BackgroundThe establishment of a functional information system for human resource for health (HRH) was one of the major challenges for the Tanzanian health sector. In 2008, the Ministry of Health and Social Welfare developed the HRH Strategic Plan, in which establishment of computerized information systems were one of the strategic objectives. In response to this objective, the Ministry developed two information systems, namely the Human Resource for Health Information System (HRHIS) and the Training Institution Information System (TIIS), to capture information from both the public and private sectors.Case descriptionThe national rollout of HRHIS and TIIS was carried out in four phases during a 6 year period between 2009 and 2014. Together with other activities, the rollout process included conducting system operation training and data utilization training for evidence-based planning, development and management of HRH and social welfare workers and health training institutions.DiscussionHRHIS was rolled out in all 25 regions of the Tanzanian mainland, including 171 districts, and TIIS was rolled out in all 154 health training institutions and universities. Information is captured from both the private and public health sectors with high-data coverage. The authors identified several key factors for the achievements such as using local experts for developing the systems, involvement of system users, positive attitudes among users, focusing on routine work of the system users and provision of operations and data utilization trainings. However, several challenges were also identified such as getting a consensus on sustainable HR information systems among stakeholders, difficulty in obtaining baseline HRH information, inadequate computer skills and unsatisfactory infrastructure for information and communication technology. We learned that detailed situation analysis and understanding of the reality on the ground helped to reduce the “design–reality gap” and contributed to establishing user-friendly systems and to improve sustainability of the systems.ConclusionsThis paper illustrates the successful development and national rollout of two information systems for HRH in Tanzania. The approaches used and activities conducted here and lessons learned could be useful for countries which are planning to establish HR information systems.

As part of health sector reform, most developing countries are in the process of restructuring the Health Information Systems (HIS) by way of standardizing and integrating various vertical reporting systems. Nevertheless, the pressure resulting from the vertical systems supported by donors renders the integration goal challenging and unachievable. While many studies have argued for the heterogeneity of interests and multiple data needs of the donors as the major cause of the problem, this paper argue for more detailed and critical analysis of the problem. To contribute to this, the paper emphasize the need to understand the main actors involved in the process in terms of the resources and rules available to them; and their implication in the HIS integration venture. By drawing on an empirical case study and Structuration Theory concepts, the paper identified the dialectic power relations between the actors resulting from the asymmetric ownership and control of resources and rules. To alleviate the power tensions, the paper proposed i) the need to build shared meaning of the integration process through communication approaches ii) and the need to distribute the control of the integrated HIS using modularization approach facilitating 'the tapping on' of the resources available to each group of actors.