Health Information Systems (HIS) are used to collect and analyze health data in order to support the improvement of health care services. Public health care in third world countries are often based on a poor functioning HIS. Simply put, data collection processes tend to be extensive, often of poor quality and typically failing to be used for practical purposes such as for effectively allocat-ing resources. Thus, exploring ways of improving existing HIS is evidently a fruitful approach to strengthen public health care. As a part of health sector reform, governments in many developing countries are in the process of strengthening their HIS through the introduction of computer based systems.
This thesis describes and discusses the implementation of the Health Informa-tion System Program (HISP) in the Indian state of Andhra Pradesh. The study was done using an action research approach over a five month period spread over two years. The challenges were to work with political, infrastructural, hu-man resources, geographical, and cultural issues to get the system developed, implemented and institutionalized. The results show that to institutionalize a HIS into the everyday working of the health department in Andhra Pradesh, it is important to rec¬ognise the interdependency between scaling and sustainabil-ity. Scaling indicates the need for the HIS to reach a certain geographic and functional scope so as to become of interest to the higher levels. Small pilot projects have problems in reaching such scale, and will therefore end up more as interesting academic exercises, unless they manage to reach a certain scope and scale.
Theoretically, concepts from information infrastructure theory have been used to better analyze the complexities of scaling and sustainability, and their inter-dependencies. An important research focus has been to explore how the smaller scale project in India that was studied could be extended – scaled up – so as to become of interest to health managers at different levels, and thereby, eventu-ally, become institutionalised. Three key processes have been identified to achieve this goal of institutionalization. These are the processes of cultivation, the creation of gateways to enable integration between the “installed base” and the “new system”, and the choice relating to the level at which data-entry and report generation should take place. To achieve institutionalization, in addition to the above focus on these processes, equal emphasis needs to be also placed on obtaining political support, thus emphasizing the need to combine top-down and bottom-up strategies.