Honest C. Kimaro

Analyzing the problem of unsustainable health information systems in less-developed economies: case studies from Tanzania and Mozambique

Most of donor-supported information technology (IT)–based projects developed or implemented in less-developed economies (LDEs) end up as complete or partial failures or unsustainable. Notably, a number of intra-organizational and external factors are associated with this problem, including inadequate infrastructure and human resource capacity, fragmented donor policy, and lack of policies to manage the sustainability problem. Accordingly, IT initiatives are often donor-driven, top-down, and hijacked by top managers who (normally) do not have adequate skills, but have enormous power to enforce such initiatives across organizational hierarchies. In analyzing the concepts from sustainability and institutionalization, key insights towards a better understanding of the problem of unsustainability are developed. It is argued that health information systems (HISs) become sustainable if they are institutionalized in the sense of being integrated into the everyday routine of the user organization. However, a sustainable HIS should also be flexible enough to allow changes as the user needs change. Moreover, introduction of a new HIS is not only a technical change, but requires the cultivation and institutionalization of a new kind of culture. Through a comparative case analysis of the HIS development and implementation processes in Tanzania and Mozambique, we have identified two sets of relationships, between the Ministry of Health (MoH) and donor agencies and between the MoH and software development agencies as critical and contributing factors to the unsustainability of a HIS. Given this setting, we highlight three key strategies for dealing with the problem of unsustainability in LDEs: (a) integration of a HIS, (b) local shaping of new cultures, and (c) cultivation approach to systems development.

Strategies for Developing Human Resource Capacity to Support Sustainability of ICT Based Health Information Systems: A Case Study from Tanzania

Information and Communication Technologies (ICTs) are typically introduced in organizations with the promise to help manage resources, increase efficiency, increase work productivity and reduce workload. In the context of developing countries, the lure of these promises is magnified given the existing conditions and inefficiencies. International aid agencies play an important role in shaping this promise. However, introduction and use of ICTs in developing countries has proven problematic due to failures or unsustainability resulting from many factors. One important factor is the lack of appropriate human resources both with respect to quantity and quality. This paper emphasizes that human resource capacity building in developing countries is an urgent issue of concern for the sustainability of ICTs. Drawing on concepts of sustainability, ICT literacy, and human capacity building, this paper analyzes challenges related to human resources in health information systems (HISs) and ICTs in the health sector of Tanzania and suggests some strategies to address the problem. Specifically, the paper focuses on initiation of ICT based HIS in the context of the health sector and argues for human resources with a mix of skills to understand the meaning of data, information, and the use of computers.

Analysis of the Acceptance Process of District Health Information Systems (DHIS) for Vertical Health Programmes: A Case Study of TB, HIV/AIDS and Malaria Programmes

District Health Information System (DHIS) is used in many parts of the world to report aggregated data at the district level. Tanzania is one of the countries where the ministry of health endorsed DHIS for such use. Although the system has been rolled out recently throughout the country, Vertical Health Programmes (VHPs) are on their way to fully adopting the system. The objective of this study was to analyse the acceptance process of DHIS by three VHPs so as to examine the facilitating conditions and the challenges that they face. Data was collected through interviews, document review and observation. Analysis of the data showed the facilitating conditions to be having a consensus on which VHP indicators to include in the DHIS, existence of infrastructure including the routine Health Information System (HIS), and support from development partners. Challenges of acceptance process of DHIS include inadequate human resource for HIS, data quality and information flow issues, and existence of separate monitoring and evaluation systems for the VHPs. The study recommends integration or interoperation of DHIS with VHP systems, creating a pool of resources for HIS, training and motivating human resource for HIS.

A framework for the acceptance process of District Health Information System for vertical health programmes

In many parts of the world, several attempts have been made to make vertical health programmes (VHPs) use District Health Information System (DHIS); however, there is no specific framework to guide the process up to date. The objective of the study was to design a framework for the acceptance process of DHIS for VHPs. The study was qualitative in nature. The framework presented puts forward three phases in which DHIS acceptance goes through i.e. attitude, adoption and acceptance. It discusses the main focus in each phase: individual and organisation for the attitude phase, organisation in the adoption phase, and the individual for the acceptance phase. It goes ahead to describe the important considerations in each phase and facilitating conditions for the whole process which are clear management goals, collaboration among stakeholders, availability of resources and funds, clear guidelines and monitoring and evaluation of each phase of the process.

Challenges and Strategies for Standardizing Information Systems for Integrated TB/HIV Services in Tanzania: A Case Study of Kinondoni Municipality

The synergetic prevalence of Tuberculosis (TB) and HIV infections led to the launch of integrated TB/HIV services, officially coined “collaborative TB/HIV activities”. The Ministry of Health, Community Development, Gender, Elderly and Children in Tanzania works with multiple implementing partners in achieving collaborative TB/HIV goals. This study assessed challenges, best practices and strategies for standardizing Health Information Systems (HIS) for integrated TB/HIV services. A descriptive cross sectional study design employing both qualitative methods was used. Data were collected through key informant interviews, observation of existing practices, and document review. Absence of health information system standards control mechanisms was noted to be the cardinal challenge. The study recommends a need to establish formal mechanisms to control information system standards across partners, reviewing existing national TB/HIV policy guidelines to include adequate aspects of monitoring and evaluation, establishing a functional partner regulatory authority and implementing data quality assurance mechanisms.