure that services followed suit. 2007 saw the introduction of "device management" -a basic maintenance service that facilitates more advanced services. PlatformCo also furthered modularisation of their services by deconstructing the value-chain into four layers: Data transmission, administration and monitoring, data processing and analysing, and high-level services that are often unique to particular business segments. These layers form a kind of hierarchy where data transmission provides the base and high-level services the apex. As the first three layers are closely related to the platform itself, PlatformCo manages these areas in-house whereas high-level services are a blend of services developed by external partners and those developed by Platform-Co. The interdependencies between layers can become bit convoluted as customers sometimes require specialised hardware in order to enable high-level services.

"[…] we've devoted our efforts to infrastructure, a platform where we can add content -content as in services. But in this case the sensors will be plugged in down

here in order to add content higher up." -Business area manager, PlatformCo

While the second generation of the platform was scalable in terms of functionality, it did not scale in terms of performance -meaning that PlatformCoMobile could not run certain desired services simultaneously. The subsequent transition to the third (current) generation of hardware did not entail a complete overhaul, but did require scrapping roughly 50% of the previous architecture.

As it stands, the mobile unit may now be considered a flexible platform that is scalable in terms of functionality as well as performance. More importantly, while the platform can be expressed as a combination of physical components (hardware) and digital components (software), services are merely co-specialised to the software. Hence, it is in some ways accurate to say that the software-component marks the essence of the platform as it stands today. The hardware-product serves as a physical link for communication between the user context and the back-office system, but in terms of the current service model, it is essentially a piece of infrastructure at this point.

"...I see that the product is supposed to enable the services required. So you focus less on how things are performed inside the product, and assume more of a bird's-eye view of what function we're after. Maybe customers also focus less on how things are solved and look to our ability to meet [their] functional requirements. You don't look as much to the product and hardware, but rather the customer that buys a service or functionality and expect it to work. That's what counts."

-COO, PlatformCo The software platform can be modified to accommodate virtually any hardwareas is evident by the fact that PlatformCo still has hardware from the first and second generations in active use. It is therefore feasible to run some services on other digital devices, such as smartphones. While this could make quality assurance an issue, Plat-formCo has based many features in its platform upon explicit customer requirements or business opportunities. A rough estimate of influences in platform design puts the ratio between explicit customer demands and designer discretion at 40-60, indicating that PlatformCo has cultivated a very pragmatic approach to quality as well as design. All three generations of the physical device have been designed by PlatformCo themselves, but have been based upon readily available standardised components as customisation would be prohibitively expensive. The evolution of the platform is therefore related not only to customer requirements, but also to what technology is available at a competitive price.

Real options in platform applicability

The idea to utilise PlatfomCoMobile as a platform for services as opposed to a specialised product for wireless communication gradually developed via several interim stages, such as the introduction of managed services in 2003 and a concerted transition from product to systems in 2004. While these events were important for the development of the platform as such, it was still limited to the finite resources of Plat-formCo and largely propelled by their core competence, i.e. the development of technical solutions for secure communication. In 2005, PlatformCo adopted a partner strategy whereby they actively sought out firms that offered applications or services that were requested by current or potential platform customers. The advantage of partnering in this manner is bilateral. The partners sought out are highly competent in their respective field, adding cutting-edge services to the portfolio of solutions that PlatformCo can market as part of their platform. Conversely, the communications infrastructure provided via PlatformCoMobile essentially enables partners to blackbox the issue of communication and focus on what data is being transmitted rather than how it is transmitted. Moreover, the aggregated network of partners could handle contracts and clients that are too big for any one supplier to manage on their own.

"We see everything that we think and do as a network, and I think…that is the way one should proceed to survive the future. These [big] companies that want it all, they won't be able to pull it off as things are moving too fast […] you have to find the cutting-edge and then fit the puzzle together." -CEO, PlatformCo A salient driving force behind the move towards services was the recalcitrance of customers towards paying for infrastructure (i.e. hardware). Explaining the merits of a platform can often be a challenge as the term does not readily convey a sense of benefit or utility. Familiarising oneself with different industries -or finding partners with the requisite knowledge -has proven to be a significant factor in the ability to successfully market services rather than products.

"…nobody is really in the market for a platform. What they want is a solution. […]

If you then look at public transportation -the bus-ecosystem -there we've learnt how the industry works in the Nordic countries in order to supply the functionality that they actually want from this platform. In doing so it has suddenly turned into a solution." -Business area manager, PlatformCo

The transition from product to services has involved working in closer proximity to customers, trying to comprehend the mind-set of a wider range of stakeholders. The business is no longer comprised of engineers who sell products to other engineers, but rather engineers developing services that everyday users can comprehend. Engaging with customers under these circumstances often entails working in close proximity to clarify a problem, deconstruct it, identify relevant causal factors, and then conceptualise feasible services that can alleviate or resolve the issue. Once services have been identified, they are matched to the current offerings available via partners. In cases where obvious match is found, PlatformCo scans the market for providers who offer services that conform to the perceived requirements. If a supplier is found, the company initiates contact and investigates the possibility of a partnership using the business opportunity as a tangible motive. If no suitable solution is found, then the engineers at PlatformCo can fill this "gap" themselves by developing a new service based on the capabilities of their platform.

" Learning how an industry works and what it needs is a time-consuming and laborious process. It does however leave in its wake the added boon of naturalising the interactions with customers in that business segment. The need to go into technical detail diminishes, leaving PlatformCo and customers free to stick with the practical concern of how to integrate the solution into the business rather than debate technologies and communication protocols. While PlatformCo strives to package their services as ready-to-order solutions, the practical reality of adapting to a variety of customers and industries limits the applicability of this approach. The efficacy of the platform is dependent upon the ability to integrate it into a given context (e.g. a vehicle) and relay desired data to a corresponding back-office system. As it is not uncommon for customers to employ an eclectic variety of hardware and machinery, the engineers and developers at PlatformCo often find themselves working alongside customers in solving novel problems related to localised integration. "It's always tough to 'productify' solutions. For instance, one particular solution is intended to work with a truck -we've done that before. But it's pulling a salt spreader from the 1980's. We need signals from that as well, so we're back to customisation again. […] That's the way it is with our customers -machinery from the 80's meets tablets from last year." -Business area manager, PlatformCo

The initial installation of the platform always requires a certain amount of manhours depending on the context. However, following the initial integration of the platform, services are activated and managed remotely via back-office systems as per customer request. In many cases, this is tantamount to enabling remote connectivity in machinery that was never designed to facilitate this feature. The sudden reality of taking a fleet of vehicles to an online-world can foster new perspectives as one improvement can snowball into new ideas of how to utilise the new infrastructure. It is therefore not uncommon for the customer to come up with several new ideas or suggestions on how they would like to use the platform in the months and years after the initial installation.

Discussion

The application of digital platforms as a means to facilitate modularity of physical products holds great potential, but also significant complexity. In the present study, we have illustrated the evolution of PlatformCoMobile in three major design moves, originating as a stand-alone solution for communication that offered a highly limited range of functionality, evolving to a connected product able to deliver a range of ser-vices, and ending up as the current scalable service-platform for customers operating in several industries. The significance of digital options is of particular relevance when taking the leap from product evolution to platform evolution. A product is a stand-alone device that alleviates or solves current problems. You may use such a device to deliver services to customers who want simple, purposeful solutions that meet their present needs. Product providers may improve upon their product in relative isolation as improvements are typically implemented in the form of a new version of the product. Platforms differ in at least two respects. First, the underlying motivation for having platforms is to afford changes to individual components that allow the structure as a whole to evolve as needed. Second, (industry) platforms are intended to serve as a hub or shared structure that enables or simplifies interactions between parties. As such, the platform may be regarded as an infrastructure [START_REF] Star | Steps Toward an Ecology of Infrastructure: Design and Access for Large Information Spaces[END_REF] that connects supplier offerings to customer needs.

The difficulty in evaluating platforms is inherent in its vicarious nature. Set against the basic premise of financial options, platforms ostensibly behave in an inverse manner. Rather than a small amount, adopters pay a significant portion of the investment up front in order to access the platform. As suggested by Taudes et al. [START_REF] Taudes | Options Analysis of Software Platform Decisions: A Case Study[END_REF], one way to justify the investment is to evaluate each function permitted by the platform in isolation and tally the result. The present study illustrates that the platform provider can facilitate this through either pre-packaged offerings as real options, or by participating in a process of sense-making to develop nascent shadow options present in the operating environment of the adopter. Additionally, the fluid nature of digital materiality is highly commensurate with the mobility of financial assets that provide part of the underpinnings for real options. Digital platforms allow adopters to either consciously hold an option (e.g. on a particular service or application) for a lengthy period of time before acting upon it, or gradually develop shadow options into real options as they come to better understand the platform or identify new organisational needs. Hence, digital platforms can be said to promote incremental decision-making with the notable exception of the physical artefact that houses the digital content.

Digitalisation allows physically non-modular devices to be modified with new software and content, potentially granting them some of the versatility of platforms. That being said, the platform provider must weigh design moves more carefully when developing a platform. A product may to a greater extent be viewed as an independent device with fixed properties, enabling the designer to limit the scope of variables. A (digital) platform may allow the designer considerable leeway with regards to amending those aspects that are obscured to the outside, but cannot redesign physical interfaces or enabling software with the same sense of carte blanche. Alterations must take into consideration an installed base of complementors and users that integrate the platform in a wide variety of local systems for an equally wide variety of purposes. In effect, myopic design moves made to improve the operations of the device could simultaneously incur technical debt for the platform if they are not in keeping with what partners expect or customers require.

Last but not least, evaluating investments on an individual basis may be disadvantageous as it limits one's ability to see the whole picture [START_REF] Teece | Explicating Dynamic Capabilities: The Nature and Microfoundations of (Sustainable) Enterprise Performance[END_REF]. This is especially sali-ent when applied to IT as one must usually take compatibility with extant systems into consideration [START_REF] Sandberg | Digital Options Theory for IT Capability Investment[END_REF]. Options theory ostensibly flies in the face of this reasoning as it advocates incremental decision making under conditions where each option is to some degree perceived as an encapsulated entity. However, when applied to a platform as in the present case study, a case-by-case perception of the different individual services appears a feasible approach as it provides a clearer case for acceptance or rejection when compared to a whole suite of services. Furthermore, the digitised nature of the services makes them inherently flexible. Once the platform qua infrastructure is in place, services can be switched on and off with short notice. Hence, adoption or cancellation of services enabled by digital platforms offers the malleability presupposed by options theory. If anything, an options perspective may be advantageous when seeking to balance a "portfolio" of different services that can enhance the firm's processes or knowledge.

Conclusions

In this paper, we argue that options theory can contribute to our understanding of digital platforms both as phenomena as well as enabling tools. We employ two conceptions of options theory, real options and digital options, and apply them to case study of a digital platform developed over the course of 13 years by an SME operating in Northern Europe. Using digital options in the form of design capital, we are able to plot the evolution of the artefact as an operand resource and see how design moves impact the transition from product to platform. Real options theory provide the other half of the discourse by showing that options are unavailable until they emerge into consciousness following a process of sense-making. In establishing a nascent platform, there is much to be gained by the platform provider in facilitating this sensemaking as each new realisation is another potential sales argument. Objects and services enabled by digital platforms ostensibly lend themselves to the end-user simplicity of real options due to the flexibility of digital materiality. A possible avenue for future research would be to further explore the relation between design and application, e.g. by studying the relationship between real options and technology affordances.

Fig. 1 .

 1 Fig.1. Real options, adapted from[START_REF] Bowman | Strategy through the Option Lens: An Integrated View of Resource Investments and the Incremental-choice Process[END_REF]

Fig. 2 .

 2 Fig. 2. Design capital[START_REF] Woodard | Design Capital and Design Moves: The Logic of Digital Business Strategy[END_REF]

Fig. 3 .

 3 Fig. 3. Platform structure

Fig. 4 .

 4 Fig. 4. Design moves at PlatformCo

Table 1 .

 1 Outline of interviews

	Position	No.	of
		interviews
	Chief Executive Officer	2
	Business Area Manager	1
	Chief Operation Officer	1
	Area Sales Manager	1

  The classic example is the children's room with pieces of [building blocks] all over the ground. You can build anything with it, but you need to know what to build, how to do it, where you find the pieces and so on. The next step is to package it in a

	box. The third step is to categorise the different models with a description and a pic-
	ture. It's about knowing the industry -for instance what the bus driver needs. Before
	you know that you cannot package a solution."
	-Business area manager, PlatformCo


Tiko Iyamu

Suama Hamunyela
email: slhamunyela@polytechnic.edu.na

Sharol Sibongile Mkhomazi
email: mkhomaziss@tut.ac.za

Rethinking the Roles of Actors in the Mobility of Healthcare Services

Keywords:

Patients seek attention and treatments to various types of diseases and symptoms. Diseases infection and symptoms are often not predictive. Normally, there is a spread and movement of people across the geographical locations, of both the rural and urban communities, in countries including Namibia. As such, healthcare could be needed at any location, and at anytime. There is significant mobility of individuals and groups within a country. Unfortunately, the healthcare services are not always as mobile at the level and speed that individuals and groups does in Namibia. Hence, there is need for the mobility of healthcare services at both primary and secondary healthcare levels, particularly in the developing countries, such as Namibia.

The population of Namibia is scantly spread among its towns and cities. The major towns and cities are situated, in the average of 175km far apart from each other, in the country's 825, 418km square landscape. The spread necessitates movements of individuals and groups, particularly the old, poor, and nomadic people. Unfortunately, healthcare records in the country are not centralised and virtualised, making accessibility into patients' records difficult or impossible, from any location. As a result, healthcare service delivering is challenged. This study therefore explored and examined the possibility of mobility of healthcare services to those who live in the country.

The study employed the qualitative research method, within which data was gathered from primary healthcare service providers, using open-ended questionnaires. The Moments of Translation from the perspective of actor network theory (ANT) was used as a lens in the analysis of the data, to examine and understand the power and factors, which influences mobility of healthcare service in Namibia. Categorisation of Patients, Response Time, Understanding the Actors, Actors' participatory to service delivery, and Actors' Alliance were found to be the influencing factors in the provision of mobility of healthcare services.

Introduction

The movement and spread of the population in developing countries is argued to impact healthcare service provision [START_REF] Rygh | Continuous and integrated health care services in rural areas. A literature study. The international electronic journal of rural and remote health research[END_REF]. To ensure effective healthcare services provision, states and healthcare organisations are engaged in transforming the industry. According to [START_REF] Sander-Granlien | Confirmatory factor analysis of service quality dimensions within mobile telephony industry in Ghana[END_REF], to improve the quality and efficiency of healthcare many hospitals are involved in extensive efforts to substitute electronic patient records for paper records. Another effort that has been made by some organisations is the integration of health information systems to improve quality of healthcare service.

Also, the shift from curative to planning and preventing of disease outbreaks and control has significantly necessitated the need for healthcare data management, efficient service delivery, healthcare information flows between health practitioners and patients, as well as information sharing between healthcare levels of operandi [START_REF] Chaulagai | Design and implementation of a health management in Malawi: issues inovation and results[END_REF]. The mission of curative, preventing and disease control can only be made possible if the information of the whole population based is made available to policy makers, healthcare profession, administrators, donors and all healthcare organisations.

However, different categories of patients exist in the healthcare sector and the needs for healthcare services are diverse. There is the nomadic patient. This inflates the need to investigate different dimensions of healthcare service provisions processes in a country. In [START_REF] Chang | Modeling the Management of Electronic Health Records in Healthcare Information Systems[END_REF] argument, there is a scenario where the patient may visit a different healthcare organisation, either because the patient is dissatisfied with the treatment of his or her previous visit or the patient moves to a different location. Distinctively in this case is the mobility of healthcare services in Namibia.

Mobility in this paper refers to the state of easy accessibility of health services from any geographical location. The essentiality of mobility of healthcare is centred on factors such as portability, transferability and availability of healthcare information including real-time interaction between healthcare providers and the needing [START_REF] Fardoun | KAU e-Health Mobile System[END_REF]. In healthcare, mobility is typically associated with mobile healthcare systems and applications, the use of health public kiosk, cellular phone devices, and other portable computing devices [START_REF]Cisco.: Mobility solution for healthcare: voice, text, images and information[END_REF]. This paper argues that mobility can also be classified by the availability of healthcare services at different levels of healthcare operandi.

Mobility of healthcare services could be translated by various human actors (patients and healthcare workers), based on the different moments. Translation is a key tenet of actor network theory [START_REF] Latour | Technology is society made durable[END_REF]. In actor network theory (ANT), translation is influenced by interest of the actors [START_REF] Iyamu | Underpinning Theories: Order-of-Use in Information Systems Research[END_REF]. Translation takes place between the object and the actors it encounters as the initial program or script is altered through interaction.

ANT is popular for its ability to provide a rich and dynamic way of bringing together the socio-technical and non-technical aspects of the organization [START_REF] Wickramasinghe | Using S'ANT for facilitating superior understanding of key factors in the design of a chronic disease selfmanagement model. Actor network theory and technology innovation: advancements and new concepts journal[END_REF]. In ANT, society and organisations are a formation of different agents, and the agents interact to form heterogeneous networks [START_REF] Law | Notes on the theory of the Actor Network: ordering, strategy and heterogeneity[END_REF]; [START_REF] Tatnall | Actor-Network theory and Information Systems Research[END_REF], [START_REF] Creswell | Actor-Network theory and its role in understanding the implementation of information technology developments in healthcare[END_REF]. Networks define, describe and provide substance to agents. ANT then, deeply question and provide retorts to the existence of strong and weak (thus power) networks.

The Namibian healthcare levels of operandi cover both rural and urban areas following the thirteen political and administrative regional demarcations of the country. As a developing country, majority of Namibians still resides in rural areas. There is a significance movement of people between urban and rural areas.

The remainder of the paper in divided into five main sections. The first and second sections cover the literature review and research methodology, respectively. The third section presents the data analysis, which the findings. Based on the findings, the implications for the mobility of healthcare services in Namibia context are discussed in the fourth section. Finally, a conclusion is drawn.

The research was guided by two main questions: (i) what are the factors which influence the mobility of healthcare services in Namibia? (ii) What are the roles of human and non-human actors in the mobility of the mobility of healthcare services?

2

Healthcare Service

The healthcare sector in many countries consists of a large contingence of institutions and organisations, ranging from centres, small and medium to large and technologically advanced hospitals [START_REF] Braa | developing information systems in developing country: the flexible standards strategy[END_REF]. The institutions are classified differently in many countries. In Namibia for example, the healthcare centres are classified according to geographical areas, namely, community (constituency) and district level, regional level and national level [START_REF] Hamunyela | Readness Assessment model for the deployment of health information systems in the Namibian MoH[END_REF]. The levels of categories cover both rural and urban geographical locations. As in many developing countries, in Namibia, 58% of the population resides in rural areas while the remaining percentage resides in urban areas [START_REF]NPC: Namibia 2011 population and housing census[END_REF]. Due to the essentiality of healthcare, different studies have been conducted in pursuit to establish and describe health services to different healthcare seekers. [START_REF] Rygh | Continuous and integrated health care services in rural areas: a literature study[END_REF] examined how mobile health could be used as an innovative solution, to providing healthcare services to patients who reside in remote locations. The later stated that locality influences healthcare service delivery, therefore Mobile healthcare services are essential. This is affirmed by [START_REF] Fardoun | KAU e-Health Mobile System[END_REF] stating that, Mobile health greatly benefits patients who reside in remote areas.

Due to the geographical spread of citizens, mobile healthcare is highly essential, however, challenges do exist. According to [START_REF] Rygh | Continuous and integrated health care services in rural areas: a literature study[END_REF], healthcare providers in rural areas face numerous challenges in providing coherent and integrated services as compared to those in urban areas, which results from lack of mobile healthcare facilities. Also, the approaches that are often used by primary healthcare service providers in the rural areas are primitive and obsolete [START_REF] Mohss | Integrated healthcare delivery the challenge and implementations[END_REF]. This also could be attributed to the fact the recipients of the services do question or protest the act by the service providers. [START_REF] Fardoun | KAU e-Health Mobile System[END_REF] emphasised that mobility means the use of mobile technologies to access healthcare service, from different places, at the same time; different places, at the different times; different time, different places; and same time, same place. Mobile of healthcare services includes electronic records, shared and accessed via mobile devices among healthcare providers and receivers. It is assumed that, with the mobile health technologies, healthcare problems, such as inadequacy of doctors and poor clinical examination as a result of insufficient skilled workers and scarcity of centre are eradicated [START_REF] Narang | Quality of Healthcare Services in Rural India: The User Perspective[END_REF]. Since available healthcare providers can now remotely interact with patients and conduct analysis remotely. According to [START_REF] Istepanian | Guest Editorial Introduction to the Specialon M-Health: Beyond Seamless Mobility and Global Wireless Health-Care Connectivity[END_REF], M-health offers a variety of benefits, such as timely access, monitoring patients remotely, and improved quality of patients care, to healthcare organisation, providers and patients.

The need for accessibility and quality of health information particularly in developing countries such as Namibia necessitates refection and attention. Thus, there is need for investigation on the mobility of services to improve delivering of healthcare. It has been empirically unveiled, it is important to have healthcare services at the communities' disposal, and at any location, as opposed to the difficulty of accessibility due to distances. The investigation to ensure achieving this objective was carried through a study. The methodology that was applied in the study is explained next.

Methodology

The case study research approach and the qualitative interpretive research method were employed. The case study approach was selected mainly because of its focus on real-life situation. According to [START_REF] Yin | Case Study Research Design and Methods, 3rd Ed[END_REF], a case study can be described as the investigation of a contemporary phenomenon within a real-life context. The Namibian Ministry of Health and Social Services (MoHSS) was used as the case, in the study. In addition the MoHSS, the general populace were allowed to participate in the study. Questionnaires and interviews were used, from the perspective of qualitative method. This was to allow the participants to share their subjective view of how they provide and receive healthcare services in the country. [START_REF] Hovorka | Reframing Interpretivism and Positivism as Understanding and Explanation: Consequences for Information Systems Research[END_REF] argued that the qualitative method recognises and focuses on the subjective meaning which the participants bring to the context of the study. Upon completion of the questionnaire, follow up telephonic interviews were conducted to establish deeper understanding of the formation of networks and build of alliances. The two techniques are well established forms of data collection in social science studies.

The participants in the study were identified. A total of 23 people participated in the study. The participants included nurses [START_REF]Cisco.: Mobility solution for healthcare: voice, text, images and information[END_REF], doctors (4), and patients [START_REF] Iyamu | Underpinning Theories: Order-of-Use in Information Systems Research[END_REF] and nonpatients [START_REF] Fardoun | KAU e-Health Mobile System[END_REF], across the country. As at the time of the study, each of the participants had been in service, in their profession for at least five years. This was to ensure the quality of data obtained from them, in terms of the services that they render to nomadic patients of the country.

The data analysis was carried out, using the moments of translation from the perspective of actor network theory (ANT). ANT was selected mainly because it allows us to examine the process of change, and the interaction that take place between technical and non-technical actors. Without the use of ANT, it would have been difficult or impossible to understand and exhume the processes and actors' influences in the mobility of healthcare services in Namibia. Translation occurs when actors start to define roles, distribute and redistribute roles and power, describe a scenario to form alliances of technical and non-technical. Translation stage involves a process of change, which occur via four major moments. The ANT translation stage involves a process of change, which occur via four major moments: problematization, interessement, enrolment and mobilization. This occurs when actors start to define roles, distribute and redistribute roles and power, describe a scenario to form alliances of technical and non-technical.

The Moments of Translation elements can be summarised as follows: (i) Problematization is the stage which reveals what necessitate the network formation. [START_REF] Uden | Service Innovation using Actor Network theory.Actor network theory and technology innovation: advancements and new concepts journal[END_REF] elaborated that during problematisation, actors establish themselves as an obligatory passage point (OPP) between them and the network for indispensability. (ii) Interessement: at this stage, actors consciously or unconsciously reveal their individual or groups' interest on the item that has been problematized by the focal actor. (iii) Enrolment: process begins with a primary agent imposing their will on others for actions to be executed; this act requires yielding from different actants. (iv) Mobilization: an enrolled actor speaks on behalf of the network, and tries to an interest to persuade others to partake in the activities of the network.

Namibian Ministry of Health and Social Services (MoHSS): The Case Studied

As it is in many countries, the Ministry of Health and Social Services (MoHSS) of Namibia coordinates and oversee the activities of the medical and health sectors in the country. The MoHSS is mandated to provide an integrated, affordable, accessible, quality health and social welfare services, which is responsive to the needs of the Namibian population [START_REF] Mohss | Integrated healthcare delivery the challenge and implementations[END_REF]. The population seeks services from the available healthcare facilities which are located at different levels of operandi in the Namibia [START_REF] Hamunyela | Readness Assessment model for the deployment of health information systems in the Namibian MoH[END_REF]. Processes and activities of the MoHSS are mostly performed manually (paperbased) or through health information systems (HIS). This can be a huge setback for the services which the MoHSS provides to the communities in the country such as distribution of the HIV treatment and immunisation against contiguous decease's outbreaks. Worse, the manual approach significantly delays centralisation of processes and activities [START_REF] Hamunyela | Readness Assessment model for the deployment of health information systems in the Namibian MoH[END_REF]. This indeed is dangerous to patient needs, particularly those who are of intensive and chronic nature and nomadic patients.

In addition, there is mobility of individuals and groups within a country. Hence, there is need for the inclination of centralizing healthcare services at both primary and secondary healthcare levels in developing and developed countries. In Namibia, the geographical spread of the population, the widely held image of the healthiness of people in rural area, different groups with needs for healthcare (the old, the poor, nomadic people est.) necessitates the mobility of healthcare services.

Data Analysis

As mention earlier in the methodology section, the analysis of the data was done, using the lens of actor network theory. The components of ANT that were followed in the analysis include Actor-Network, and Moments of Translation. In each of the sections of the analysis, the findings are presented and discussed.

Patients are attended to when seeking for health services at the centre, where a discussion (Translation) between the patient and the healthcare takes place. It is procedural to bring along a medical passport (a form of identity which issued by healthcare service providers) when seeking for health services and routine for the healthcare provider to note in the health passport the diagnosis taken and prescriptions. Interactions between healthcare and patients can be classified as part of a durable network that exists to offer services. It is a durable network because a fixed health centre exists and there are actants stationed at each centre.

Currently there are no records readily available when attending to in transit patients except for the health pass port and the medication labels which might not be available at times or lost. For example HIV patients who have been under the care of private doctors and wish to move to state hospitals might not be attended to or attended to after a long time due to communication break down between public and private centres. One of the common challenges encountered by the healthcare providers was a repetition of treatment course which were not effective. There were no records to show that the same treatment or test was carried out, and that it was not effective. One way to overcome these issues is implementation of an Electronic Patient Monitoring System (EPMS) and Electronic Dispensary Tool (EDT) linked to all health facilities providing HIV care for patients to be helped without relying on hard copies only.

Actor-Network

The human actors in the healthcare sector includes healthcare needing people, healthcare professionals (Doctors and Nurses), and the government MoHSS. The nonhuman actors consist of processes, ICT artefacts and other medical tools. As at the time of this study, different networks existed, some of them were in the categories of nurses' professionals, urban patients, rural patients, and tribal patients. The actors had different interest. Each of the actors made a difference, either as a receiver or provider of healthcare service. The difference was based on the impact that the actors had on each other. For example, the knowledge a professional acquired in the course of providing health service to a patient.

Currently, there exist different networks to which actors belong. The enrolment of actors in the different networks was influenced by their interests. As gathered from the participants in the study, the primary interest of the general actors were, to receive service from the practitioners, and to render service to the patients. These interests were however, influenced and manifested by other factors and interests, which included spoken language, culture, and accessibility.

Findings: Categorisation of Patients

Categorisation of patients was found to be significant, due to the different healthcare services they require, and how the services could be provided and by whom. The categorisation is divided into grouping and indexing: i. Grouping -the actors require groupings, in terms of networks. The different networks, formed in accordance to categories, such as health related challenge, gender, spoken language, and resident location. This will help in terms of referral of patients, to specialist. ii.

Index key -indexing of patients' record is critical. This is to enable searches, in the different categories, such as spoken language, tribal origin, current location, and illness type. This will help improve response time. Some of the patients could only enrol in the network where there preferred language was used as the medium of communication. Even though interpreters were readily available, they preferred to express themselves than the use of translation. Enrolment into a network by many patients in some parts of the country was influenced by their culture. According to some of the participants, their tradition does not allowed them to be treated by professional of opposite sex.

Moments of Translation

The moments which consist of four stages, namely problematisation, interessement, enrolment and mobilisation was employed in the analysis primarily to examine and understand the interactions which happen amongst the actors. This was to further understand the suitability, and transformation of the current status quo to era of mobility of service within the healthcare environment.

• Problematisation

The activities of the healthcare sector were initiated, problematised through two primary channels, patient and the government. The patients problematise an activity through illnesses, which were often varied. While the other focal actor, the government does same, problematise its healthcare related activities through the Minister of the Ministry of Health and Social Services (MoHSS).

The patients or their representatives (guardian) report incidents of illness, including vehicle accident involving human at the nearest healthcare centre. The incidents were recorded by the front-office professional, who normally were the Nurses. The Nurses escalate the incidents to the appropriate or respective specialist for further and detailed attention. Another criterion that was used for the referral of patients was language, to enable communication and precise understanding between actors (patient and specialist). The Nurses does so, record and escalate incidents based on the power bestowed on them by the authority of the organisation, which comes from their qualification to practice.

The government problematises all initiatives relating healthcare in the country through the Minister of health. The Minister further problematises the initiatives to heads of units and departments of agencies and organisation within the health sector, through workshops and strategic meetings. Unfortunately, the initiatives are not fit for the districts and rural communities, where they are considered needed most e.g. Unavailability of medical reports 'breaks' the continuity of HIV care between health districts.

Healthcare service providers are stationed at different locations of operands. The spread of the operands are far apart, of about 150kms in average. The travelling and nomadic people are therefore forced to seek healthcare service from the nearest location of medical operand. There is a national policy which is intended to address the challenges of patients who are "on-transits" within the country. The policy defines "on-transit" as a maximum duration of three months stay from original or residence location. The implication is that, a patient who exceed that period may be denied the privilege which the on-transit healthcare service offers. Also, on-transit patient require a letter or medical passports in other to receive medical attention. The requirement is be able to access medical history, which includes previous diagnoses, treatments, and consultations. Unfortunately, some healthcare service providers are adamant on the requirement before service. The challenge is that many people inevitably lose or damage their medical passport. Some people do not always have the passport with them as the medical incidents are not always predictive. Even though the health passport is replaceable, the process is not real-time. As such, it delays treatment to the patient, worst, if the incident is severe.

Findings: Response Time

Following the process of problematization, from the moment of translation, we found Response Time to be crucial in delivering healthcare service to patients. This is even more critical because of the distances the patients have to travel to get the services. Response time is further viewed from two perspectives of significance, in the mobility of healthcare services in Namibia. The factors include the impact of bureaucracy and lack of access to real-time medical data: i. Bureaucracy -the process of initiating medical attention is too bureaucratic for incidents which are health related. It is worst if the incident is severe, or become live-threatening. The situation can be more challenging in rural areas, and where there is no next of kin to provide relevant information about the patient. ii.

Real-time data -there is lack of real-time data of patients' record. This makes it difficult for healthcare providers to provide relevant and instance services to patients, or to know of previous diagnosis and prescriptions. Our interpretation of the findings indicates that the impact of bureaucracy and lack of access to real-time medical data requires cloud computing solution, as shown in Figure 1. Cloud Computing -Figure 1, depict the use of cloud computing solution to store, and access patients' data for health services in Namibia. [START_REF] Armbrust | A view of Cloud Computing[END_REF] referred to cloud computing as both the applications delivered as services over the Internet and the hardware and systems software in the data centers that provide those services. This allows personnel or specialists to store and access patients' data from Private and Public hospital, including clinics, using different devices, such as laptop, mobile phones, and desktop. The architecture (Figure1), using the cloud solution, enables all healthcare medical personnel in the country to have access to real-time data for their services.

The overall problem is the provision of healthcare services to the nomadic patients of the country. The MoHSS aim to provide effective services to all patients regardless of their dwelling status are currently a challenge, as many of the patients are given too much responsibility in addition to their individual illness. In response to the need for a more effective health services, highly qualified and skilled workforce is enrolled in this activities. Furthermore, procedures to deliver or receive healthcare services are enforced (e.g. only registered nurses can attend to patients or patients should carry their healthcare passport in case looking for healthcare services). This in turn leads to the consideration of suitable healthcare provision, healthcare received and medical history for patients. For healthcare service innovation by the MoHSS, the problematisation proposed by the instigators is that to improve healthcare services to all patients including the nomadic patients, there must be service innovations that enable the desired outcomes. This is seen as an OPP by the MoHSS to remain a competent healthcare service provider in the country. In the case of the patients, they need to be certain that they will receive adequate services at any time anywhere.

• Interessemment

As earlier revealed in the analysis, the actors had different interests. The actors were categorised into two main groups, healthcare service recipients and providers, which consist of patients and professionals, respectively. The interests of these groups were diverse, even though the primary goal was healthcare services. The interest of the healthcare recipients were influenced by factors such as locations, type of health related service that was required, and the affordability of services. Proximity was a hindrance to many of the people who lived in the rural areas of the country. The healthcare facilities were far apart from each other. As a result, there were few options to those who need services such as Human Immunodeficiency Virus (HIV) patients, who needed to get their Antiretroviral (ARV) medications from healthcare centre. Due to the fewness of the facilities, the common ones were "General Practitioners". This made it difficult or impossible to access specialists and certain services.

The MoHSS for instance, interest concern its public mandate and social responsibility visible in different directorates and divisions that formed up the MoHSS. The MoHSS also has directorates and division managers in different roles that oversee the execution of duties (e.g. delivery of services), managing healthcare centres, recruit healthcare providers, procurement of necessary medications and other equipment's. These individuals set themselves up as the focal actors and as such, making rues for obligatory passage point.

The healthcare providers' interests were of professional progress, income, status and job descriptions. Healthcare providers in service benefited differently during the course of their duties, depending on the location and the responsibilities that they were assigned. Some of the benefits included flexibility and shifts working hours, housing subsidy, and free medical aid. Also, exposure to different health related cases which in long term can be attributed to experience gained.

ICT artefacts were used differently in the healthcare organisations to support the delivery of services, such as diagnostics and documentation of individual and group records. The use of ICT artefacts were also based on the interest of the users. The interests were informed by their technical skill and know-how of the technologies, and what they needed them for. Another factor was whether the technologies were supported for use in the environment that they were deployed. This played a critical factor in individual and group interest to make use of available technologies for healthcare services in Namibia. As a result, many of the professional anchor their interests on paper-based processes, which they were more comfortable with in delivering services. Paper technology is crucial to nomadic patients thus; it is required for them to forward the healthcare passport to receive the necessary services.

Findings: Understanding the Actors

In our examination of the empirical data, using the interessment tenet of the Moments of Translation, we found Understanding of the Actors to be significantly useful. In that, only through understanding of the involving actors mobility of healthcare services can be influenced. Understanding of the actors was shared from the perspective of awareness and technology know-how: i. Awareness -the actants (healthcare providers and patients) took part in the healthcare services, including in the ways in which the services were provided and received, were based on their levels of awareness. For example some health professionals were became health professionals for personal benefits; and some patients' preference for healthcare services centres were influenced by factors, such as their knowledge of the type of services provided by the centres, the types of their illness, and knowledge of proximity to the centres. ii.

Technology know-how -healthcare providers made use of the technologies that they were familiar and comfortable with. For example, some professional could hardly use computer systems to record or access patients' data. However, different technological tools are applicable in diagnosis and other services provision As already established, the lack of awareness and technology know-how has detrimental implication on the mobility of healthcare services. Thus, a mobile kiosk provides a redress. The use of mobile kiosk will help to reduce or eradicate factors, such as proximity, as it changes location. Also, it could assist patients to garner more information that are offered and available in the different centres, as the patients visit the kiosk in their locations. As shown in Figure 2, the mobile kiosk is intended to continually, move from one location to another. The kiosk is expected to move within cells (geographical location covered by base station), so it could access, and be accessed by hospitals and clinics, at any location, using any mobile device. According to [START_REF] Haeberlen | Practical Robust Localization over Large-Scale 802.11 Wireless Networks[END_REF], mobiles devices include microwave ovens, Bluetooth devices, and cordless phones. However, personnel from the hospitals and clinics need to be able to make of mobile devices in order to access the mobile kiosk.

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Enrolment to the network

This process begins with a primary agent (in this case the MoHSS management) imposing their will on others in attempt to achieve for common goal. This was mainly because of the significant of participation of all key stakeholders, which determines the success of failure of healthcare initiatives in Namibia. However, participation was always a challenge, as a result, definition of roles and responsibilities were seen as critical.

The ministry defines the regulations, roles and responsibilities to healthcare providers, and standards of service deliveries at public healthcare centres. This process centred on negotiation and alignment of actants' interests within the different networks. The process was challenging in that it was always lengthy and difficult, and so many conflicts arose. The challenges were manifestation of the different cultural background, interests' focuses, as well as recording keeping. For example, some patients had relocated, and others had lost their health passport, and they needed medical attention. In such cases provision was made to create a new health passport for them through negotiation.

Even though health services were considered essential and critical, some patients would not enrol or reluctantly enrolled in the health related programs. This challenge was prevalence in the rural parts of the country. Many of the communities' members cited the same reason for their lack of participation in the health programs. Some of the reasons included accessibility, literacy, and affordability. For example, some of the participants in this study claimed that many needing healthcare are not literate enough to understand the messages which were used as medium of communication to them. Inscription occurs in this case in the sense that the primary interest of the MoHSS at different healthcare centres was to provide efficient services to all patients including the nomadic patients. Interest of all actants has been aligned and now there is a need to maintain the network. This results into a durable or not durable network.

Existence of conscious and unconscious networks of people, and their enrolments which were created overtime and space across the country signifies that there is need for durability and mobility of healthcare services. Thus, patients communicate their healthcare complains to healthcare providers, provide the healthcare passport if in possession, healthcare providers carry out the diagnosis process and offer prescriptions, again healthcare providers communicates the different cases encountered at reporting intervals to supervisors which in return reports to management (regional, district or national). Or though healthcare providers have power in durability of the network, MoHSS management have the most power to ensure the existence and the growth of the network.

Findings: Actors' participatory to service delivery

The analysis revealed that actors' participatory, drawing from the connection and relationship between human actors and interactive systems, is essential to the mobility of healthcare services in the Namibian context. The connection and relationship between the actors is enacted by different tools and devices, to enable and encourage participation in the MoHSS initiatives on health programs, across the country. The components of the participatory factor, connectivity of the actors and interactive system:

i. Connectivity of actors -connectivity will foster actors' enrolment in the mobility of healthcare services. As shown in Figure 2, users (healthcare service providers and patients) need to have application on their devices, which will enable them to easily access the mobile kiosks. The application should be symmetrical, in that it is user friendly to both literate and illiterate actors in their needs to access the kiosks. The application will enable users to easily access the kiosks, from any location including at impromptu times. ii.

Interactive system -the interactive system establishes a step-by-step conversation, with the caller. The system is intended to scrutinize calls from the communities, thereby narrow the request or inquiring towards a specific need of the caller. This is purposely for efficiency and effectiveness of the mobile kiosks, in response to the community needs.

• Mobilisation

Due to the essentiality of health services in the country, it was vital for some actors from both MoHSS and the community to mobilise the healthcare service providers and recipients towards a common goal. During mobilisation, some actors were assigned the role of new initiators by becoming delegates or spokesperson for the focal actor [START_REF] Iyamu | The impact of netwrork of actors on the infomation technology. Actor network theory and technology innovation: advancements and new concepts journal[END_REF]. In this case, hospital matrons, and supervisors at different healthcare centres tried to mobilise healthcare providers to actively participate in the network (carry out their duties). This resulted to a stability of the process of delivering healthcare services in some areas, particularly in the urban areas.

As a result of the stability through adequate services, more patients became spokespersons to different healthcare centres. The self appointed spokespersons encouraged others with the same or different health issue to seek healthcare services from designated locations of their preference. Also, the altitude and tribal inclination were the others factors which influenced mobilisation and of patients. For example, some patients recommended others to visit or seek assistance from health centres where majority of the health professional were on their tribal origin and spoke the same language as them.

Findings: Actors' Alliance

The actors formed formal and informal alliances. The alliances were significantly helpful in understanding the challenges factors in the quest to provide healthcare services to the various communities in the country. The alliances were seen as forms of collaboration and political affiliation: i.

Collaboration -mobility of healthcare services require collaboration between community members and healthcare providers. The collaboration could be driven by an agent, but it is the responsibility of all that are involved in the mobility of healthcare services. The collaboration could happen at different levels, such as community members, health professional, and the government (MoHSS). Political affiliation -the mobility of healthcare services in Namibia is endangered by tribal preference for services. This manifests from political affiliation of individuals and groups. Political inclination has potentials of influencing mobilisation of actors, to participate in the mobility of healthcare service in their communities. Political inclination is critical as some actors are heterogeneous in the networks, as shown in Figure 3. Social Networking -the social networking approach will help to bring all actors together, in fostering the mobility of healthcare services in Namibia. According to [START_REF] Dwyer | Trust and privacy concern within social networking sites: A comparison of Facebook and MySpace[END_REF], ssocial networking is a type of virtual community that has grown tremendously in popularity over the past few years. Social networking has no boundaries, in terms of spoken language, and tribal origin. It brings people of common interest together in the same network.

Another important factor of social networking is that, an actor can be heterogeneous in that the actor can belong to more than one network, as shown on figure 3. In this instance, the actor is able to influence and connect the networks to each other. This help to eradicate or silence tribal or political inclination which has potential to hamper the common goal, of the mobility of healthcare services.

Mobility of Healthcare Services in Namibia

People, technology and procedures are the actors in the process of healthcare service delivery. ANT's translation process that was followed in this study defines the formation of networks, which helped to identify the groupings and how they were created. The process starts with the main actor who defines the roles through problemitisation of the issue or item. This was done by localization of the issue, so as to foster relationship, and get more and regional actors to be interested, and partake in the initiative.

Although the employment of technical actants can be viewed as the consequences of the action of all actants to an extent, the ministry of health in this case has power to hire healthcare providers and extend the provision of services to all health service level of operation. This signifies authority to define procedures of service delivery e.g. change the national policy of the in transit patients or implement an Electronic Patient Management System (EPMS) at health centers. By so doing, associations of technical and non technical actants are strengthen.

Moreover, the mobility of healthcare services is enabled and constrained within network such as community by the actions of actors, which often based on individual or group knowledge. Mobilisation is necessary to educate and inform actants about the services. Patients need to know about their rights to health services at any location and the importance of a health passport.

A health passport, referral letter or medication container was issued to patients by medical personnel at different locations or health centres across the country. Thus, the patients present whenever they needed health related treatment anywhere in the country. Challenge of presenting the above is that they are vulnerable to loss or results to unclear information on the passport or letter. The consequence of such loss and unclear information make services complex and complicated to both healthcare service providers and the patients. Hence it is critical to enforce electronic systems, which allow access to patients' health related records from anywhere across the country, and on real-time.

Conclusion

This paper presents a critical analysis of the role and account of actors in the mobility of healthcare services in Namibia. The analysis is of vital important to the Namibia, and other countries which has similar setup and challenges, in that it unveiled issues that the State government and many healthcare professional are not aware of, take for granted.

In the past, and continuous (before this study), the state Government as in many developing countries continue to invest and focus on technical issues, which often become "white elephants" due to lack of usefulness. This study revealed fundamental and primary issues, which makes technology useful and ease of use in the mobility of healthcare services across Namibia.

The paper emphasises on the importance of relationships between the actors (health professional and patients), and as well the significance of networks in the mobility of healthcare services at different health operandis. As at the time of the study, patients in transit were handled in accordance to the national health policy as promulgated by the MoHSS. The study revealed how healthcare service providers, through the use of spoken language and tribal origin, enable, and at the same time, constrain the services that they are supposed to render to the patients for better healthcare. These factors were often conscious, and sometimes unconsciously exhibited by the actors. However, little or nothing was known of the impact, the service providers of healthcare in Namibia.

Fig. 1 .

 1 Fig. 1. Patients data in the cloud

Fig. 2 .

 2 Fig. 2. Mobile Kiosk

Fig. 2 .

 2 Fig. 2. Collaboration