The Information Paradox

Journal of Health Management

In an era where every public health action is expected to be backed by credible evidence, health policy-making has also been increasingly seen to follow the same. The general consensus across the globe is to strengthen health information systems and the decisions of the policy makers are increasingly relying on the information provided to them through such systems. COVID-19 has clearly brought out the need for accurate, timely and relevant information in planning for and responding to public health emergencies that can be equally devastating, if not more. It is crucial for information providers to understand the importance of communicating and disseminating it in a timely manner so that it leads to public health action for the larger good of the population.

2000

Health is crucial for development, and well-working health information systems are required for sound decision making and effective use of resources. However, establishing working information systems in developing countries is truly a challenge. Moreover, strategies for the development and integration of large and growing collections of information systems escape simplistic recipes. This is a pressing practical problem globally, as well as analytically under-researched within the IS field. We aim to contribute to the understanding and development of such strategies by underscoring two core dilemmas: (i) the conservative influence of historically accumulated and institutionalized practices, technologies and perceptions (dubbed the 'historicity' of information systems) and (ii) the lacking integration and increasing fragmentation across the collection of information systems (dubbed the 'heterogeneity' of information systems). The empirical underpinning for our analysis is an action research project, the Health Information Systems Program (HISP), which aims at improving existing suboptimal health information systems in developing countries. HISP provides a particularly poignant illustration of the challenges related to historicity and heterogeneity of information systems as these are implied in the politico-historical context. Our empirical material is a cross-national comparative analysis of the current reporting systems for administrative health data in Mozambique, Tanzania and in the state of Andhra Pradesh in India. Several problems are associated with the existing systems and the need to change or replace them is recognized. For example, due to the donor-and aid-dependent economies of most developing countries, there are often other specialized health care programs e.g. targeted towards specific diseases like malaria, tuberculosis and HIV/AIDS. These programs usually have their own reporting systems, and the result emerging over time is a disintegrated and heterogeneous collection of systems. The challenges associated with attempting to change such large-scale, heterogeneous and fragmented systems involve complex dilemmas. As the current information systems are embedded and institutionalized nationwide, a realistic strategy need to take a phased approach whereby present systems are gradually integrated into the environment. In the case of donor-supported and-managed program, the national health authorities may not even have the required power to intervene. Thus the existing reality cannot be ignored or done away with, whether it be the information systems, the institutions or the work practices; they constitute the point of departure. Analytically, we draw on recent socio-technical conceptualizations of large, integrated systems-so-called information infrastructuresespecially through recent elaborations in the theoretical foundation in actor-network theory (ANT). The development strategy we suggest emphasizes an evolutionary, 'cultivating' approach while at the same time accepting that there will be a certain level of non-integration (often perceived of as 'mess') as chronic.

The Electronic Journal of Information Systems in Developing Countries

The topic of this paper is the integration of different information systems, and in our case study we analyse information systems in the Mozambican health care sector. The context is a health care sector reform that involves the integration of separate, stand-alone, or so-called vertical health programmes. These programmes are usually disease-specific, i.e. targeted towards malaria, HIV/AIDS, or other major diseases. The reporting and monitoring systems for the activities within these programmes are organised differently, in terms of which data elements are collected, to whom and how frequently they are reported etc., but in general they are all paper-based, at least at the peripheral level. The multitude of different systems places an unnecessary high workload on the health care personnel who do the initial data collection. However, the practical challenges related to the integration of the diverse information systems have not yet been the focus for the decision makers. Our aim with this paper is to describe some of the differences between the systems. Our claim is that these differences are not arbitrary. On the contrary, they may be significant indicators of different realities and different interests. Integration of these systems will thus not be a purely technical or practical issue, but will entail a political negotiation of interests. We employ the notions of multiple rationalities as a theoretical tool to discuss this issue. In particular we find tensions between rationalities 'on the ground', i.e. in the health care facilities, and 'on the top', among the policy makers, the government and the donor organisations.

Availability and accessibility of the right information, in the right format, at the right time has appeared as the ‘messiah’ to address all healthcare service delivery needs of our times. The intention of this paper is to highlight the ever-growing attention towards knowledge management and information systems as the panacea to effective and efficient healthcare service delivery, and to highlight the fact that technical strategies may only be effectively designed if there is equal recognition of the social, cultural and political dimensions of the situation under consideration. This paper is centred around a cardiac informatics research and development project, and its parallel academic research, informed by a set of five research questions. In this paper, I will discuss the background withinwhichthispaperispositioned,introduce the academic and operational approaches to this project, talk about some of the preliminary findings and introduce some of the initial insights from the study. I will also discuss the importance of information and knowledge management at the present time, and how valid information has almost come to play the role of a ‘messiah’.Finally,Iaimto introduce the project on which this paper is based.

Bulletin of the World Health Organization, 2005

Public health decision-making is critically dependent on the timely availability of sound data. The role of health information systems is to generate, analyse and disseminate such data. In practice, health information systems rarely function systematically. The products of historical, social and economic forces, they are complex, fragmented and unresponsive to needs. International donors in health are largely responsible for the problem, having prioritized urgent needs for data over longer-term country capacity-building. The result is painfully apparent in the inability of most countries to generate the data needed to monitor progress towards the Millennium Development Goals. Solutions to the problem must be comprehensive; money alone is likely to be insufficient unless accompanied by sustained support to country systems development coupled with greater donor accountability and allocation of responsibilities. The Health Metrics Network, a global collaboration in the making, is inten...

ABSTRACT This paper reported on the Influence of National Health Management Information System on National Policy Health in Nigeria. The article, aimed at combining insights of how National Health Management Information System implementation, bridges different aspects of National Health Policy in Nigeria; through objective identification of the basic philosophy of NHMIS, its place in the National Health Policy, the concept of NHMIS and assessment of the effect of NHMIS on National Health Policy. The presentation started with introduction, followed by discussion on National Health Policy, definition of NHMIS, objectives of NHMIS, sources of health information and responsibilities of various levels. The roles of NHMIS in monitoring and evaluation, approaches and procedures, for planning and developing National Health Policy, were extensively discussed. Also, the relationship between NHMIS and National Health Policy formulation and implementation were established, including their challenges, and this was followed by summary, conclusion and recommendation. The method used for this study are, literature review, theoretical discussion, and qualitative analysis. Inferences drawn from existing literatures and postulated theories indicated that, correlation exists between National Health Management Information System and National Health Policy, as evident in previous research work and case studies. This study recommended the need for government at all levels to procure and install appropriate information technology to sustain NHMIS implementation. Also capacity building, adequate funding, timely collection, processing, and availability of health information are very imperative to, an evidence-based and result-oriented National Health Policy in Nigeria.

Health informatics journal, 2014

2019

BACKGROUND There is limited understanding about the development and implementation of the one-stop shops for evidence in a limited-resource setting such as Uganda. Previous efforts to develop one-stop shops have focused on global research evidence and local policy-relevant documents to address questions about health interventions and health systems in high-income countries. OBJECTIVE This study aimed to identify key steps in the development of on-line evidence-based information resources for health policy and system for a limited-resource setting. METHODS We utilised a case study design to address our objective where the case (i.e. unit of analysis) was defined as “the development process of the Uganda Clearinghouse for Health Policy and System”. We collected data from multiples sources including key informant interviews, participant observations and archival records to develop a comprehensive account for the case under investigation. RESULTS We found out that the development of the...

2001

At present Ireland lacks really effective and usable health information systems. The priorities listed in the draft 'Information for Action'report cannot be realised within the constraints of the existing systems. Our health information systems are not people centred; they do not facilitate assessment of quality; they make measurement of equity very hard; they do not support an adequate level of democratic or political accountability.

The Journal of Applied Behavioral Science, 2006

Health sector reform, including structural and process changes such as the incorporation of feasible information and communication technologies, is a priority in many least developed countries. However, such changes have not been particularly effective, the reasons for which will be explored in this article. Particular attention will be paid to attempts to integrate information systems in HIV/AIDS program in Mozambique. The article draws on new institutional theory to argue that the focus of this program on formal rules (i.e., Sector Wide Approach policy and national plans), which deemphasize the informal constraints at the point of service delivery (i.e., priority given to health care over reporting), has resulted in limited change. Furthermore, the limited overlap between the formal and informal domains raises the need for enhancing incentives and enforcement as key mechanisms through which more effective change can be enabled in the future.