Global Standards and Local Health Information System Applications: Understanding their interplay in the context of Tajikistan
Appears in the following Collection
- Institutt for informatikk 
AbstractThis thesis presents the study of the dynamics of global/local interplay of standards related to the development and implementation of Health Information Systems (HIS) with a primary focus on Tajikistan. These standards come in form of software artifacts, classifications and guidelines, practices, procedures and many others. Implementing such global standards is challenged by the existing particularities in the context of implementation, but where also exist various similarities with global systems. The differences as well as similarities play out during implementation processes, spanning different institutional and technical dimensions embedded both in the global standards and also the national HIS. This raises the paradox of standards being both a uniform solution, whilst also containing elements of locality. Managing this paradox remains a clear challenge in HIS implementation initiatives.
This thesis thus tries to extend our understanding of the dynamics of standardization in the course of HIS implementation in a developing country context. Particularly it tries to address issues related to localization of global standards as part of a process of information infrastructure building which involves negotiation, cultivation, work-arounds and contextualization. The thesis takes a socio-technical perspective to understanding the interplay and draws upon theoretical concepts from the domains of information infrastructure, standards and standardization, and institutional theory. Together, the concepts provide an with an analytical lens to study the tripartite relation between the actors (human and non - human) involved, the standard, and the topic the standard seeks to address.
Empirically, this research has been carried out over the last 4 years, and a primary focus has been on the health sector in Tajikistan. I have been engaged in this reform process since 2007 as an action researcher in various tasks such as software development, capacity development, mediating between the international development partners and the ministry, and various others. An underlying focus has been around negotiating different standards, such as indicators, trying to localize and adapt them in the software, and training. Another component of my empirical work took place in a district hospital in North India, where I was involved in the design, development and implementation of a patient record based hospital information system, which gave me insights to a different class of standards relevant to HIS.
The empirical work was aimed at addressing two key research questions: One is related to understanding the nature of dynamics in the interplay between global standards and their local adaptations and the other studies challenges and opportunities arising from global/local interplay of standardization process, and how these processes are best managed. While first question helps to understand factors and entities influencing process of localization of global standards and their interplay, the second question helps to develop strategies for guiding implementation of global standards into the national HIS.
A key theoretical contribution has been the development of a conceptual framework to help analyze the relationship between actors, standards and the topic of interest to actors. This further allows the development of a perspective to understand the process of incremental and transparent introduction of technology as supporting existing institutional arrangements. Another practical contribution has been the formulation of a three dimensional framework of completeness, fittingness, and actionability for analysing the data element - indicator linkage. The notion of facets of infrastructure proposed in this thesis helps to develop guidelines for creating teams to do a larger task of HIS implementation. These implications, although developed through empirical experiences from Tajikistan and India, can potentially be applied to other contexts of countries and functional domains such as Civil Registration.
List of papers. Paper IV is removed from the thesis due to publisher restrictions.
Paper I: Sahay, Sundeep; Latifov, Murodillo Abdusamadovich. (2009). “The Data to Indicator (mis)match: Experiences from trying to strengthen this link in the Health Information System in Tajikistan”. In: Elaine Byrne, Yasar Jarrar, Brian Nicholson (editors): Proceedings of the 10th International Conference on Social Implications of Computers in Developing Countries (IFIP 9.4.). ”Assessing the contribution of ICT to Development Goals”. Dubai School of Government, Dubai, United Arab Emirates 26-28 May 2009.
Paper II: Latifov, Murodillo Abdusamadovich; Mukherjee, Arunima; Chakravarthy, Vasudha; Sahay, Sundeep. (2011). “Practical Approaches to Designing Standards: the Case of a District Hospital Information System in Northern India”. In: Maung K. Sein, Subarna Shakya, Bjorn Furuholt, G. Harindranath, Devinder Thapa (editors): Proceedings of the 11th International Conference on Social Implications of Computers in Developing Countries (IFIP 9.4.). “Partners for Development: ICT Actors and Actions”. Kathmandu, Nepal, 22-25 May 2011.
Paper III: Latifov, Murodillo Abdusamadovich and Sundeep Sahay (2012). Data Warehouse Approach to Strengthen Actionability of HIS: Experiences from Tajikistan. The Electronic Journal of Information Systems in Developing Countries. Vol. 53, 2012. Available from http://www.ejisdc.org/ojs2/index.php/ejisdc/article/view/932
Paper IV: Murodillo Abdusamadovich Latifov and Sundeep Sahay (2013). Challenges in Moving to ”Health Information for Action”: an Infrastructural Perspective from a Case Study in Tajikistan, Information Technology for Development, Volume 19, Issue 3, 2013, pages 215-229. doi:10.1080/02681102.2012.751575
Paper V: Latifov, Murodillo Abdusamadovich (2013). Global standards and Local Applications: Case of Implementing ICD-10 Standard in HMIS of Tajikistan. Journal of Health Informatics in Developing Countries. Volume 7, issue 1. Available from http://www.jhidc.org/index.php/jhidc/article/view/94