Paper published: Understanding HMIS Implementation in a Developing Country Ministry of Health Context – an Institutional Logics Perspective

This Public Health Informatics research paper discusses the institutional aspects of HMIS implementation in the real world setting of a developing country Ministry of Health. It highlights the complexity of such an endeavor, in a context that, as HMIS implementers generally agree, can often be contested, dysfunctional and/or simply put, a hard nut to crack.

I generated the paper’s word cloud (see below) – a word cloud is a visual representation of the paper’s text data, highlighting the most used words or keywords.

The paper’s abstract

Globally, health management information systems (HMIS) have been hailed as important tools for health reform (1). However, their implementation has become a major challenge for researchers and practitioners because of the significant proportion of failure of implementation efforts (2; 3). Researchers have attributed this significant failure of HMIS implementation, in part, to the complexity of meeting with and satisfying multiple (poorly understood) logics in the implementation process.

This paper focuses on exploring the multiple logics, including how they may conflict and affect the HMIS implementation process. Particularly, I draw on an institutional logics perspective to analyze empirical findings from an action research project, which involved HMIS implementation in a state government Ministry of Health in (Northern) Nigeria. The analysis highlights the important HMIS institutional logics, where they conflict and how they are resolved.

I argue for an expanded understanding of HMIS implementation that recognizes various institutional logics that participants bring to the implementation process, and how these are inscribed in the decision making process in ways that may be conflicting, and increasing the risk of failure. Furthermore, I propose that the resolution of conflicting logics can be conceptualized as involving deinstitutionalization, changeover resolution or dialectical resolution mechanisms. I conclude by suggesting that HMIS implementation can be improved by implementation strategies that are made based on an understanding of these conflicting logics.

Keywords: Social issues in Public Health Informatics; developing countries; health management information systems; institutional logics; institutional aspects of information systems; action research; Nigeria; Ministry of Health; change management

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In Nigeria, Mobile overtakes Desktop – Generation mI

This has long been discussed; the large potential that exist for m4D, mobiles for development. But it is now cemented by data, which clearly illustrates how the internet is increasingly accessed in developing countries.

Mobile Overtakes Desktop

Note: It doesn’t necessarily mean that access on the desktop is reducing. No, look again, the y-axis is percentage, so it means it more of a ratio or percentage. The actual number of hits from personal computers may still be rising (or may be stagnant…or worse dropping) but clearly this shows that most of the hits to the internet from Nigeria have been from mobiles…from few months ago.

Permit me to say that Nigeria’s mobile internet (mI) generation began a while back. I feel opportune to be able to place my thesis right in this center of activity and investigate how this can be used to leverage health care, which is in dire need of a fix.
I think this data clearly makes an argument for expanding our global health arsenal to mobile web tools. More so as the current mobile internet price wars in Nigeria will further increase access to more people.

Contrast this to the worldwide trend, which shows a change that is less than 10%;

Lets leave it at that for now…
PS: Data based on thousands of sites on the StatCounter network (as recognized by ip address). By May 2010 the StatCounter site had 19,336,215 hits from Nigeria (out of a worldwide total of 16 billion hits)

Writing up thesis on mHealth…Scaling mHealth in Low-Resource settings

Scaling is a central concern in public health. More so, it is an underlying assumption because it is largely concerned with the health of the entire populace. The motivation to scale health services and its associated components including health information networks is underpinned by everything ‘public’ about public health. It is a basis for WHO’s mission and was well captured in its landmark ‘Health for All’ conference in Alma Ata 40 years ago (WHO, 1978). It is also the basis for spreading evidence-based and scientifically proven small-scale interventions to the populace (Black 1986, Taylor 2010). Scaling up global health initiatives and packages, rolling them to the lowest levels is thus a core strategy in reaching for the Millenium Development Goals targets by 2015 (United Nations, 2010).

Despite considerable increases in funds directed at scaling health services in low-resource settings and their associated information systems (Ravishankar et al 2009), reaching the lowest levels of care and the populace in targeting the MDGs have been largely unsuccessful (United Nations, 2010).

In this regard, mHealth, the application of mobiles for health is promising. Mobile technology is transforming healthcare by increasing access to healthcare and health-related information including hard-to-reach populations, improving the ability to track diseases, providing timlier and more actionable public health information and expanding access to health education as well as training (VitalWave, 2009). From a mass media perspective, it is also regarded as the fastest scaling media technology in history compared with how long it took print, recordings, cinema, radio, television and internet to scale (Ahonen, 2008).

In this research, the role of mHealth in scaling health information networks is investigated. Is mHealth the magic bullet it is envisioned to be? Are they any constraints – technical, strategic, organizational? What are the key lessons for architectural and implementation design?

Research aims and objectives coming…

Another day

Its a few days since my last post…the weather has gotten worse than it had been.

But my reading has gone better…

Had a nice presentation on Hanseth et al’s paper, Developing Information Infrastructures

And a discussion with the head of the Global Infrastructure Group

… I will always remember “Research is sort of an apprenticeship; like learning to be a carpenter”

Those were words of wisdom, something I guess I didnt really factor out well earlier on. Now I see the practical consequences.

I would end this blog by showing a model of his paper I created using IHMC’s concept mapping software Cmaps

Conceptual model of an Information Infrastructure showing relationships between standardisation and flexibility.