The Struggle for District-Based Health Information Systems in South Africa

Abstract

This article describes the initial period (1994-2001) of an ongoing action research project to develop health information systemsto support district management in South Africa. The reconstruction of the health sector in postapartheid South Africa striving for equity in health service delivery and building of a decentralized structure based on health districts. In terms of information systems (IS) development, this reform process translates into standardization of health data in ways that inscribe the goals of the new South Africa by enhancing local control and integration of information handling. We describe our approach to action research and use concepts from actor-network and structuration theories in analyzing the case material. In the detailed description and analysis of the process of IS development provided, we focus on the need to balance standardization and local exibility (localization); standardization is thus seen as bottom-up alignment of an array of heterogeneous actors. Building on a social system model of information systems, we conceptualize the IS design strategy developed and used as the cultivation of processes whereby these actors are translating and aligning their interests. We develop a modular hierarchy of global and local datasets as a framework within which the tensions between standardization and localization may be understood and addressed. Finally, we discuss the possible relevance of the results of the research in other countries.

Articulando perspectivas teóricas para analisar a informática em saúde no Brasil

“…Especificamente na área da saúde, o "Health Information Systems Project" (HISP) desenvolve SIS há dez anos para países do Hemisfério Sul Hedberg, 2002;Sahay, 2004 Assim, nesta seção são destacadas as principais contribuições das pesquisas sobre SIS em países em desenvolvimento, tanto para a caracterização dos resultados dos projetos de implantação como para a análise dos fatores associados a tais resultados.…”

“…Esses atores mobilizam grupos de interesse, debatem os SIS em espaços de discussão e estabelecem redes que influenciam a alocação de recursos -financeiros, humanos e de infraestrutura -, assim como os rumos da informática em saúde. ----------Fragmentação (Moraes, 1994;Moraes e Gomez, 2007) Por fim, a constituição de padrões de interoperabilidade Hedberg, 2002;Moraes;Cavalcante, 2002) é um fator fundamental tanto para o sucesso dos SIS como para a melhoria das práticas em saúde. Os padrões permitem a sustentação e expansão dos SIS (Braa et al, 2007), aumentando a capacidade do Estado brasileiro atender às necessidades de saúde da população Moraes;Cavalcante, 2002).…”

Linking theoretical perspectives to analyze health information and communication technologies in Brazil

“…Thus, after a bibliographical survey of national and international scientific journals, two theoretical perspectives stand out by the efforts of researchers in understanding the dynamics of HIS in developing Fornazin and Joia Linking Theoretical Perspectives to Analyze Health ICT Proceedings of SIG GlobDev Sixth Annual Workshop, Milano, Italy, December 14, 2013 countries, namely (a) European studies of HIS in developing countries (Avgerou, 2010;Braa et al, 2007;Braa and Hedberg, 2002;Braa et al, 2004;Heeks et al, 1999;Nhampossa, 2005, 2007;Kossi et al, 2009;Sheikh and Braa, 2011;Walsham and Sahay, 2006), and (b) Information and Information Technology in Health, developed under the Brazilian Sanitary Movement (Cavalcante and Vasconcellos, 2007;Moraes, 1994Moraes and Gomez, 2007;Moraes and Vasconcellos, 2005;Moraes et al, 2009;Vasconcellos et al, 2002). Each research perspective has addressed, on its own, similar questions regarding HIS in the Global South since the 1980s.…”

“…Specifically, in the health context, the Health Information Systems Project (HISP) has developed HIS for countries in the Southern Hemisphere for the last ten years (Braa et al, 2007;Braa and Hedberg, 2002;Braa et al, 2004;Kossi et al, 2009;Sahay et al, 2009;Sheikh and Braa, 2011).…”

Counter Networks, Communication and Health Information Systems

“…Within this research program, HISP has developed a free open source software applicationDistrict Health Information System (DHIS) database, based on MS Access and designed for data collection, analysis and reporting. The aim of HISP is to develop health information systems to support the emerging decentralized health administrative structures in various developing countries (Braa and Hedberg, 2002). The broader agenda of HISP is to enable local control of health information at the district and sub-district levels and thus to empower local users to have greater control of their work processes.…”