Customization of Generic Open Source Software for Health Sector in Developing Countries: A Practice Based Approach

Abstract

A consequence of globalization has been the increased use of generic software in multiple contexts. Customization is one of the activities adopted to make these systems to fit the local contexts. This activity is a non-trivial challenge, involving the need to engage with various technical and institutional issues. These challenges are magnified in the public sector context of low and middle income countries (LMICs), which face extreme challenges of human resource capacities, poor infrastructure, and inflexibilities in the institutional arrangements. Our understanding of these customization related challenges and the approaches to deal with them, remains limited. A key aim of this thesis is to examine customization related challenges and approaches within the context of the public health sector of LMICs, and formulate a model that can help to guide customization and capacity-building efforts. To study software customization dynamics, a practice-based perspective was adopted and the notions of situated practice and networks of practice were take on as the analytical lenses. The research took place as an interpretive study within the Health Information Systems Programme (HISP) action research framework. Empirical material is drawn mainly from three case studies carried out in healthcare organizations in Malawi, Mozambique and Guinea- Bissau, all related to a generic open source software called the District Health Information Software, developed and maintained by the University of Oslo. Data collection took place in the period between 2009 and 2012, and involved the use of multiple sources, including participant observation, actual customization work, interviews, artefact examination, brainstorming and reflexive discussions. Key findings emphasise that while generic software systems provide several benefits, there are challenges related to weak skills and competence, software misfit, poor supporting infrastructure and others. Strengthening and sharing of experiences and ideas across different groups was an overarching principle. The first kind of practices included improvisation and bricolage, the querying for artefacts and requesting for help and were used to support work performance. Secondly, the interplay between different customization sites enabled the emergence of competence-building practices of cross-site interaction, tailored training and colocated learning. Finally, the practice of interaction across sites permitted the development of requirement that led to the customizability or strengthen of the generic software systems. This thesis contributes to practice-based theory by (a) providing an alternative paradigm to study improvisation, the human-centred improvisation; (b) discussing the situatedness of software customization; (c) illustrating the boundaries spanned during customization; (d) discussing the process of participatory design during software customization; and (e) conceptualizing customization capacity-building as situated and clustered. The practical contribution of the thesis consists of a model that highlights the main building blocks of OSS customization, with especial focus on capacity-building. The model suggest combining the customizers knowledge with exposures to (i) the complexity of the sites and domains where the software will be applied, (ii) guests that support and help with the customization work, and (iii) environments where customizers can develop a broader view of their activity through inter-professional collaborations.