Abstract
This thesis presents an action research study into the design of generic health information system (HIS) based on District Health Information Software 2 (DHIS2) for the public health contexts of developing countries. As a core designer of the HIS and also engaged with its incountry implementations in different places, I take both “global” and “local” perspectives, to understand the challenges of design, implementation and their interplay. I contribute to debates on “generification” through articulating the concept of “open generification” . The thesis has also implication on strategies of information systems innovation in developing countries as well as mechanisms of scaling, in particular when transporting a technology that has worked in one context to multiple other contexts.
A practical motivation for this study is the endemic failures of HIS in developing countries, contributed significantly through “design-reality” gaps. Making generic design for multiple contexts or specific design for a particular context have both been deemed problematic, leading for calls for developing a “pragmatic balance”, although with little direction on how this can be achieved. Open generification is my contribution on how such a balance may be achieved, which is based on practical design guidelines at both the strategic and operational levels. Theoretically, open generification presents a conceptual perspective based on unpacking processes of building systems for both generic and specific based on principles of openness and collaboration. This depends on the configuration and interaction of social and technical elements at global and local levels. To facilitate this, the open generification framework suggests for mechanisms of embedding and disembedding. While open generification represents an ideal state, I also identify some potential distortions from this, and how they may be achieved. Supporting concepts of organizational field and scaling are used to build the open generification perspective. The concept of scaling helps to unpack processes of technology spreading and expansion in time and space while organizational field sensitizes to interdependent sectoral influences that shape the generification process other than suppliers and consumers. In this way, the thesis seeks to answer the following two guiding research questions: (i) how can we understand generic HIS design in the context of developing countries? (ii) what are appropriate strategies to help us design generic HIS that fits into the public health needs of multiple countries?
Methodologically, the study was conducted within the framework of the Health Information Systems Programme (HISP), which is an international project engaged in strengthening health data collection, analysis and management in many African, Asian and Latin American countries. Key activities in HISP are design, development and implementation of DHIS2, which I have taken a central stage as an action researcher. I conducted four different action research projects each analyzing processes of DHIS2 spreading, expansion, restructuring and architectural innovation in a generic fashion. Multiple qualitative data collection methods were used in the process. For data analysis, I followed inductive approach within the framework of interpretive IS research tradition. Findings from the data analysis are presented in five conference and journal papers. Practical outputs from my actions are mobile-enabled DHIS2 modules supporting practices of recording, tracking and reporting in rural healthcare organizations of multiple developing countries.