Chipo Kanjo

PRAGMATISM OR POLICY: IMPLICATIONS ON HEALTH INFORMATION SYSTEMS SUCCESS

The most fundamental issue for any information system is to produce information that is relevant to organisational goals. A number of research studies have reported failures in information systems, especially in health information systems (HIS) in developing countries. The challenges of success lie in the heterogeneity of the players, the requirements, the practices and some of the policies in place. In some cases, national policies affect the success of the information systems. This paper describes and analyses some of the factors that affect HIS success in developing countries. The aim of this research was to identify, within the environment where the information systems are implemented and used, issues that could be stumbling blocks to their success. Although the use of HIS is seen as a satisfactory outcome of health sector reform, there are certain social aspects, both internal and external to the organisation and system that influence its success or failure.

Implications of baseline study findings from rural and deep rural clinics in Ethiopia, Kenya, Malawi and South Africa for the co-design of mHealth4Afrika

mHealth4Afrika is a collaborative research and innovation project, co-funded under Horizon 2020, that is evaluating the potential impact of co-designing an open source, multilingual mHealth platform on the quality of maternal and newborn healthcare delivery in rural and deep rural clinics. This paper presents results from a comprehensive baseline study carried out with 40 informants from the leadership of 19 healthcare clinics in Northern Ethiopia, Western Kenya, Southern Malawi and Eastern Cape, South Africa during November — December 2015, using focus groups and semi-structured interviews. These findings identified human resource capacity, environmental, practical and technical challenges, and equipment and infrastructure deficits. Training requirements of healthcare workers were also identified. Constraints identified include the need for: intuitive, easy-to-use user interfaces to reduce the need for extensive training; use of flexible data protocols to facilitate cost effective bandwidth and effective data exchange; cost effective; low power consumption technologies to reduce cost of replication and scaling; solar charging units to increase availability; support for sensors and telemedicine due to a deficit of healthcare professionals in rural and deep rural clinics; and the need for easy configuration and adaptation to facilitate wider adoption. This insight will be used to inform co-design of the mHealth4Afrika platform during 2016–2018, based on user-centered design principles, leveraging current state-of-the-art in terms of electronic patient record systems and medical sensors. It will also inform the minimum ICT infrastructure required in each clinic. The expected outcome is a multi-region proof of concept that can make a significant contribution in accelerating exploitation of mHealth across Africa.

Strengthening the Link between Traditional and Modern Practices for improving Data Quality in Health information systems: The Case of Malawi

This paper describes an empirical qualitative analysis of how knowledge and data generated through traditional health practices, specifically by traditional birth attendants, with respect to maternal and child health, define and control data quality in health information system. The aim is to gain an understanding of how knowledge and data crosses the boundary between traditional and modern sectors with varying practices, and how the existing mechanisms linking the two sectors can be strengthened. Using an interpretative approach, this research provides the health informatics and information systems community with an understanding of how bridging the divide between scientific and indigenious knowledge can improve data quality in a context where two different sectors exist; each utilising different types of knowledge. Concepts from community of practice theory were employed as the framework for analysis. We recommend that boundary crossing of knowledge and data between the two health sectors must be tailored from histrorical, cultural and modern perspectives, with an emphasis on: i) utilizing the historical‐cultural means of capturing data through chiefs and ii) the modern mechanisms of utilising health surveillance assistants as the link.

Design of tooltips for health data

Tooltips are regarded as beneficial methods for users to understand either a user interface element or tasks related to the system. However, little research has compared text, tables and illustrations or addressed the content of tooltips, thus this research aims to address this aspect. Through a question-suggestion approach, accompanied by interviews and questionnaires, we have looked at what actual users would prefer as expression format and content type for tooltips. We found that text is the preferred type of expression, while normal values are the preferred content type.

ICT solutions for financial inclusion: Reaching out to the unbanked in low resource settings

Most of the population in developing countries remains unbanked and financially excluded. On the other hand, mobile phones have proved to have the potential for mobile payments in developing countries. Mobile payment is financially inclusive, offering great potential for financial integration. Africa, by and large, is considered to be having a higher percentage of the unbanked. This paper concerns how the mobile payment potential can be leveraged in the context where most of the population is financially excluded. The paper reflects results of a study carried out in Malawi focusing on provision of ICT-based financial solutions to the unbanked in developing countries, particularly in the low resource settings of Africa using a technology called e-ticketing system. Mobile payments encompass a range of different payment types, some of which may not appeal in some contexts. In this study USSD communication mode was adopted, choice of which depended on its affordability, ease of use and responsiveness.

Bringing Visibility to Community Health Work with mHealth Systems: A Case of Malawi

The paper explores how technology created visibility of work and its implications. Places create social meanings and significance in which work is situated. Community health work is mostly confined in places of physical settings for many mobile and distributed workers. As their work contexts stretch in place and far from other actors, the visibility of their work becomes blurry. An in-depth interpretive case study of a mobile health system designed to support decision-making for Community Health Workers in maternal and infant care in Malawi was used to unravel how mHealth systems make their work visible. We uncover work aspects like; work interactions, collaboration, coordination, surveillance among others that flow through place and space in our empirical findings. Each relates to work visibility/invisibility creating both theoretical and practical implications.

Methods for Evaluation of Tooltips

Tooltips are context-sensitive help aimed at improving learnability of a system. Evaluation of tooltips would therefore be a part of evaluation of documentation, which is a subcategory of evaluation of software learnability. Previous research only includes two evaluations of tooltips, both gauging learning outcome after initial training, while the purpose of tooltips is helping users whenever in doubt when using systems after training. The previous evaluations are therefore of a low content validity. This paper concerns data field tooltips aimed at improving correctness of data entry. It present studies a scale of content validities. On the low level is a questionnaire on users’ opinion, which is a cheap evaluation. The medium type of evaluation was an adapted question-suggestion test measuring learning outcome. The high content validity evaluation method was a field experiment over two weeks, which demonstrated improved performance caused by tooltips. If the cheap questionnaire came out with the same preferences as the costly experiment, doing the questionnaire could have replaced experiments. However, the experiment did not confirm the results from the questionnaire.

Design of Tooltips for Data Fields

Many health professionals in developing countries carry out tasks which require a higher level of education than they have. To help such undereducated health workers filling correct data in patient information systems, data fields were furnished with tooltips for guiding users. In a previous study with questionnaires and interviews, health workers preferred tooltip contents being normal values of the data with medical explanation as the second best. The experiment reported in this paper set out to test these content alternatives and also aimed at finding health workers’ use of tooltips and possible effects on data correctness. In order to resemble the work setting, each of the 15 undereducated health workers participating was given a tablet PC with the patient information system and booklet of 22 cases to be entered over a period of two weeks. They were given a one hour introduction to the system. Their use of the tablet was recorded, and after completing, the participants were interviewed. The health workers opened tooltips frequently for the first cases, and thereafter the use dropped. Reasons given were that they learnt the data field during the first cases, and thereafter they did not need the tooltips so often. The number of correct data entries increased over time. The group with medical explanation tooltips performed better than the group with normal value tooltips, thus the preferred tooltip in the questionnaire gave a lower performance than the second alternative. While the experiment demonstrated that tooltips improved performance, it did not quantify the effect.

Power to the people — Unintended effects of ICTs in democracies

The author argues that much as ICTs are enablers for democracy, their practices are not always as intended. This paper explores factors that lead to unintended effects and the impact of such unintended effects on democracies. The unintended effects may turn out to be either positive or negative. Online case studies (such as mailing lists, social networks and online newspapers) and document analysis of previous research studies are used to examine the unintended effects. Case studies are drawn from Malawi.