The research is based on understanding the challenges related to the design, development and implementation of a GIS tool for health care in developing countries. Specifically, the study analyses how the GIS application developed in one context can be adapted and introduced inthe current health information system for decision making support in the process of planning and monitoring of health services. Another objective of the thesis was to analyze approaches to customize and adapt software developed in one country to another country context.The research was conducted in team of three master students within the framework of Health Information System Program (HISP). The research setting was provided by the Community Health Department (CHD), within the health sector of Mozambique. In addition to empirical work carried out in the headquarters in Maputo, field work was also conducted in the two provinces of Gaza and Inhambane in order to answer the two research questions that guided the study, namely: What are the potential challenges to the development and introduction of a GIS application within the health sector in developing countries? and; How can a GIS application developed for one context be effectively customized for another?
A case study research design within an action research framework was used with a focus on the Ministry of Health generally, and the CHD more specifically. The challenges experienced during the process were studied using qualitative research methods that helped to inform boththe data collection methods and analysis. Participatory action research was used for facilitating the software development through a prototyping approach. The aims of the action research effort were to both enable the practical success of the implementation, and also simultaneously help generate scientific knowledge about these implementation challenges. The adoption of GIS involves the interplay of human, organizational and technical aspects, which cannot be easily separated, and requires them to be considered in relation to each other. Thus, to analyze problems addressed in this thesis, I drew upon theories and concepts in three areas: GIS as socio-technical systems, Information Infrastructure and Actor Network Theory. While the socio-technical perspective helped to provide the broad perspective underlying the research, Actor Network Theory helped to unpack the complexity inherent in such implementation process.
Finally, the concepts of installed base and cultivation drawn from Information Infrastructure theory helped to understand respectively the challenges of history in introducing new systems (like the GIS) and (cultivation) approaches to deal with these challenges.
This thesis has made both theoretical and practical contributions towards the implementation of GIS technology for the health care context of developing countries like Mozambique. The following theoretical contributions were made:
(1) identification of approaches for the design of GIS applications for the health sector and potentially also to others like education, in the context of developing countries; (2) unpacking the conceptual relationship between the installed base and approaches to their cultivation; (3) emphasizing the socio-technical nature of the installed base; (4) emphasizing how the development of the spatial database isdependent on the non-spatial installed base; (5) unpacking the multi-level nature of theinstalled base, and how various technical and institutional aspects are embroiled at each level; and, (6) elaborating on mechanisms for cultivation including the strategy of using gateways to link incompatible components; and, (7) developing an approach for the customization of software developed in one country to another country context.
The following practical contributions were made:
(1) the development of the GIS application, by linking the non-spatial and spatial components; (2) for supporting ongoing initiatives of HIS reform in the CHD within the Ministry of Health; (3) for developing awareness about the potential of the GIS technology and also about the challenges to making it work effectively in practice. (4) practically supports the implementation of HISP in Mozambique.