Negotiating Multiple Rationalities in the Process of Integrating the Information Systems of Disease‐Specific Health Programmes

Abstract

The topic of this paper is the integration of different information systems, and in our case study we analyse information systems in the Mozambican health care sector. The context is a health care sector reform that involves the integration of separate, stand-alone, or so-called vertical health programmes. These programmes are usually disease-specific, i.e. targeted towards malaria, HIV/AIDS, or other major diseases. The reporting and monitoring systems for the activities within these programmes are organised differently, in terms of which data elements are collected, to whom and how frequently they are reported etc., but in general they are all paper-based, at least at the peripheral level. The multitude of different systems places an unnecessary high workload on the health care personnel who do the initial data collection. However, the practical challenges related to the integration of the diverse information systems have not yet been the focus for the decision makers. Our aim with this paper is to describe some of the differences between the systems. Our claim is that these differences are not arbitrary. On the contrary, they may be significant indicators of different realities and different interests. Integration of these systems will thus not be a purely technical or practical issue, but will entail a political negotiation of interests. We employ the notions of multiple rationalities as a theoretical tool to discuss this issue. In particular we find tensions between rationalities 'on the ground', i.e. in the health care facilities, and 'on the top', among the policy makers, the government and the donor organisations.

Configurable Politics and Asymmetric Integration: Health e-Infrastructures in India

“…The various reporting systems are heterogeneous technically (in terms of application, platform, protocols, language), in relation to funding mechanisms (from government, donor agencies, universities, the World Bank, or local municipalities), and with respect to institutional grounding (central ministries, district administration, local health clinics, vertical programs). This heterogeneity in politics and institutions must be accounted for and must not be superseded by technical aspects of integration (Chilundo and Aanestad 2005 An implication of our focus on the political aspects of integration is the importance of aligning new information systems with the existing institutions' agendas and concerns. Specifically, as we will demonstrate in the case narrative below, small and relatively non-influential actors have to carve a niche for themselves without intervening unduly with the existing practices and routines (Braa et al 2004).…”

Challenges and Strategies for Standardizing Information Systems for Integrated TB/HIV Services in Tanzania: A Case Study of Kinondoni Municipality

“…The reporting and monitoring systems of activities within vertical health programs are organized differently in terms of data elements, to whom and how data are reported, resulting in high workload for health care providers who do the initial data collection (Chilundo and Aanestad, 2005). Yet Jacucci et al (2006) argued that there is a need for local adaptation and appropriation of global standards so as to have quality data.…”

Information infrastructures and public goods: Analytical and practical implications for SDI

“…There is a general agreement that these systems overlap, but actually attempting to integrate these systems is complex and politically charged. The information systems are different in non-arbitrary ways: in relation to their history, how they are shaped by the characteristics of the problems (disease) addressed, and how they are embedded into different institutional settings at local, national, and international levels (Chilundo & Aanestad, 2005). The differences between reporting systems can be illustrated by the three major programs of malaria, tuberculosis, and HIV/AIDS.…”