Digitalization Trajectories of Health Information Systems and the Role of Governance in Development Projects

Abstract

The study argues that state-led development reforms are the preconditions necessary for structural transformation and long-term, large-scale health information systems (HIS) digitalization in developing countries. However, the context and practice of development projects and the socio-political nature of partnership between NGOs and government institutions remains a barrier to such reforms. Drawing on a donor-funded national HIS project in Ethiopia, theoretical and practical insights are outlined in this thesis. Theoretically, the findings and analytical approaches offer relevant insights to ICT4D and development management researchers. Combining Margaret Archer’s morphogenetic approach and social interface analysis from the sociology of development, the study constructs an analytical narrative to explain the digitalization trajectory by identifying the conjecture of four causal mechanisms. Practically, the study highlights key strategic priorities in digitalization. These include; cultural shifts from project-based development arrangements towards locally integrated development initiatives, formalization of state-NGO accountability and collaborative environments, and a renewed engagement with institutional capacity development instead of gap-filling. To drive these aims, the study proposes guidelines on how governance reforms around IT initiatives can be implemented in the developing country HIS context.