Health information systems implementation: Weaving alliances in East African Community

Abstract

This paper addresses the problem of fragmentation and lack of coordination in the context of health information systems. Drawing on a longitudinal action research study of implementing a regional database in East African Community; a process model is developed illustrating forms of institutional work in weaving alliance through three non‐linear phases: standardisation, evolving and stabilisation. The study first contributes by conceptualising weaving alliance as a process whereby novel Information and Communication Technologies (ICT) capabilities such as the implementation and use of dashboards emerge and co‐evolve with intentional actions by actors aligning stakeholders with diverse interests. The second contribution concerns how dashboards emerge and co‐evolve with existing work practises facilitating a common understanding among multi‐stakeholders. Collectively, the study broadens our understanding of introducing and sustaining ICT4D solutions in settings characterised by fragmented information systems.

Open government, civic tech and digital platforms in Latin America: A governance study of Montevideo's urban app ‘Por Mi Barrio’

“…Consistent with Kooiman (2003) and IS research, the notion of institution that we adopt in this work is that of intermediary agreements and rules that shape corporate and organisational arrangements (North, 1990;Powell & Di Maggio, 1991). The second order is therefore compatible with long standing work in information systems research, which suggests power battles (Bloomfield & Hayes, 2009;Danziger et al, 1982;Kraemer & King, 1986) and institutions (Fountain, 2001;Iannacci, 2010;Sahay et al, 2009;Sarker et al, 2019;Senyoni 2020) mediate digital government transformation, while they tend to explain the mismatch of expectations between set goals and actual results. Following Kooiman's conceptualization of this second order ( 2003) we operationalise this level by addressing the types of interactions between the actors, and the formal and informal rules that steer and guide these actions within organisational and temporal frames.…”

“…Our focused literature review found no studies of HIS in Latin America, which is a limitation to apply the highly contextualised insights of these studies. In addition, HIS contexts are well known for its challenges of coordination of multiple stakeholders in highly fragmented settings (Senyoni, 2020). Unlike HIS, civic technology applications including open government platforms like the one we study, are not characterised by the highly fragmented nature of health systems (Davies et al, 2019).…”

“…Within IS more broadly, the studies of health information systems (HIS) in developing countries have looked at similar challenges from an institutional lens (Sahay et al, 2009; Sarker et al, 2019). HIS have historically been characterised as having multiple stakeholders with divergent interests and multiple systems adopted in uncoordinated ways (Braa et al, 2004; Nicholson et al, 2022; Senyoni, 2020). Substantial institutional work conducted in the field of HIS has confirmed the suitability of understanding politics, institutions, and the value of incremental approaches (Sahay & Walsham, 2006; Sahay et al, 2009; Senyoni, 2020), and the need to link micro processes with larger ones (Madon et al, 2007).…”

“…HIS have historically been characterised as having multiple stakeholders with divergent interests and multiple systems adopted in uncoordinated ways (Braa et al, 2004; Nicholson et al, 2022; Senyoni, 2020). Substantial institutional work conducted in the field of HIS has confirmed the suitability of understanding politics, institutions, and the value of incremental approaches (Sahay & Walsham, 2006; Sahay et al, 2009; Senyoni, 2020), and the need to link micro processes with larger ones (Madon et al, 2007). We build on the relevant mediating role of institutions in the three‐governance framework that we present later.…”

“…While relevant, however, most empirical research on HIS has been largely conducted in African countries, India (Kimaro & Nhampossa, 2005; Madon et al, 2007; Sahay et al, 2009; Sahay & Walsham, 2006; Senyoni, 2020), and also the Eastern Mediterranean Region (Sahay et al, 2020). Our focused literature review found no studies of HIS in Latin America, which is a limitation to apply the highly contextualised insights of these studies.…”