Improving routine health information management at health districts : an action research study

Abstract

This research falls under the domain of information systems development in developing countries. The context of the research is Zanzibar, Tanzania. The main objective of this research was to study the existing HIS, identify problems related to it and propose and implement solutions for the purpose of improving it. The research focused on the study of the HIS at the local levels aiming at exploring the procedures, tools and problems related to routine data collection, storage, analysis and information uses; and to inform ‘prototyping’ of DHIS software for its adaptation to Zanzibar’s healthcare system and context, as an alternative solution to the existing paper-based system. A longitudinal case study approach was used where two cases from two different districts were studied and compared. The two districts are North ‘A’ in Unguja Island and Micheweni in Pemba Island. Qualitative research methods were used including ethnographic interviews, observations and document analysis. Empirical data were analysed following the principles of grounded theory. A participatory action research approach was employed regarding the process of introducing changes. The research revealed some efforts in the process of data collection, analysis and information use at the local levels of the healthcare sector in Zanzibar. However, these efforts are constrained due to the problems that exist in the existing HIS.

The problems are grouped into three main areas: (1) lack of a clear information strategy within the Ministry of Health resulting in fragmentation of the HIS, especially at the higher levels and the absence of clear guidelines; (2) scarcity in human and nonhuman resources; and (3) the problem of information system design that caters only for the needs of the top levels of the national healthcare system without addressing local levels needs.

The problems are interrelated and are associated with the socio-cultural, economic, political and organizational structures that shape the healthcare sector. Acknowledging the social interlinking of the HIS and the work environment, I conceptualize HIS as socio-technical systems. The HIS development process is viewed from the information infrastructure perspective. The process involves changing from the old existing HIS to the new integrated HMIS and the process of computerising the new HMIS. The process acknowledges the importance of the installed base where the development of the infrastructure is highly influenced by the existing systems, work process, users and organization procedures that govern the overall processes. Actor-network theory has been used to unpack the socio-technical complexity related the development process. The development process calls for the need of flexibility of the infrastructure in order to prevent possible lock-in effects when the infrastructure gains momentum towards inertia. For that purpose, a cultivation approach was used.

The research advocates for the importance of garnering political support for the process of introducing new technologies into the healthcare organizations in developing countries. Viewing the process from a socio-technical perspective helped to identify important aspects to be considered by the organization in order to align with the introduced change. This helped to identify issues in advance that may facilitate or inhibit changes in order to plan how to reduce the gap between the technology requirements and the real situation within the organization. The issues identified include identifying the existing staff capabilities in terms of quantity and quality in relation to the requirements of the new technology, identifying and securing financial support, identifying areas and structures of the organization that are going to be affected, and suggesting possible solutions in order to align the organization in the right direction to respond to the introduced new technology.