Challenges in building user competence in Health Information Systems : A case study from health sector in Trivandrum, Kerala.

Abstract

Abstract To strengthen and further develop health information in Kerala, the state decided to implement a robust Health Management Information System (HMIS) and to switch to electronic reporting from facility level up to state level. The software application to use is called District Health Information System (DHIS2) and is developed by Health Information System Project (HISP), a global action research project. The change represented a large scale implementation and was a challenge with respect to capacity building and training to make the new system up and go. To overcome the challenges, a two year scaling period was decided and 10-12,000 health staff was given initial training in two or three days to learn the new routines. The thesis evaluates the user learning and capacity building in the first part of the period in Trivandrum district with the following research questions: 1) What were the results of the training and support? How did the results compare to the aims? 2) Why did these results come about concerning project activities and how did social, political and cultural elements influence competence building? 3) How do these results compare with other experiences?

To be able to answer these questions I used triangulation in the methodology, observations and conversations at training courses, interviews and group interview, fieldtrips and questionnaires. Findings related were: 1. The course was too short for most of the participants. They did not learn how to operate the software, but they learned about it. 2. Causes: Many of the attendants were not IT literate from before and found the exercises difficult. The length of the training day was too long. The time gap from training course to work place practice was too long. Gender and age played a role. 3. Most of the respondents were positive to the implementation, but for the majority, perceived usefulness rested in the benefit of easier reporting and reduced workload for their own job, not quality of data and information for action in the health service management. In a similar action research project from Zanzibar they found that a combination of initial training followed up by in-service support gave positive results.

Key words: Implementation, Health Information, Organizational learning, User learning, Super users, Communities of practice, Kerala,