Counter Networks, Communication and Health Information Systems

Abstract

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."

Research on information systems in developing countries: Current landscape and future prospects

“…For example, Mosse and Sahay (2003) described attempts to improve health provision to poor districts in Mozambique, itself one of the poorest countries in the world, through computer-based health information systems. They argued the need to create counter-networks, using a term drawn from Castells (1996Castells ( , 2000, to the existing dominant networks of human and nonhuman actors operating within deep-rooted sociocultural structures.…”

“…A reason for this is that, unlike some other sociological theories, ANT offers an explicit way of conceptualizing technology as one of the "actors" in the actor-networks. A number of the papers in the previous section drew on ANT explicitly or implicitly (Mosse & Sahay, 2003;Sayed & Westrup, 2003). Braa and Hedberg (2002) discussed above also referenced the theory as a way of conceptualizing actor-networks involving heterogeneous elements such as people, organizations, software, and standards.…”

“…When addressing broad and complex phenomena such as globalization, typical theorists such as Castells (Mosse & Sahay, 2003) and Giddens (Liu & Westrup, 2003) have been drawn on, with occasional mentions of other authors such as Albrow (Madon & Sahay, 2001). Development is another broad and diffuse topic with a range of theorists being used including Escobar (Silva & Figueroa, 2002) and Sen (Madon, 2003).…”

“…It is not uncommon in the poorer countries of the world to find expensive computing equipment lying idle due to an inadequate power supply, or the unavailability of spare parts or technicians due to impassable roads. Mosse and Sahay (2003) described how the large physical distances and lack of adequate transportation impede the flow of health information in Mozambique. Solutions to technological problems thus need to be seen in conjunction with other physical constraints, and of course with human resources, so as to develop approaches that gain benefit from the potential that ICTs offer, but are also sensitive to broader constraints.…”

Redesigning health information systems in developing countries: the need for local flexibility and distributed control

“…For this task, an effective HIS with updated information on disease burden and the performance of health services is crucial (World Health Report, 2004;WHO, 2004). An effective HIS may also help making the local health problems more visible which can provide the basis for greater advocacy and raise political will to attract more focused resources to the local level (Mosse and Sahay, 2003). Beyond the local context, the HIS should also contribute to the information needs of the higher levels in the health administration.…”