Speculating with Care: Worker-centered Perspectives on Scale in a Chat-based Health Information Service

Technological scale and human care work are often seen as incompatible. Yet, seeking to address barriers to in-person care, governments and non-governmental organizations globally have been pushing for scaling remote care technologies such as chat- or phone-based helpdesks or telehealth systems that rely on care workers to engage with users. Despite theoretical tensions between care and scale and the essential role of care workers, workers' perspective on scale and its impact on care provision is rarely centered early on in decisions to scale. In this paper, we examine care and scale from the perspective of medical support executives (MSEs) who support a chat-based health information service for maternal and child health deployed across multiple states in India. We draw on interviews with MSEs, NGO staff who implement the service, and families who use the service, as well as speculative design sessions conducted with MSEs. We find that by centering MSEs' perspectives, we can differentiate between growth of the relationships and heterogeneity that enable social impact, versus scale-thinking that promotes the decontextualization of care. We leverage our findings to discuss implications for the design of remote care technologies, including the importance of place and human connection.