Plans and “off‐plan activities”: Exploring the roles of data and situated action in health planning in Burkina Faso

Abstract

Implementation of health management information systems (HMIS) has gone hand in hand with a growing global demand for high-quality data. While this has sustained HMIS implementation, it has also promoted a data-centric assumption that better data leads to better action on health. An example is health managers envisaged using HMIS data to make action plans for health service delivery. The paper draws on an in-depth study of practices of health data use in Burkina Faso to explore this relationship further. In this context, deviation from the agreed plan is not seen as problematic. Local action plans are often overruled because of requirements of higher levels, unexpected developments in diseases, or sudden provision of fresh funding. Health managers organize work under these uncertain circumstances through situated action. The concept of "off-plan activities" is used to handle unforeseen events. Mobile phones are used extensively to make and remake plans. It is argued that the findings invite us to consider a less datacentric approach to the role of HMIS data in health service delivery, where HMIS data are seen less as a tool to discipline local practices than as one element of the dynamic practices undertaken by individuals in the organization of daily work. KEYWORDSdata use, HMIS, planning, situated action, uncertainty 1 | INTRODUCTION District health managers in Burkina Faso are in charge of the day-to-day functioning of health districts, which involves making plans for the delivery of health services. However, their work comprises a whole range of functions. They work in the field, in clinics, and hospitals, where they carry out supervision, training, and vaccination campaigns, and where they can exchange information directly with health workers. They work in meeting rooms, where they present and discuss progress reports and strategies. Furthermore, they work in offices, where they engage in meetings, finalize reports, and sign off a wealth of papers, ranging from medical prescriptions via annual action plans to displacement permits. These offices are usually welcoming spaces with comfortable chairs and air-conditioning. Their walls are seldom bare, perhaps displaying key district health statistics, clinical guidelines, photos of an official visit to the district, or certificates that the health district manager has been awarded. One item, always on display, is a large institutional calendar with a standard display of each month of the year in columns and spiced up with photos and headlines about larger donor-driven projects. One day, I was studying the landscape of these office walls in more detail than usual, as the district manager I interviewed had to take a long phone call. It struck me that these calendars were almost always empty. I started to make note of this when I visited other offices and noticed that, although there were calendars everywhere, they had hardly any notes on them, if any at all. Why would you put a calendar on your wall if you were not going to use it? Maybe, they were simply used to t...

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