Analysing inhibitors of integrating and routinizing Health Information Systems for Universal Health Coverage: the case of Cameroon
Background and Purpose: The purpose of this paper is to describe the state of HMIS in Cameroon, with particular emphasizes on the organisational factors affect integration, routinization and use of information for decision-making for the achievement of UHC goals.
Methods: This paper is based on an interpretative case study on the implementation of electronic data-based in Cameroon. Data was collected through interviews conducted with District Health Managers, Facility Information Officers, and Matron-In-charge of healthcare facilities from December 2015, to January and July 2016. Document review was used as secondary data collection. Multiple variation sampling technique was used to select interviewees.
Results: Though there is a “general expectation that as electronic IS (DHIS) has been implemented, computers and Internet dongles provided to district and facilities information managers, the quality of information generated will certainly become of good quality and could be used for decision making”. This assumption neither concurs with the perspective of ICTs for development nor ICT as an agent for institutional change. According to advocates for ICT as an agent for changes IS is an institution and in order for it to bring about change, all aspects (human and non-human, social, cultural and political factors) have to be given equal attention.
This paper analysed inhibitors of HMIS integration in Cameroon. Factors that affect effective routinzing, integrating and use of HMIS are; multiple data collecting tools, centralized information management, inadequate information system infrastructure, lack of IT specialist and basic computer skills and non-culture of information use.
Conclusions: HMIS offers a remarkable potential for improving the efficacy and effectiveness for healthcare and also for achieving the goal of UHC. However, its integration, routinization and use are quite variable depending on the context.
Aanestad, M. (2002). Cultivating Networks: Implementing surgical telemedicine: The Interventional Centre, Rikshospitalet, Faculty of Medicine, University of Oslo, Oslo: University of Oslo (Doctor Scientarum).
Alliance for Affordable Internet (2014). Case study: Internet and Broadband in Cameroon, barriers and affordable access. Available at https://a4ai.org/wp-content/uploads/2014/08/A4AI-Case-Study-Cameroon_FINAL1.pdf . Access on 10th January 2017
Aqil, A., Lippeveld, T., Hozumi, D. (2009). PRISM framework: a paradigm shift for designing, strengthening and evaluating routine health informtion systems. Health Policy and Planning 2009;24:217-228
Ashraf, M. (2007). Some perspective on understanding the adoption and implementation of ICT interventions in developing countries. The Journal of Community Informatics, Vol 3, No. 4
Avgerou, C. (2002). Information Systems and Global Diversity. Oxford University Press.
Bhatnagar, S. (1992). Information technology and socio-development: Some strategies for developing countries. In S.C. Bhatnagar & M. Odedra (Eds). Social Implications of computers in developing countries (pp. 1-9). New Delhi: Tata McGraw-Hill.
Boerma, T., Eozenou, P., Evans, T., Kieny, MP., Wagstaff, A. (2014). Monitoring progress towards Universal Health Coverage at county and Global levels. PLOS Med 11(9).
Braa, J., Blobel, B. (2003). Strategies for developing health information systems in developing countries. In D. Khakhar (ed.), WITFOR 2003 White Book (pp. 175-219). Laxenburg, Austria: IFIP Press.
Braa, J., Hanseth, O., Heywood, A. Mohammed, W, Shaw, V. (2007). Developing Health Information systems in developing countries : The Flexible Standards Strategy, MIS Quarterly, Special Issue on IT and Development 31
Bunduchi, R., Graham, I., Smart, A., Williams, R. (2005). The tensions shaping the emergence of standard bodies: The case of a national health informatics standard body, Prometheus 23(2): 149-166.
Callon, M. and Law, J. (1989). On the construction of sociotechnical networks: content and context revisited. Knowledge and Society 9:57-83
Cameroon Economic Update. (2013). Towards greater equity. The World Bank. July 2013 issue 6. Available at http://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2013/08/27/000333037_20130827110226/Rendered/PDF/806710WP0ENGLI0Box0379812B00PUBLIC0.pdf [Accessed April 2016]
Chen, S., Ravallion, M. (2004). How have the World's poorest fared
since the early 1980s? Washington, D.C., World Bank, Development Research Group, Poverty Team.
Chilundo, B. and Aanestad, M. (2004) Negotiating Multiple
Rationalities in the Process of Integrating the Information Systems of Disease Specific Health Programmes, Electronic Journal on Information Systems in Developing Countries (20:2), 2004, pp. 1-28.
Creswell, J. (2007). Research Design: Qualitative, Quantitative, and mixed methods approaches. Thousand Oaks, CA: Sage Publications.
Doherty, F., King, M. (2001). An investigation of the factors affecting the successful treatment of organizational issues in systems
Elo, S., Kyngas, H. (2008). The Qualitative content analysis process. JAN, vol. 62, Issue 1, April 2008, 107 – 115.
Fichman, R., Kohli, R., Krishnan, R. (2011). The Role of Information System in Healthcare current research and future trends. Information Systems Research Vol. 22, No. 3, September 2011, pp. 419-428
Hanseth, O. (2002). From systems and tools to networks and infrastructures- From design to cultivation. Towards a theory of ICT solutions and its design methodology implications. Retrieved January 09, 2017, from http://heim.ifi.uio.no/~oleha/Publications/ib_ISR_3rd_resubm2.html
Heeks, R. (2002). I-development not E-development: special issue on ICTs and development. Journal of International Development. 14, 1p. 1-11.
Heeks, R. (2006). Theorizing ICT4D Research. Information
Technologies and International Development, 3(3
Heeks, R., Kenny, C. (2002). Is the Internet a Technology of Convergence or Divergence? Washington, DC: World Bank
Kamadjeu, R., Tapang, E., Moluh, R.(2005). Designing and implenting an electronic health recod system in primary care practice in sub-Saharan Africa: a case study from Cameroon. Informatics in Primary care 13: 179-86
Kimaro, H., Sahay, S. (2007). An Institutional Perspective on the Process of Decentralisation of Health Information Systems: A Case Study from Tanzania", Information Technology for Development, Vol 13, No. 4, pp 363-390.
Kling, R. (2000). Learning about information technologies and social change: The contribution and social informatics. The Information Society 16(3):217-232.
Lippeveld, T. (2001) Routine Health Information Systems: the glue of a unified health system. RHINO Workshop.
MA4Health, Health Measurement and Accountability Post 2015: Five-Point Call to Action. Available at http://www.who.int/hrh/news/2015/5-point-call-to-action.pdf?ua=1 (2016)
Ministry of Public Health Cameroon. Department of Human Resource. General census report of health personnel. Yaoundé, 2012
Mutale, W., Chintu, N. et al. (2013). Improving health information systems for decision making across 5 sub-Saharan African Countries: Implementation strategies from the African Health Initiative. BMC Health Services Research 2013, 13(Suppl.2):S9
Nielsen, P., Sæbo, J. (2015). Three strategies for functional architecting: Cases from the Health Systems Development Countries, Information Technology for Development, 22:1, 134-151
Nsubugo, P., Eseko, N., Tadase W., et al (2002). Structure and performance of infectious disease surveillance and response, United Republic of Tanzania, 1998. Bulletin of the World Health Organization 80: 196-203
Odhiambo-Otieno, G. (2005). Evaluation criteria for district health management information systems: lessons from the Ministry of Healty, Kenya. Internatinal Journal of Medical Informatics 74: 31-8
Orlikowski, W., Baroudi, J. (1991). Studying Information Technology in Organizations: Research Approaches and Assumptions. Information Systems Research, 2, 1-28
Orlikowski, W., Iacano, C. (2001). Research commentary: Desperately seeking IT in IT research – A call to theorizing the IT artifact. Information Soceity Research 12:121-134
Rotich, K. Hannan, T., Smith, F. et al (2003). Installing and implementing a computer-based patient record system in sub-Saharan Africa: the Mosoriot Medical Record System. Journal of the American Medical Informatics Association 10: 295-303
Sachs, J. (2012). From Millennium Development Goals to Sustainable Development Goals. Lancet 2012;379:2206-11
Sahay, S., Sundararaman, T. (2015). Are we Building a Better World with ICTs? Empirically Examining this Question in the Domain of Public Health in India. Information Technology for Development, 22:1, 168-176.
Schmidt, SK, Werle, R. (1998). Coordinating technology: Studies in the international standardization of telecommunications. Cambridge, MA: Massachusetts institute of Technology
Silva, L. Figueroa, E. (2002). International intervention and the expansion of ICTs in Latin America: The case of Chile, Information Technology & People 15(1):8-25
UNICEF. (2015) Trends in Maternal Mortality 1990-2015. Estimates by WHO, UNICEF, UNPFA, World Bank Group and the United Nations Population Division.
Walsham, G. (1995): The emergence of Interpretivism in IS research. Information Systems Research, vol. 6, no. 4, pp. 376-394.
Walsham, G. et al. (1988). Information Systems as Social Systems: Implications for DCs, Information Technology for Development, Vol. 3, No. 3, pp.189-204
WHO: World Health Report. (2010): Health Systems Financing: The Path to Universal Coverage WHO, Geneva, Switzerland, 2010), pp. 1–128. http://www.who.int/whr/2010/10_summary_en.pdf
WHO: World Health Report. (2008). Primary Health care – now more than ever. Geneva: The World Health Report