Gert-Jan de Vreede was the associate editor. Brian Butler served as a reviewer. Two additional reviewers chose to remain anonymous.

MomConnect is a national initiative coordinated by the South African National Department of Health that sends text-based mobile phone messages free of charge to pregnant women who voluntarily register at any public healthcare facility in South Africa. We describe the system design and architecture of the MomConnect technical platform, planned as a nationally scalable and extensible initiative. It uses a health information exchange that can connect any standards-compliant electronic front-end application to any standards-compliant electronic back-end database. The implementation of the MomConnect technical platform, in turn, is a national reference application for electronic interoperability in line with the South African National Health Normative Standards Framework. The use of open content and messaging standards enables the architecture to include any application adhering to the selected standards. Its national implementation at scale demonstrates both the use of this technology and a key objective of global health information systems, which is to achieve implementation scale. The system’s limited clinical information, initially, allowed the architecture to focus on the base standards and profiles for interoperability in a resource-constrained environment with limited connectivity and infrastructural capacity. Maintenance of the system requires mobilisation of national resources. Future work aims to use the standard interfaces to include data from additional applications as well as to extend and interface the framework with other public health information systems in South Africa. The development of this platform has also shown the benefits of interoperability at both an organisational and technical level in South Africa.

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.

The expansion of ICT across Africa is influenced by many factors including political imperatives, donor priorities, private sector and NGO needs, and economic interests and as a result takes place in a haphazard and largely uncontrolled fashion. The health sector is no exception. The challenge, as in many developing countries, is to provide a robust and reliable health information system while effecting a transition between paper-based systems and computerized systems. The transition involves not only the introduction of new ICT, and the accompanying social and educational transformations of people and processes that accompany the introduction of ICT, but also the development of scalable health information systems that can facilitate a smooth transition as ICT expansion and development takes place. This chapter draws on 10 years of experience of the Health Information Systems Programme (HISP), an action research orientated network of public health practitioners and academics who initiated a pilot project in health information systems development in the post-apartheid transformation of South Africa, and which has subsequently had a profound effect on the development of health information systems in Africa and Asia. Through an exploration of health information systems development in numerous countries in Africa, we highlight insights into approaches and methodologies that contribute to successful and sustainable health information systems in resource constrained settings.

The expansion of ICT across Africa is influenced by many factors including political imperatives, donor priorities, private sector and NGO needs, and economic interests and as a result takes place in a haphazard and largely uncontrolled fashion. The health sector is no exception. The challenge, as in many developing countries, is to provide a robust and reliable health information system while effecting a transition between paper-based systems and computerized systems. The transition involves not only the introduction of new ICT, and the accompanying social and educational transformations of people and processes that accompany the introduction of ICT, but also the development of scalable health information systems that can facilitate a smooth transition as ICT expansion and development takes place. This chapter draws on 10 years of experience of the Health Information Systems Programme (HISP), an action research orientated network of public health practitioners and academics who initiated a pilot project in health information systems development in the post-apartheid transformation of South Africa, and which has subsequently had a profound effect on the development of health information systems in Africa and Asia. Through an exploration of health information systems development in numerous countries in Africa, we highlight insights into approaches and methodologies that contribute to successful and sustainable health information systems in resource constrained settings.

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