Abstract:Mozambique, actively trying to deploy ICTs like many developing countries, faces critical problems in providing health care services to its population, especially those living in rural areas. These attempts are extremely complex due to a variety of constraints ranging from inadequate infrastructure to manpower shortages, to a culture that does not yet value the "efficient use of information." In this paper, we unpack the relationship between communication practices and health information flows within the context of th .. primary health care system of Mozambique, and argue that understanding this relationship is crucial for developing context-sensitive approaches to implementing computer-based health infonnation systems. Through an empirical analysis of ongoing efforts in a health district within the Health Information System Program (HISP), we seek to understand the communication practices which surround processes of collection, analysis and transmission of health data up and down the various levels of the health administration hierarchy. The nature of these communication practices has a visible impact on the quality, timeliness and usage of health data. The paper describes the functioning of the health information system as a network comprising multiple human and non-human actors within deep-rooted sociocultural structures. Inspired by Castells, we examine how understanding the reciprocal relationships between communication practices and health information can help to develop "counter networks" to provide hitherto marginalized groups and regions in the potential access to "network society."
In this article we provide a theoretically informed empirical analysis of the introduction and use of information and communication technology (ICT) within the primary health care (PHC) sector of Mozambique. The theoretical lens for this analysis is developed from Manuel Castells ' (1996, 1997, 2001) ideas on the network society and counter domination. These ideas help us to conceptualize the communicative action required to strengthen the PHC sector as a "counter network," which has the normative aim to strengthen the health information system (HIS) as a key strategy to improve health care delivery. Taking an informational perspective, the role of communication is highlighted as playing an important constitutive basis in the strengthening of this network. These conceptual ideas are applied to the empirical analysis of an ongoing project (the Health Information Systems Programme or HISP), and to analyze some key constraints and strategies for strengthening these networks. This study makes key contributions to both the theoretical and practical domains of HIS in developing countries. C 2005 Wiley Periodicals, Inc.
There is a need to look beyond the immediate process of implementation of computerized information systems to understand the broader social context in which the information and communication technology is being implemented. Using an interpretive approach to the implementation of a computerized health information system in a rural district in Mozambique we reconstruct an important aspect of this context from our interviews and observations-how the process of collective identity formation and information systems implementation are interconnected. Using this understanding of collective identity, we emphasize the importance of communication and shared meanings in developing and extending the primary health care network and in the successful implementation of a computerized health information system. C 2005 Wiley Periodicals, Inc.
ABSTRACT:Communication within organizations is more than functional transmission of information between different actors. Communication practices are also composed of ritualistic and symbolic aspects, together building a relation between context and practice. This paper discusses communication practices within and among different levels of the health information system in Mozambique and efforts to implement ICTs to support these paperbased practices. The analysis builds on a case study, based on participatory observations and interviews revealing these different aspects of communication practice. Applying our analytical lens, we describe the ongoing communication practice as shaping and shaped by the context.
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