Digitalisation, co-production, and management control: transforming management accounting and accountability in Thailand’s primary healthcare

This thesis investigates how mandated digitalisation transforms budgeting, accountability, and management accounting controls within Thailand’s primary healthcare sector. While datafication is promoted globally to enhance public sector efficiency, a significant gap exists between top-down policy mandates and the complex realities of implementation, particularly in the resource-constrained contexts of emerging economies. Employing an extended six-month ethnographic study based on Actor-Network Theory, this research utilises 50 in-depth interviews, 6 focus groups, and participant observation to explore how digital management accounting practices are translated, negotiated, and adapted by practitioners. The findings reveal that organisational adaptation is an emergent process influenced by the tension between top-down mandates and bottom-up adaptations. Datafication does not replace legacy systems; instead, it creates complex, hybrid budgeting practices that can intensify resource inequalities. This results in a dynamic mix of formal, data-driven demands and informal, community-based relational practices, often mediated by village health volunteers. Organisational intermediaries, such as hybrid IT specialists, play a crucial role in enabling this adaptation. It requires new professional practices, including the development of a hybrid ethos and significant hidden work to sustain the latest control systems. This thesis makes three primary contributions to academic debates. First, it offers a sociomaterial perspective that challenges techno-optimistic narratives by demonstrating how digital budgeting reforms can produce hybrid practices that deepen institutional inequalities. Second, it develops the concept of ‘multiform accountability’ to theorise how formal, data-driven systems become entangled with informal, community-based practices, a process critically mediated by local intermediaries. Finally, it introduces an integrated conceptual model combining diffusion and translation theories to explain organisational adaptation, emphasising that successful implementation depends on the often hidden, essential work of practitioners and organisational intermediaries. These contributions provide policymakers with valuable insights into effectively implementing digital systems in practice.