Dolapo Bilkis

Olumide Longe

The Adoption of Mobile Health (mHealth) Services by Internally Displaced Persons (IDPs) in Nigeria

Keywords: Mobile Health, mHealth, UTAUT, internally displaced persons, IDPs

This study operationalized the unified theory of acceptance and use of technology (UTAUT) to study the attitudes and opinions of internally displaced persons (IDPs) in Malkohi host community Yola, to mHealth if deployed to support their healthcare and health information needs. Findings from the research revealed that the IDPs have a positive behavioral intention towards mHealth technology, which could then lead to its adoption. The study also unveiled new constructs such as "Language" and "No Tariff" which are more vital determinants of the IDPs attitude towards mHealth than the original UTAUT constructs. These newly discovered constructs were added to modify the UTAUT to make it a suitable framework to check attitudes and opinions of IDPs towards mobile health (mHealth).

Introduction

Nigeria has a high population of displaced persons living in the country. The major reason for this is the Boko Haram insurgency that has been plaguing the country for almost a decade, with this terrorist group having carried out most of their attacks in the North East region of Nigeria leaving more than 2million people displaced [START_REF] Gwadabe | Forced Displacement and the Plight of Internally Displaced Persons in Northeast Nigeria[END_REF]. These displaced people seek refuge in IDP camps and host communities, the living conditions of these people having been very well explored in literature and has been stated to be deplorable. The relief items donated and distributed by humanitarian agencies and health care services and information are found to be inadequate, as a result of the overcrowding situation in these camps [START_REF] Eme | BOKO HARAM AND POPULATION DISPLACEMENT IN NIGERIA : A CASE FOR PSYCHOLOGICAL INPUT[END_REF]. The studies that have been conducted on IDPs in Nigeria have mainly revolved around their living conditions, their plights, physical health conditions, mental health, causes of their migration, educational needs, psychological needs and various other needs [START_REF] Eme | BOKO HARAM AND POPULATION DISPLACEMENT IN NIGERIA : A CASE FOR PSYCHOLOGICAL INPUT[END_REF][START_REF] Gwadabe | Forced Displacement and the Plight of Internally Displaced Persons in Northeast Nigeria[END_REF][START_REF] Okon | Poverty in Nigeria : A Social Protection Framework for the Most Vulnerable Groups of Internally Displaced Persons[END_REF][START_REF] Owoaje | [END_REF]. The health problems of these displaced persons in the camps is one of the issues that is stated in almost all the literature reviewed on IDPs in Nigeria. However, research has not comprehensively covered possible solutions to their lack of adequate healthcare and health information [START_REF] Owoaje | [END_REF]. [START_REF] Patil | The Role of ICTs in Refugee Lives[END_REF] on the role of ICT in the lives of refugees, recommends that we start viewing displacement problem as a development problem rather than just a humanitarian crisis. Thus, technological solutions are being explored in literature for refugees and IDPs to provide sustainable solutions to their plights and to allow them to create self-reliance opportunities. However, this area of research has not gained much popularity in the Nigerian context because the majority of the literature reviewed on refugees and ICT has been carried out in other countries and this has focused on addressing the issues of refugees. Mobile health provides the advantage of the use of mobile phones to provide medical health services to patients in remote areas. Based on the gaps identified from the foregoing, this study aims to explore the attitudes and opinions of IDPs to adopting mHealth technology to support their lack of adequate healthcare and health information. With this in mind, the research asks the following questions:

1. To what extent do IDPs utilize mobile phones? 2. What is the attitude and opinion of IDPs to mobile phones to provide for their health information needs?

The remainder of the paper is structured thus; section 2 explains a brief history of the cause and current situation of IDPs in Nigeria. Section 3 highlights the theoretical foundation adopted for the study. Section 4 explains the research methodology and method of data analysis. Lastly, section 5 explains the empirical evidence and findings, and sections 6 & 7 contain the contribution to knowledge and research conclusion.

Internally Displaced People in Nigeria

IDPs are people that have been forced to elope from their natural place of habitat or homes but are still within the borders of their country, while refugees are displaced people that have had to run beyond the borders of their county [START_REF] Gwadabe | Forced Displacement and the Plight of Internally Displaced Persons in Northeast Nigeria[END_REF] to seek refuge in other countries. The population of IDPs in Nigeria as at 31st of December 2018 is 2,216,000 as reported by the Internal Displacement Monitoring Centre (IDMC, 2018). Nigeria has the worst IDP situation in Africa which has made it become the third in the world after Syria and Columbia [START_REF] Lenshie | THE INTERNATIONAL JOURNAL OF HUMANITIES & SOCIAL STUDIES Boko Haram Insurgency , Internally Displaced Persons and Humanitarian Response in Northeast Nigeria[END_REF]. Mukhtar et al. (2018) in their study stated that 80% of the IDPs in Nigeria are found in the Northeastern part of Nigeria according to The National Emergency Management Agency (NEMA). This high population of displaced persons in the North East region of Nigeria is as a result of the attacks from the Boko Haram terrorist group that has been ongoing in the country for almost a decade now. The Boko Haram religious terrorist group started its attack against the Nigeria Government in 2009 in Maiduguri, Borno state [START_REF] Gwadabe | Forced Displacement and the Plight of Internally Displaced Persons in Northeast Nigeria[END_REF]. Borno state is one of the North eastern states in Nigeria, it contains 27 local Government areas and about 20 of these local governments areas are controlled by the Boko Haram terrorist group with the Government controlling the remaining 7 [START_REF] Sambo | Internal Displaced Persons and Their Information Needs[END_REF]. This provides evidence of the reason why Nigeria has such an overwhelming population of IDPs from the year 2009 because the population of people that are displaced due to natural disaster is only about 24%, with the other 12.6% being from the Fulani herdsmen crisis with farmers. The remaining 85% of the total population of IDPs in Nigeria are from the terrorist attacks in the North east [START_REF] Nwaoga | Self-acclaimed Religious terrorism, Refugee crisis , and the Plight of Internally Displaced Persons in Nigeria[END_REF]. Adamawa and Yobe state and other North Eastern states also have a high population of IDPs after Borno state with a distribution of 18%, 13% and 63% respectively. IDP camps were created for victims of these terrorist attacks in the local Government areas that are safe from the attacks. Such camps receive donations of relief items from well-meaning Nigerians, the Nigerian Government, International Government and humanitarian agencies [START_REF] Nwaoga | Self-acclaimed Religious terrorism, Refugee crisis , and the Plight of Internally Displaced Persons in Nigeria[END_REF].

Technological Solutions for Refugees and IDPs

Considering the fact that the world has gone digital over the years, more people (old, young, literate or illiterate) are adopting information and communication technologies. Lewis and Thacker, (2016) considers displacement as a continuous trend in the "21st century" and suggests that adequate preparedness should be made to meet the needs of this occurrence. [START_REF] Okon | Poverty in Nigeria : A Social Protection Framework for the Most Vulnerable Groups of Internally Displaced Persons[END_REF] also suggests that the IDP situation in Nigeria is "recurring and large scale". Much research has been conducted on ways to provide solutions to the issues experienced by IDPs by making recommendations on Government policies to protect their rights, and also suggestion on the role of trained social workers as opposed to just volunteers [START_REF] Chinwe | The role of social workers in ameliorating the plight of internally displaced persons (IDPs) in Nigeria[END_REF]. [START_REF] Patil | The Role of ICTs in Refugee Lives[END_REF] recommends that the issue of displaced persons should also be seen as a "development problem" rather than just a "humanitarian problem" and also calls for more research to be done on the impact that technology would have on the lives of displaced people. Hence, the need to consider ICT solutions for the problems of displaced persons.

Theoretical Foundation

Unified Theory of Acceptance and Use of Technology (UTAUT)

The UTAUT theory was created through a combination of eight technology acceptance and motivation models which includes the TAM and DOI theories. In the early 2000's technology adoption in organizations became rapid. However, these technologies wouldn't have improved productivity if the users had not accepted the technology. Thus, research on technology acceptance became important and there were various types of theories and models from information systems research, sociology and psychology which researchers were adopting to measure users intentions to use a new systems. Researchers were also faced with the choice to decide among the various number of models, and found they had to pick constructs across the models or pick a "favoured model" which tended to overlook the contributions from other models. This situation prompted [START_REF] Venkatesh | User Acceptance of Information Technology: Toward a Unified View[END_REF] to complete a study that reviewed and synthesized literature on user acceptance models to create a unified view of user acceptance theory. This model is presented in figure 3.1 below. Gender, age, experience and voluntariness of use are used as moderating variables in the model but are not used in this study. Among the studies that utilize information technology theories to review the components influencing the adoption of mobile health, the TAM model was utilized more than other models. Perceived usefulness (PU) and perceived ease of use factors (PEOU) in TAM are also very well represented in the UTAUT model as are performance expectancy (PE) and effort expectancy respectively (EE). The performance expectancy, effort expectancy and facilitating conditions from UTAUT are the best in predicting the adoption of mHealth technology as reported in a systematic literature review study on published articles from year 2004-2015 which was designed to discover the factors that influence users adoption of mHealth [START_REF] Garavand | Accepatance of Health Information Technologies, Acceptance of Mobile Health: A Review Article[END_REF]. The UTAUT model is thus a combination of all major technology acceptance theories, and is considered a right fit for the study because it not only consists of constructs that have been tested to be adequate to measure users intentions towards the mHealth technology, but also because it has been reported to have a 70% accuracy rate on testing users intentions compared to other models [START_REF] Hoque | Understanding factors influencing the adoption of mHealth by the elderly: An extension of the UTAUT model[END_REF][START_REF] Garavand | Accepatance of Health Information Technologies, Acceptance of Mobile Health: A Review Article[END_REF][START_REF] Pheeraphuttharangkoon | The Adoption , Use and Diffusion of Smartphones among Adults over Fifty in the UK[END_REF].

Although the UTAUT model has gained a lot of popularity amongst researchers and its level of reliability is reported as being high, the model poses some limitations. In our study we were able to find out that the constructs of the UTAUT model are not all encompassing, and it required some modification to fit the context of our study. The original constructs of the UTAUT alone wouldn't have yielded a strong positive behavioral intention to adopt the mHealth technology if the new constructs (language and no tariff) were not included in the constructs; i.e. without the new constructs, the results may have shown that the IDPs might not be interested in adopting technology. This is a major limitation because it goes on to insinuate that the UTAUT model would always need modification when it's been used to investigate the intentions of individuals towards technology. In addition, "the original UTAUT model which was focused on large organizations in the business environment has caused an extensive discussion among researchers who contend that the UTAUT constructs alone may not be adequate to clarify user acceptance of new technology in a voluntary setting as its initial purpose of use limits its explanatory power" [START_REF] Ali | Extending the UTAUT model to understand the customers' acceptance and use of internet banking in Lebanon: A structural equation modeling approach[END_REF].

4

Research Methodology

Interpretivism

The interpretivist acknowledge that realities exist in the minds of individuals differently. They recognize that notions of "reality" exist in a social setting and that the most suitable method for understanding activities of social actors may not really be through numbers and thorough measurable tests. This view is explained by Roode ( 2003) who affirms that "the interpretivist scientist perceives that numerous significant issues identified with the improvement, use and execution of information systems personally concern individuals, and acknowledges that the social world exhibits a superior stage to consider these wonders than the simply material universe of technology." This research has adopted a case study design with a qualitative method which includes observation, focus group discussions and interviews. The data collection process from the IDPs in Malkohi host community started on 9 th September and was concluded on 1 st October. Having spent some time on the field, we understood to some extent the way of life of the IDPs in that camp. They rely solely on authority in their decisionmaking process and are mostly united on all other fronts. The data gathering process started off by seeking permission from the host community chairman who is also an IDP, which led on to him being the first interviewee. He felt it was important to include and invite the 9 other elders who have spent the highest number of years in the host community and are very well knowledgeable about the happenings and needs of the community. This led to the focus group discussion that started our data gathering process. Although, the general opinions received from the people was that the response of the chairman and elders was sufficient for them and that he speaks the mind of the people, the researchers still obtained permission to go on with interviewing other participants for research credibility. The 20 other respondents of the interviews included 10 women and 10 men distributed across different age groups.

The participants were all fluent in only the Hausa language, so the data collection process was done with the help of an interpreter who was fluent in both English and Hausa. The interview questions were open-ended questions, with responses to each question interpreted during the discussion and interview process with notes being taken during this process. The community chairman gave an estimate that about one-third of the people in the host community use mobile phones, and they can make calls, receive calls, and also send text messages. A purposeful random sampling method was employed in recruiting other participants that were interested in participating in the study. These included men and women from different age groups that use and own mobile phones. Each interview took about 10-15mins, with a total of 30 participants interviewed. The researcher stopped the process after reaching a level of data saturation; i.e. when no new data was being received [START_REF] Fusch | Are we there yet? Data saturation in qualitative research[END_REF].

Method of Data Analysis

This study adopts a thematic analysis method of data analysis. Transcripts were transcribed manually into a Word document, and the transcribed data was read over and over again to produce a coherent understanding of the data. Notes on the first impression gotten from the data were taken, and the data was run through over again and then used to generate codes from the data. Code generation involves identifying and labelling relevant pieces present in the data, such as opinions, actions, activities, incidents, emotions etc. The amount of data collected from interviews and focus group discussions was quite large and it was difficult to identify what was relevant to code. However, identifying codes can be done by probably considering a point that appears a couple of times within the data, including points that seemed important to the respondents and points that are new and can be an addition to the study. This also includes preconceived theoretical concepts or points that seem important to the researcher. These codes are then brought together for review to decide which ones are important and relevant to the study, with the codes identified as important then put together in categories or themes. This is done without bias with the codes and themes being strictly defined by the data. At this point the data is beginning to become conceptualized.

When the relevant themes are labelled and the relationships between them have been identified, the process builds the results of the study which provides new information about the world from the perspectives of the participants of the study. The connections between the themes can then be represented diagrammatically to create a thematic map. The results are then described, and this includes detailed descriptions of the themes and the connections between the themes. Also included are some scripts from the respondents which are used to support the results.

Empirical Evidence and Findings

This section examines the initial themes generated from the interview codes as derived from the research model. These themes can be seen on table 5.1 below and are discussed in greater detail in the following sections.

Themes Description Based on the Dimensions of Research Model

Performance Expectancy

According to Venkatesh et al. ( 2003) "Performance expectancy is defined as the degree to which an individual believes that using the system will help him or her to attain gains in job performance". In this case, performance expectancy would refer to the degree to which IDPs believes that mHealth will help improve their current healthcare situation. The majority of the participants of the study believed that if they were provided an alternative to their current health situation, even if it is via a mobile phone, they were willing to accept it. There were also many complaints about the situation of the hospital in the camp. Apart from the host community where the study was conducted, there is another IDP camp very close by and they are also served by the same hospital and one doctor. Some respondents described situations where they have had to stay home throughout their sick days because there was no space for examination or admission in the hospital due to the large number of people seeking treatment at the same time. This is usually common in the rainy seasons when they are more prone to all sorts of diseases, e.g. malaria.

Table 1: Initial Themes Generated from Interview Codes

Quite a number of respondents expressed their dissatisfaction about having to go to the specialist hospital for treatment because of the distance, and some of them mentioned they couldn't afford to go there at all and had to rely on whatever services the hospital on the camp provides. There have also been some situations where the doctor in the hospital on site was not equipped to handle some cases that had occurred in the camp and which needed immediate attention.

Effort Expectancy

According to [START_REF] Venkatesh | User Acceptance of Information Technology: Toward a Unified View[END_REF] "Effort expectancy is defined as the degree of ease associated with the use of the system". As mHealth services are dispensed through mobile phones and other wireless devices, the basic phone calls and text messaging services are utilized in some mHealth initiatives. This study involved discovering the capabilities of the IDPs as regards the utilization of mobile phones. Thus, the study purposely chose samples of respondents that utilize mobile phones and would be able to relate to idea of mHealth technology. It should be noted that the population that use mobile phones are less than the population that do not have access to a mobile phone. This is mostly because some of them cannot afford a phone and furthermore some of them cannot use it. The majority of the respondents could however make and receive phone calls with their mobile phones without help, and the younger respondents are able to make calls, receive calls, send, read text messages as well as do other various things on their phones. This is because the younger respondents were more educated than the older respondents. However, the older respondents explained that they receive help from their children to operate the mobile phone when they need to do other things on their phones.

Solo Influence

According to [START_REF] Venkatesh | User Acceptance of Information Technology: Toward a Unified View[END_REF] "Social influence is defined as the degree to which an individual perceives that important others believe he or she should use the new system". This was an important factor in the study as the IDPs are people with similar experiences and are able to relate to each other's situation. They are a community of people that have being brought together through crisis and they have had to grow, survive, support, and protect each other on a daily basis. This has enabled them build trust amongst themselves as they always come together as a unit whenever there was a decision to be made about the happenings in the camp. Through this, they also select a representative of their community which is someone they believe has been around for the longest time, is trustworthy and also capable of making good decisions for them whenever the need arises.

Facilitating Conditions

It is suggested that "Facilitating conditions are defined as the degree to which an individual believes that an organizational and technical infrastructure exists to support use of the system" [START_REF] Venkatesh | User Acceptance of Information Technology: Toward a Unified View[END_REF]. mHealth involves the use of mobile phones and mobile phone services, and this services also needs mobile network connectivity. The population of people with mobile phones was relatively low, and the only reliable mobile network is the Globacom network.

Language

This construct was added as a modification to the UTAUT model. This was done in order to check if this would also be a factor that could make a positive influence on the attitudes of the IDPs to the mHealth technology. As already stated, all the respondents in the study were only able to communicate fluently in Hausa language and only a few of the younger respondents declared their ability to understand and speak English. Thus, the general consensus was that they would be more comfortable if they could interact with their healthcare provider in Hausa. The available healthcare provider in the host community also communicates with them in Hausa, so they find it easier to explain their symptoms to him. This construct is considered a strong determining factor to the positive attitude of IDPs towards mHealth technology.

No Tariff

This is a new construct that was discovered during the process of conducting this study. The Chairman of the camp was the first to raise concerns about this and he was supported by others during the focus group discussion. This then became an addition to the interview questions as everyone raised concerns about having to recharge their phones to utilize the mHealth technology. They complained about their struggle to feed and survive on a daily basis and expressed that it would be difficult to adopt the technology if they had to be recharging their phones all the time to make use of the service.

Discussion

The issues of IDPs in Nigeria is a problem which is yet to be provided with a solution. This is not because there has been no effort to find a solution, but because their population around the country continues to grow and has become too complex to manage. In Nigeria, extant studies have investigated the issues experienced by IDPs in the IDP camps. The solutions recommended in most these studies have been geared towards Government policies, but barely any study has been geared towards technological solutions for their plights. This is the research path followed by this work, with the study based on the quest to discover IDPs mobile phone use and their attitudes and opinions towards adopting mHealth technology. Healthcare is vital to society and this happens to be one of the major needs of the IDPs. This was established in extant literature and also confirmed during the course of this study. Many technology innovations have failed in the past as a result of the refusal of the users to adopt the technology, which is why technology acceptance theories were created in the social sciences to investigate users' intentions towards a particular technology. This study adopted the UTAUT model to analyze the attitudes and opinions of IDPs in the Malkohi host community, to mHealth technology, with the model being modified to fit the empirical situation. The findings from the study based on the theoretical foundation are discussed in the following sections.

Performance Expectancy

The healthcare situation in the Malkohi host community was found to be inadequate and the IDPs were interested in an alternative solution. The kidnappings and other lifethreatening crisis that had occurred in the past to volunteers in the camp were explained to be a major reason why healthcare providers are scared to stay in the host community. Hence, they have had to make do with just one doctor that has been there since the invention of the camp, who is an indigene of the community, conversant with the environment, and is comfortable staying back to provide his services to the IDPs. However, the services provided are inadequate, the respondents of the study discussed some of their present situation which they think having access to a healthcare provider even if it is via a mobile phone will help solve these problems. Therefore, performance expectancy is a construct that would strongly influence the IDPs intentions to adopt mHealth technology.

Effort Expectancy

This a strong determinant of user's intentions to adopt a technology, if the effort needed to use a new technology is greater than what is existing users are most likely to reject the technology. Here, mHealth services can be provided through the basic phone calls and text messages. As mentioned, the IDPs have the ability to make and receive phone calls and also to send and read text messages. Some of the respondents that stated that their mobile phone use ability is limited to making and receiving phone calls, and they also mentioned that they get help from their educated children to read and send text messages. This construct has a strong positive influence on the IDPs intentions to adopt the mHealth technology.

Social Influence

The circumstances in which the IDPs find themselves have made them dependent on each other. However, it has also built the trust which they have amongst themselves. Social influence is a construct that will have a strong positive influence on their intentions to adopt the technology. They believe that if other members of the community can use the technology they will also use it, with the chairman of the community being the most influential factor.

Facilitating Condition

A technology solution cannot be effective without existing infrastructures that will enable smooth operation of the technology. An example is the availability of network and mobile phones required to enable the mHealth technology. The findings from the study showed that Globacom network is the only reliable mobile network that is available in the host community, and this is a hindrance to the smooth operation of the mHealth technology. Also, as many of the IDPs cannot afford mobile phones the number of people that use mobile phones in the community is relatively few.

Language

This construct was introduced into the study due to the geographic location of the study site. The study confirmed that IDPs in the Malkohi host community mostly communicated through the Hausa language, with only a few of the younger participants of the study able to communicate using the English language. Despite this they were still of the opinion that they would be more comfortable if the healthcare providers could communicate in Hausa language. This was also found to be one of the strongest determinants that could positively influence the IDPs intentions to adopt the health technology.

No Tariff

This construct is the second strongest determinant of IDPs positive attitude towards the mHealth technology. They believe that the Government should provide support that makes such services free to them. This includes introducing mHealth services that require charges which are likely be rejected by the IDPs. This is because the IDPs are people that have been affected a crisis which has seized their means of livelihood. Although they attempt to survive in the new environment in which they find themselves, they are still living in deplorable conditions where the poverty rate is high. Thus, any technology that requires extra expenses would most likely not be used.

Additional Model Modification

The already modified UTUAT model was further extended/modified based on findings from the research by adding a "No Tariff" construct. This is because this construct was considered to be vital to the positive behavioral intention of the IDPs to accepting mHealth. Also, the opinions from the participants about the host community chairman being a very important influencing factor on whether or not any new technology would be accepted. Thus, leadership was added to the model as a moderating factor affecting the construct social influence.

Discussion

As previously mentioned, the problem of refugees and IDPs should be seen as a development issue and not just a humanitarian issue. This is why technological solutions are being recommended for the needs of the IDPs in this case. This study aimed to make recommendations of technology solutions for IDPs by exploring their mobile phone use and their attitudes and opinions towards mHealth technology. Adopting the previously described research approach, findings shows that IDPs have a positive behavioral intention towards the mHealth technology. The findings also revealed new constructs which became a modification to the original UTAUT model and are considered to be the more vital constructs to determine the successful adoption of mHealth by IDPs.

Figure 3 . 1 :

 31 Figure 3.1: The UTAUT model (Source: Venkatesh et al., 2003)

Figure

  Figure 6.1: Finding-Based Modified UTAUT Model


N Collinson

P Nielsen
email: pnielsen@ifi.uio.no

Different Approaches to Complementing Software Platforms: A Case Study of Digital Innovation across 10 Developing Countries

Keywords: Complementors, Software Platform, Fringes, Innovation

Software platforms offer a foundation for digital innovation and have the potential to take advantage of and leverage the knowledge and skills of distributed and diverse software organizations as 'complementors'. Due to their location far away from platform owners, scarce resources, and limited capacity to hire and retain skilled human resources, organizations in developing countries typically face barriers for participating in digital innovation. This paper aims to improve our understanding of how these organizations can take part in digital innovation. The basis for our research is a case study of software organizations located in different developing countries and their role as complementors related to the DHIS2 software platform, a platform made for the public health sector in developing countries. We contribute by exploring and showing how these organizations differ along multiple dimensions, for instance, the maturity of their software development team, their relation to the platform owners, and their access to resources. Further, we identify and develop a taxonomy consisting of six different forms of digital innovation unfolding in the fringes of a software platform ecosystem and identify contextual factors influencing these different forms.

Introduction

As software platforms permit and require innovations on top of them for their prosperity, to release their economies of scope and scale, the platform owners must ensure that other organizations engage in innovations on top of their platforms. This effort is enabled by the underlying architecture of platforms which is characterised as an 'extensible codebase' [START_REF] Tiwana | Platform Evolution : Coevolution of Platform Architecture , Governance , and[END_REF]. While the objectives and governance of software platforms might be different from one platform to another, they are all defined by their architecture comprising of two parts; one with low variety and high reusability and another with high variety and low reusability [START_REF] Baldwin | The architecture of platforms: a unified view[END_REF][START_REF] Gawer | Platforms, markets and innovation: an Introduction[END_REF]. The first part forming the core of the platform while the second forming the periphery, or the fringes [START_REF] Msiska | Innovation in the fringes of software ecosystems: the role of sociotechnical generativity[END_REF]. Innovations related to software platforms thus unfold on two levels: at the core platform to improve its generic features, and on the fringes to serve specific local needs [START_REF] Msiska | Innovation in the fringes of software ecosystems: the role of sociotechnical generativity[END_REF]. Being, in the last case undertaken by individuals or organisations, other than the platform owners, commonly referred to as complementors [START_REF] Boudreau | Owners on Both Sides of the Deal:Mergers and Acquisitions and Overlapping Institutional Ownership[END_REF][START_REF] Gawer | Platforms, markets and innovation: an Introduction[END_REF][START_REF] Hilbolling | Complementors as connectors: managing open innovation around digital product platforms[END_REF][START_REF] Schreieck | Design and Governance of Platform Ecosystems -Key Concepts and Issues for Future Research[END_REF], because they develop 'complements' both to the core of the software platform [START_REF] Gawer | Platforms, markets and innovation: an Introduction[END_REF][START_REF] Hilbolling | Complementors as connectors: managing open innovation around digital product platforms[END_REF] and to the fringes.

Participating in innovations on a software platform requires a considerable amount of resources. Despite that, organizations in developing countries that are not wellpositioned, being far from the platform owners, with scarce resources and limited capacity in terms of skills, also participate in digital innovation. We attempted to understand this phenomenon and answer the research question; in what ways do individuals and organisations in developing countries complement software platforms? We respond to this question by engaging in a qualitative case-study method in which we follow ten organisations working and complementing a software platform known as District Health Information System version 2 (DHIS2).

DHIS2 is a software platform meant for managing public health data in different formats. It is currently used in more than 100 developing countries [START_REF] Adu-Gyamfi | The Dynamics of a Global Health Information Systems Research and Implementation Project[END_REF], with 15 of them using it as a national standard for health data management. Several other organisations including the US President's Emergency Plan for AIDS Relief (PEPFAR) are also using the platform. DHIS2 is developed and managed by the University of Oslo through an action research network known as Health Information Systems Program, HISP. Founded in the early 2000s [START_REF] Adu-Gyamfi | The Dynamics of a Global Health Information Systems Research and Implementation Project[END_REF][START_REF] Braa | Sustainable Action Research : The Networks of Actions Approach[END_REF], HISP built a network of universities, local HISP groups, and individuals actively taking part in the development of health information systems. It, therefore, consists of the platform owner who in this case is the University of Oslo and more than twelve organisations, the HISP groups, serving as complementors to the platform. This study investigates the ways ten of these HISP groups take part in developing innovations related to the platform, as well as the social and technical factors influencing their efforts.

2

Related literature

Research on software platforms is steadily increasing [START_REF] Asadullah | Digital Platforms : A Review and Future Directions[END_REF][START_REF] Koskinen | Digital Platforms in the Global South: Foundations and Research Agenda[END_REF], which is indicative of their role in society. Different studies have addressed several issues related to software platforms. Some have endeavoured to understand what software platforms are [START_REF] Baldwin | The architecture of platforms: a unified view[END_REF][START_REF] Gawer | Platforms, Markets and Innovation[END_REF][START_REF] Yudina | Features of digital platforms functioning in informationdigital economy Features of digital platforms functioning in information-digital economy[END_REF], others have investigated their architectures [START_REF] Baldwin | The architecture of platforms: a unified view[END_REF][START_REF] Tiwana | Platform Evolution : Coevolution of Platform Architecture , Governance , and[END_REF] and many others have had concerns on how these platforms are managed [START_REF] Ghazawneh | Balancing platform control and external contribution in third-party development: The boundary resources model[END_REF][START_REF] Schreieck | Design and Governance of Platform Ecosystems -Key Concepts and Issues for Future Research[END_REF][START_REF] Tiwana | Platform Evolution : Coevolution of Platform Architecture , Governance , and[END_REF]. Despite this increase in studies, though, studies on approaches and impact of platforms in developing countries are still minimal [START_REF] Koskinen | Digital Platforms in the Global South: Foundations and Research Agenda[END_REF]. Having this in mind, we attempted through the current study, to contribute to this.

Innovations on Software Platforms

One of the ways to identify the types of innovation is in relation to what other items are connected to the Software Platforms. Hilbolling et al [START_REF] Hilbolling | Complementors as connectors: managing open innovation around digital product platforms[END_REF] identify three types on this basis; complements dedicatedly connected to the core only, complements connecting platform and other products, and connecting between platforms or one plat-form with larger ones. In turn, Gizaw et al [START_REF] Gizaw | Open generification[END_REF] look at innovations in terms of how the global and local contexts are reconciled. As such they introduce the terms embedding, referring to how the global context fits into the local, and disembedding, referring to the local context influencing the global. In this sense, one form of embedding is what they refer to as appropriation [START_REF] Gizaw | Open generification[END_REF], where local developers address their local needs by configuring the platform through the capabilities that the platform owner intentionally built. An advanced form of embedding includes the development of applications on the platform to address needs that the platform owner did not anticipate. Eaton [START_REF] Eaton | The dynamics of digital platform innovation: unfolding the paradox of control and generativity in apple's ios. PQDT -UK & Ireland[END_REF], on the other hand, identifies two types of compliments to a software platform; applications or apps and enablers. While investigating the mobile devices software platform, the last author refers to application type of complements as small software applications that address the immediate needs of the users and, as enablers those software applications which support the development and use of other applications on the software platform. Several scholars have attempted to investigate the contributing factors of innovations on software platforms, suggesting that these come from both, the platform owners development and working modality (endogenous), and the environment in which the platform works (exogenous) [START_REF] Tiwana | Platform Evolution : Coevolution of Platform Architecture , Governance , and[END_REF]. The recurring endogenous determinant of innovation on a software platform relates to governance. Although the evolution of digital platforms is unpredictable and without control [START_REF] Aanestad | Information Infrastructures and the Challenge of the Installed Base[END_REF][START_REF] Ciborra | Introduction: From control to drift[END_REF][START_REF] Hanseth | Understanding Information Infrastructure[END_REF] scholars agree that governance of the social and technical components of a software platform can influence the trajectories of its innovation. Ghazawneh and Henfridsson [START_REF] Ghazawneh | Balancing platform control and external contribution in third-party development: The boundary resources model[END_REF] look at governance in light of controlling resources for enabling or constraining third parties in developing innovations on the platform. They, therefore, introduce two contrasting concepts, resourcing and securing. In rudimentary terms, resourcing refers to less control by the platform owners to allow for more innovations while securing refers to more control by the platform owner. Control can also change over time, for example related to what is most strategically sound for the platform owners [START_REF] Nielsen | Control Devolution as Information Infrastructure Design Strategy: A case study of a content service platform for mobile phones in Norway[END_REF]. Similar to resourcing, Koutsikouri et al [START_REF] Koutsikouri | Building Digital Infrastructures : Towards an Evolutionary Theory of Contextual Triggers[END_REF] present three triggers to innovations namely adding service value, creating design attractors, and lowering infrastructure barriers. The last two are a direct match to the concept of securing. Rocha and Pollock [START_REF] Rocha | Innovating in digital platforms: An integrative approach[END_REF], however, argue that the purpose of the platform is much more determining than its control.

Other studies investigated these factors in a combination of endogenous and exogenous. Mahundi et al [START_REF] Mahundi | The social and technical conditions enabling innovations in information infrastructures: A case study from public health in Tanzania[END_REF], for example, describe three sets of factors influencing innovations; structural support, which is about organisations, technical support that are provided through endogenous support by the platform owner, and process support related to organisations for the sustainability of the introduced innovation.

Method

In this study, we attempted to understand reality through the perceptions of actors in their field [START_REF] Creswell | Designing a qualitative study[END_REF]. We, therefore, employed a qualitative inquiry, which involved practitioners in the selected settings. Since we wanted a detailed understanding of 'how' complementors engage with the platforms and why some ways are more common than others we employed case study approaches [START_REF] Baxter | Qualitative Case Study Methodology: Study Design and Implementation for Novice Researchers[END_REF][START_REF] Creswell | Research design Qualitative quantitative and mixed methods approaches[END_REF]. We built the empirical setting around the DHIS2 software platform and the different ways in which individuals and organisations complement it.

A Data collection

In qualitative studies, a researcher has a significant impact [START_REF] Creswell | Designing a qualitative study[END_REF]. Researchers in this study have influenced the collected data following their positions. One of the authors, being a co-coordinator of the development and implementation of DHIS2 at the University of Oslo, has vast experiences in how this platform is managed in different parts of the world. Another author has been working with HISP Tanzania for the last fourteen ( 14) years in different capacities related to DHIS2, including development, capacity building, and technical support. The third author, working at University Eduardo Mondlane in Mozambique, is currently engaged in research and technical support to the DHIS2 local implementations through the HISP Mozambique. Besides their experiences, researchers also conducted ten semi-structured interviews with practitioners in the field. We selected HISP groups, to engage in the study and then selected individuals based on the time they have spent in their organisation and the roles they have taken in their teams. From Africa, the study included HISPs Tanzania, Mozambique, Malawi, Rwanda, Uganda, Nigeria, and the HISP Western and Central Africa, whereas from Asia the study benefitted from experiences of HISPs India, Bangladesh, and Vietnam. Most of the interviews were audio-recorded and transcribed verbatim into different text files, except for three, which experienced some technical constraints. We gathered information related to the organization, financing, and extension of their operations.

Data Analysis

We employed a theoretical thematic analysis [START_REF] Braun | Using thematic analysis in psychology[END_REF][START_REF] Clarke | Teaching thematic analysis: Overcoming challenges and developing strategies for effective learning[END_REF][START_REF] Maguire | Doing a Thematic Analysis: A Practical, Step-by-Step Guide for Learning and Teaching Scholars[END_REF] as a guide to the data analysis process in which we strictly observed the six phases of analysis that Braun and Clarke [START_REF] Braun | Using thematic analysis in psychology[END_REF] suggest. In phase one, we familiarised ourselves with the data by listening to the audio files and later transcribing them, verbatim. This gave us an idea of the contents in the interview as well as interesting findings. We could also clearly establish the different characteristics features of the HISP nodes which were a part of our study. We understood how they are organized, how they interact with DHIS both in the field and in their development sites and other innate features. Following, in the second phase, we picked two issues of interest for our research question; ways/forms of engagement and influencing factors. We then listed the codes related to the issues and identified others as potential issues to explore further. These codes included; configuration, hacking, customisation, scaling, extending, integration, interoperability, application to the core, local application, and many others. During phase three and four we embarked on an iterative process of suggesting themes and discussing them among ourselves, in a process which helped us to refine our understanding of the process of innovation. It was through these iterations that we were also able to establish relationships between codes and their patterns and eventually started charting relevant themes. In stage five we defined the resulting themes that we had finally agreed upon and, in phase six we documented them as present in the findings section.

Case Description: The HISP Groups

The organizations we focus on in this paper are all HISP groups that have a history of support from the University of Oslo (UiO) from their inception. [START_REF] Hanseth | Understanding Information Infrastructure[END_REF], Uganda [START_REF] Gawer | Platforms, Markets and Innovation[END_REF] and Rwanda [START_REF] Baxter | Qualitative Case Study Methodology: Study Design and Implementation for Novice Researchers[END_REF] East Africa / Consortium Mozambique [START_REF] Gawer | Platforms, markets and innovation: an Introduction[END_REF] Lusophony countries in Africa Vietnam [START_REF] Clarke | Teaching thematic analysis: Overcoming challenges and developing strategies for effective learning[END_REF] 4 countries in South East Asia Malawi [START_REF] Baxter | Qualitative Case Study Methodology: Study Design and Implementation for Novice Researchers[END_REF], Nigeria [START_REF] Braun | Using thematic analysis in psychology[END_REF], India (45) and Bangladesh [START_REF] Boudreau | Owners on Both Sides of the Deal:Mergers and Acquisitions and Overlapping Institutional Ownership[END_REF] Own country

While some of these organizations are non-profit, by nature, all share similar support mechanisms based on projects and contracts with MoH, Universities, or donors. Due to limited funding, most of them experience human capacity constraints, and with the need for continuous development of local competence, the teams rely on support from UiO employees. The HISP groups are actively involved in capacity building and training locally and abroad, involving team members, health practitioners, and students from the Universities related to the local projects. In a collaboration between them, HISP groups organise international academies, sometimes with the support and involvement of the core development team at UiO. These training activities are conducted in different languages, for instance in French, Portuguese, and English by HISP Western and Central Africa, HISP Mozambique, and HISP Tanzania, respectively, and according to the actual needs and maturity of the local users.

Besides academies, HISP groups also closely collaborate through cross-country projects. The language here plays a significant role, for instance, the Eastern Consortium that connects the HISPs Tanzania, Uganda, Rwanda, Malawi, and others are English speaking. HISP Mozambique, on the other hand, supports implementations in three Portuguese speaking countries within the region covered by the HISP Western and Central Africa. Sometimes collaborations are intercontinental where HISP groups in Asia have had several collaborations with HISP West Africa.

Each HISP group maintains its profile. For example, some only work with NGOs that support the government, like HISP India, while others do not limit their relations and work with private and other non-governmental organizations as well, like HISPs Uganda and Nigeria.

The organizations selected for this study are in different stages of maturity, with HISPs India, Bangladesh, Western and Central Africa, Tanzania, Uganda, Rwanda, and Mozambique being the more mature. HISP Vietnam, Nigeria, and Malawi are still in a phase of capacity building. The different HISP groups typically have a staff of technical DHIS2 experts, public health experts, implementers and project managers. Some of the HISP groups have a stronger technical capacity and is thus more involved in software development.

Ways local organisations complement DHIS2

We have seen before that individuals or organizations can be considered 'complementors' if they develop 'complements' to a software platform. In our case study, the activities related to this complementing have continuously transformed the DHIS2 platform in many different ways. We define complementing as engaging in activities to improve the working or usefulness of a platform by developers other than the platform owner. We identify, through analysis of our empirical data, six ways through which organisations from developing countries take part in the innovation of a software platform. We classify these ways into three, hacks and customisation, requirements translation and development. Subsequent sections describe these ways in detail.

Hacks and Customisation

Complementors in this category attempt to customise and hack the software platform to fit the contextual requirements. The first way in this category is customisation.

Through customisation complementors with a fair understanding of how the platform works incorporates the local requirements into the platform. In Tanzania, for example, the first official use of the DHIS2 involved three data collection tools related to HIV in 2009. The HISP team kept defining more tools as needs were arising and this is a common exercise in the organisation since then. The national rollout of the system with the DHIS2 platform was done in 2014 with fifteen (15) data collection tools defined in the platform.

Complementors also engage the software platform by extending the use-domain. In this, complementors use the same platform to address the system requirements in the domain other than the intended. Compared to customisation, this engagement required more support from the platform owners as it involved both, hacks by the complementors and generalisation of some features by the platform owner. In table 2 we list a few examples of were to different HISP teams have been extending the use-domain of DHIS2.

The third way of complementing is through integration. Software platforms often meet other systems in local contexts. Some of these existing systems are deeply institutionalised and therefore not easy to change. A way to work with them is by integrating them into the new platform or communicating data between them and the platform. HISP Mozambique presents a good example of this. They worked to connect a system from COVIDA, with the dashboards in DHIS2. So while stakeholders were managing data in their system, reports and visualisations were managed through DHIS2. They further developed mechanisms to connect DHIS2 with the data from an ODK server.

Requirements Translation

In this way, complementors do not develop the innovation but, instead, structure the requirements and serve as clients to the platform owner who then develops the innovation. A member from HISP West and Central Africa stated, generically, that; "At the same time, we have also been pushing for some features coming from the field and those features have been another part of DHIS2 core, although we cannot claim that it is only from our side but we also express this demand" HISP West and Central Africa, June 2019

This also happened in Bangladesh; "… so [in 2011] we build dashboard into DHIS2 with the framework and that idea was quite good, and I think that triggered the need for the dashboard and introduced it to the DHIS2, so that's actually our idea…" HISP Bangladesh, February 2020

Development

Through this, complementors develop software solutions on software platforms. First complementors can engage in local application development. This happens when users of a platform face a challenge that the existing platform cannot address and it is not in the priority of the platform owner. As exemplified in table 3, complementors then resort to developing applications on the platform as a solution to the challenge. Stressing on this necessity, a HISP Vietnam team member explains that; "It depends on the requirements, one of the things is… if everything can be solved in DHIS2, we just … use the DHIS2, writing any new code or any new app, maintenance and all the different things is a long time commitment, so that is the one thing which we want to avoid most of the time" HISP Vietnam, November 2019 Complementors can also engage in cross-setting development. This resembles local application development but differs in that the resulting application becomes useful in other settings. It requires not only programming skills but an accurate understanding of the platform core. Once in every year, the UiO organises week-long conferences attended by DHIS2 stakeholders from all over the world to promote this kind of engagement, among other things. Table 4 lists some examples of applications that later formed part of the core, Table 4. Some of the contribution of the HISP Groups to the software platform

HISP Group Application HISP West and Central Africa

Minimize data collection tools to reduce overlap data Extend the predictor functionality to create specific Indicators HISP Tanzania i. Bottleneck analysis (BNA) application. HISP Tanzania had the development roles while systems analysis was managed by HISP Uganda ii. Function maintenance: an application meant to help with all the computations which the DHIS2, by default, is not supporting iii. Interactive Dashboard: A dashboard that presents data from the DHIS2 database but allows dynamic changes in the options of presentation

Discussion

Literature shows a variety of forms and types of innovations on a software platform [START_REF] Eaton | The dynamics of digital platform innovation: unfolding the paradox of control and generativity in apple's ios. PQDT -UK & Ireland[END_REF][START_REF] Gizaw | Open generification[END_REF][START_REF] Maguire | Doing a Thematic Analysis: A Practical, Step-by-Step Guide for Learning and Teaching Scholars[END_REF]. This study focused on understanding how individuals and organisations in developing countries take part in contributing to the innovations of a software platform. Our empirical data reveals six ways through which these third party organisations contribute to the progress of software innovation. These include customisation, extending use-domain, and integration. Others are requirements translation, local application development, and cross-setting development. We, further, grouped these ways into three classes; customisation and hacks, requirements translation, and development. This study is significant for two main reasons, among others. First, it systematically identifies the different ways of engaging in the innovation process. Several other studies have listed a few ways of engaging with the software platform in a manner we found not comprehensive. Eaton [START_REF] Eaton | The dynamics of digital platform innovation: unfolding the paradox of control and generativity in apple's ios. PQDT -UK & Ireland[END_REF], for example, lists apps development to mean small apps and enablers' development to mean bigger apps that support others. This partly coincides with one category of ways in which we identified development. We found out that development can be in two forms, either developing applications for local use or developing applications that can also be used in other contexts. Gizaw et al [START_REF] Gizaw | Open generification[END_REF] to the former as embedding where developers attempt to fit the global artefact into a local context, and the former as disembedding which means local contexts abstracted for use in the global. The effort, we found, is not on the size but the context of use. Second, our analysis highlights the need to consider what exists already. One of the ways of engagement, we found, was integration. Software platforms are not installed in vacuum. They often meet existing systems in the different settings they arrive at. One of the innovations on these platforms is that of connecting them to the existing, well-rooted electronic systems, either for permanent or temporary use.

This study also found different factors influencing these innovations. Some related to the architecture of the platform, others related to the platform owners conduct, while others related to the capacity of the complementor. The strength of the community of complementors is also another factor.

The architecture of the platform itself determines how much the platform supports innovation. While the generic architecture of platforms is by default to allow innovations, some allow more than others. This is congruent with what Ghazawneh and Henfridsson [START_REF] Ghazawneh | Balancing platform control and external contribution in third-party development: The boundary resources model[END_REF] One particularity of the open software platforms, such as DHIS2, is the possibility to attract independent complementors. While it allows for extension through scaling or chartings and does not pressure the platform owner with dependencies of the complementors. The platform owner, also, has so much influence over how innovations on platform progress. The UiO as platform owners devised several mechanisms to promote innovations on DHIS2. They, for example, organise annual meetings to show-case innovations, they train complementors on the platform through technical systems as well as postgraduate educations. Many individuals in the complementor organisations are graduates from the UiO. The UiO also plays an intermediary role where international institutions channel their requirements for development to them and the UiO connects the different nodes for development. Importantly, the UiO modality of working with stable institutions was one of the driving forces. HISP West and Central Africa started as a UiO initiative to support Sierra Leon 2008, with locals from Togo who had an affiliation with the UiO. Later, in 2012, the locals with support from the UiO formed the HISP West and Central Africa. HISP Tanzania, on the other hand, started as a project within the UDSM, but later registered HISP Tanzania as an incorporated company that now works in complementarity with the UDSM.

Several factors are related to the complementor organisation. Such factors include their setup which is not antagonistic with the existing government structures. Irrespective of the size and maturity of the team, the endorsement of DHIS2 by the government has positively influenced innovations on the platform. One HISP manager declares their strength to be;

"… that we have a good relationship with the government and we are working with the government so this is a very big strength because we do not need to convince the ministry to do work with us, they are relying on us and this trust and understanding is our major strength" HISP Manager, Bangladesh, February 2020

Conclusion and recommendations

There is a considerable body of literature on the architecture of software platforms and how that architecture influences innovations. It is, further, clear that for an increase in the economies of scale and scope, third party developers have to contribute to the progress of a software platform through innovations. Not much is known, though, on the ways through which these third parties situated in Developing Countries take part in the innovation processes. In this study we attempted to respond to the research question: in what ways do individuals and organisations in developing countries complement software platforms? We engaged this question by examining how ten (10) members of the HISP network complements the DHIS2 software platform through innovations. We were motivated by the fact that these organisations work from the developing countries and, therefore, not well-positioned in terms of funding, skills, and other resources. We identified six ways through which these organisations complement to the DHIS2 software platform. Such ways include customisation to fit the contextual requirements, extending features to address, developing local applications, developing functionalities for the core platform, integration with the existing software systems, and rationalising requirements. We, further, identified the social and technical factors influencing third party actors into complementing the software platform. These factors include those related to how the platform owner motivates innovation. In our case study, the platform owner has been very active in supporting third parties in development. These have been through organising training academies and annual meetings. We also found that some of these factors are related to the software platform itself, how its interfacing features like API support innovation. Other factors included the organisation of the third party institutions, and how the community of practice around the platform promoted complementing by these complementors. Clarity on the ways of engaging in innovation by third parties, and the different factors influencing that is beneficial to platform owners and third parties in furthering the use of software platforms.

Further research could focus on if and how these factors are also relevant related to other software platforms and in other contexts, establishing quantitatively how each of these factors influences the process of innovation and through which of the six ways we have identified.

Table 1 .

 1 These, either based in local universities or as independent organizations, typically with a close relationship with the Ministry of Health (MoH) through research and development projects. Many of the lead local experts in these organizations are graduates with a Ph.D. from UiO. Table1lists the HISP Groups involved in the study, The main target of support from the HISP Groups selected for the study.

	HISP Group (team size)	Country/Region supported
	Western and Central Africa (23)	16 countries in the region and 5 countries in other African regions
	Tanzania

Table 2 .

 2 Examples of other domains the DHIS2 platform had been implemented.

	New Domains	Countries
	Education	Gambia, Malawi, Guinea Bissau and Mozambique (in discussions)
	Agriculture (with Forestry and Veterinary)	Rwanda, Mozambique, and Tanzania
	Environmental Health	Uganda
	Water points management	Tanzania and Mozambique
	Road safety	Tanzania

Table 3 .

 3 Examples of local application development.

	HISP Group	Example Local Applications
	HISP West and Central Africa	Predictor functionality in DHIS2 to support eLMIS
	HISP Tanzania	USSD Manager: An app that enables the configuration of
		USSD forms in DHIS2 by non-programmers.

  describes in terms of control over a software platform. They cite two forms affecting how much a platform can allow innovations. Resourcing and securing, where the former means giving more control, technically, to complementors and the later means less control to complementors. A member of HISP Mozambique declares that; "What enablers, to individuals [who are] developing… first is what the DHIS2 provides, when they start to open up a friendly API so that people can do local development, I think this is the one that enables individuals to start thinking on how to develop… and the second one [enabler] is the possibility of having these academies where you teach individuals how to use the API… so now we know that I can use the API to develop my local applications" HISP Mozambique, November 2019