This article describes the initial period (1994-2001) of an ongoing action research project to develop health information systemsto support district management in South Africa. The reconstruction of the health sector in postapartheid South Africa striving for equity in health service delivery and building of a decentralized structure based on health districts. In terms of information systems (IS) development, this reform process translates into standardization of health data in ways that inscribe the goals of the new South Africa by enhancing local control and integration of information handling. We describe our approach to action research and use concepts from actor-network and structuration theories in analyzing the case material. In the detailed description and analysis of the process of IS development provided, we focus on the need to balance standardization and local exibility (localization); standardization is thus seen as bottom-up alignment of an array of heterogeneous actors. Building on a social system model of information systems, we conceptualize the IS design strategy developed and used as the cultivation of processes whereby these actors are translating and aligning their interests. We develop a modular hierarchy of global and local datasets as a framework within which the tensions between standardization and localization may be understood and addressed. Finally, we discuss the possible relevance of the results of the research in other countries.
Background: Worldwide immunization coverage shows an increase in the past years but the validity of the official reports for measuring change over time has been questioned. Facing this problem, donor supported initiatives like the Global Alliance for Vaccine and Immunizations, have been putting a lot of effort into assessing the quality of data used, since accurate immunization information is essential for the Expanded Program on Immunization managers to track and improve program performance. The present article, discusses the practices on record keeping, reporting and the support mechanism to ensure data quality in Mozambique.
The implementation and development of routine health information systems continue to provide a number of challenges for managers-the more so in developing countries where resources are scarce and human resource and technical skills limited. This article conceptualizes the interdependence between the local adaptation and appropriation of global standards, and the value that this adds to the global standard through improved quality of data. These processes reinforce one another in the creation of sustainable information systems. The article draws upon a case study of a rural hospital in South Africa. A successful change process is documented, wherein the organization, through innovative management and leadership, actively and successfully appropriated the national standard. The case study is used to highlight three main messages, namely, that standards should be able to be locally appropriated, that the creation of networks helps to support the local adaptation of standards, and that the layering of information systems is important to encourage the use of information and helps to improve data quality. C 2006 Wiley Periodicals, Inc.
This article presents results from a study on the use and appropriation of information and communication technologies (ICT) in Mozambique with a focus on the health sector. The three provinces of Gaza, Inhambane and Niassa were surveyed and two questionnaires addressing 1) computer users and their ability to manage ICT, and 2) health workers and their handling of health information, were used. Based on this study appropriate strategies for developing an ICT‐infrastructure with the needs of the health sector as points of departure are discussed. The study is born out of a program to strengthen and further develop the health information and management systems at district and provincial levels as part of a process to support decentralisation of the health system in Mozambique. The study shows that computers and Internet are rapidly being spread to the provincial capitals and major districts in Mozambique. A main problem identified is the lack of ICT‐skills and education and poorly developed infrastructure and networks of support. There are very few formal ICT companies providing hardware, and even less, software support. Maintenance and learning about ICT are to a large extent going on within informal networks of computer users in the provinces.
A main finding in this study is that development of ICT capacity and information systems at district and provincial levels in Mozambique needs to be an integrated effort across sectors. A district health information system cannot be developed in a void.
A general recommendation is to develop educational programmes ranging from training of ICT entrepreneurs and health workers and managers, to Masters and PhD programmes in ICT and health information systems. A specific recommendation related to health information systems development is to focus on the district level and to develop a strategy which encompasses and integrates all districts, both the advanced districts with computers and the majority of the districts where there are no computers.
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