Analyzing the problem of unsustainable health information systems in less-developed economies: Case studies from Tanzania and Mozambique

Abstract

Most of donor-supported information technology (IT)-based projects developed or implemented in less-developed economies (LDEs) end up as complete or partial failures or unsustainable. Notably, a number of intra-organizational and external factors are associated with this problem, including inadequate infrastructure and human resource capacity, fragmented donor policy, and lack of policies to manage the sustainability problem. Accordingly, IT initiatives are often donor-driven, top-down, and hijacked by top managers who (normally) do not have adequate skills, but have enormous power to enforce such initiatives across organizational hierarchies.In analyzing the concepts from sustainability and institutionalization, key insights towards a better understanding of the problem of unsustainability are developed. It is argued that health information systems (HISs) become sustainable if they are institutionalized in the sense of being integrated into the everyday routine of the user organization. However, a sustainable HIS should also be flexible enough to allow changes as the user needs change. Moreover, introduction of a new HIS is not only a technical change, but requires the cultivation and institutionalization of a new kind of culture.Through a comparative case analysis of the HIS development and implementation processes in Tanzania and Mozambique, we have identified two sets of relationships, between the Ministry of Health (MoH) and donor agencies and between the MoH and software development agencies as critical and contributing factors to the unsustainability of a HIS. Given this setting, we highlight three key strategies for dealing with the problem of unsustainability in LDEs: (a) integration of a HIS, (b) local shaping of new cultures, and (c) cultivation approach to systems development. C 2005 Wiley Periodicals, Inc.

Improving quality and use of data through data-use workshops: Zanzibar, United Republic of Tanzania

“…2 Although there has been increasing international attention to the need to develop strong health information systems, it has proved difficult to do so for several reasons, including fragmentation and lack of coordination of health programmes and insistence by international agencies on maintaining their own vertical systems 3 ; lack of shared data standards 4 ; unrealistic ambitions 5 ; inability of system developers to handle complex organizational, social and cultural issues 6 ; and problems of sustainability. 7 The Health Metrics Network, established in 2005, has been instrumental in addressing the problem of fragmentation in health information systems through its technical framework, 8 which promotes a data warehouse approach to information system integration, 3,9 and in creating global consensus on the need for all actors to join forces and work towards integrated systems. Zanzibar, in the United Republic of Tanzania, provides an early example of this shift towards integration and the use of an integrated data warehouse/repository application to achieve it.…”

Remontando a Rede De Atores Na Implantação De Um Sistema De Informação Em Saúde

“…Com vistas à mobilização para suporte aos SIS, são, portanto, necessárias estratégias de projeto flexíveis e ações participativas (Braa et al, 2004). Pesquisas também identificaram que a mobilização ocorre em conjunto com a aprendizagem organizacional (Kimaro & Nhampossa, 2005), bem como com o desenvolvimento de capacidades para uso dos SIS (Sheikh & Braa, 2011 No Brasil, embora estudos tenham evidenciado os aspectos sociais e políticos associados à implantação de SIS (Albuquerque, Prado, & Machado, 2011;Joia & Magalhães, 2009;Sun, 2010), as práticas no País têm sido desconsideradas, assim como a realidade heterogênea na qual esses empreendimentos se inserem. As implantações de SIS são tratadas como projetos técnicos, conduzidos de modo linear e seguindo metodologia preestabelecida, visando o atingimento de objetivos predefinidos.…”

Transcending the Digital Divide: A Framing Analysis of Information and Communication Technologies News in Native American Tribal Newspapers

“…Some of the areas in which ICTs have been shown to bring about development are in education [33], [32], [36]; healthcare [3], [21], [16]; software development [5]; direct reduction in poverty [4], [15]; better government [46], [28], [22]; civic engagement [23], off-Shore outsourcing [25], [12], [34] and small business development [8], [27]. While a plethora of research has taken place in the effects of ICTs in the developing regions of the world, little work has been undertaken in Native American communities on how ICTs can bring about development, even though just about any measure indicates that American Indians are among the poorest, sickest, and least educated populations in the United States.…”