Strategies for Development and Integration of Health Information Systems: Coping With Historicity and Heterogeneity
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Date
2005
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Abstract
Health is crucial for development, and well-working health information systems are
required for sound decision making and effective use of resources. However, establishing
working information systems in developing countries is truly a challenge. Moreover,
strategies for the development and integration of large and growing collections of
information systems escape simplistic recipes. This is a pressing practical problem
globally, as well as analytically under-researched within the IS field. We aim to
contribute to the understanding and development of such strategies by underscoring two
core dilemmas: (i) the conservative influence of historically accumulated and
institutionalized practices, technologies and perceptions (dubbed the ‘historicity’ of
information systems) and (ii) the lacking integration and increasing fragmentation across
the collection of information systems (dubbed the ‘heterogeneity’ of information
systems). The empirical underpinning for our analysis is an action research project, the
Health Information Systems Program (HISP), which aims at improving existing suboptimal
health information systems in developing countries. HISP provides a particularly
poignant illustration of the challenges related to historicity and heterogeneity of
information systems as these are implied in the politico-historical context. Our empirical
material is a cross-national comparative analysis of the current reporting systems for
administrative health data in Mozambique, Tanzania and in the state of Andhra Pradesh
in India. Several problems are associated with the existing systems and the need to
change or replace them is recognized. For example, due to the donor- and aid-dependent
economies of most developing countries, there are often other specialized health care
programs e.g. targeted towards specific diseases like malaria, tuberculosis and HIV/AIDS.
These programs usually have their own reporting systems, and the result emerging over
time is a disintegrated and heterogeneous collection of systems. The challenges
associated with attempting to change such large-scale, heterogeneous and fragmented
systems involve complex dilemmas. As the current information systems are embedded
and institutionalized nationwide, a realistic strategy need to take a phased approach
whereby present systems are gradually integrated into the environment. In the case of
donor-supported and -managed program, the national health authorities may not even
have the required power to intervene. Thus the existing reality cannot be ignored or done
away with, whether it be the information systems, the institutions or the work practices;
they constitute the point of departure. Analytically, we draw on recent socio-technical
conceptualizations of large, integrated systems - so-called information infrastructures -
especially through recent elaborations in the theoretical foundation in actor-network
theory (ANT). The development strategy we suggest emphasizes an evolutionary,
‘cultivating’ approach while at the same time accepting that there will be a certain level
of non-integration (often perceived of as ‘mess’) as chronic.
Description
Keywords
Health Information System, Action Research, Actor-network theory
Citation
Aanestad, M., Monteiro, E., Kimaro, H., Macombe, E., Macueve, G., Mukama, F., Muquingue, H., Nhampossa, J. L. and Lungo, J. (2005). Strategies for Development and Integration of Health Information Systems: Coping with Historicity and Heterogeneity. Working Papers in Information Systems; 5:1-51.Available at: http://www.ifi.uio.no/forskning/grupper/is/wp/052005.pdf