Shaping the Evolution of the Health Information Infrastructure in Zimbabwe


  • Rangarirai Matavire University of Oslo, Department of Informatics
  • Henry Chidawanyika RTI International
  • Jørn Braa University of Oslo, Department of Informatics
  • Ponesai Nyika Ministry of Health and Child Welfare, Zimbabwe
  • Joshua Katiyo Ministry of Health and Child Welfare, Zimbabwe



Background and Purpose: This article describes the implementation process of an integrated health information system within the context of a developing nation. The Ministry of Health and Child Welfare (MOHCW) in Zimbabwe was engaged in migrating legacy article and desktop based information systems to the District Health Information Software (DHIS2), a web enabled and open source technology. The aim of this article is to contribute to the development of theory that can be adopted to improve outcomes in such endeavours.

Methods: The study is conducted using the Action Research (AR) approach whereby the authors were actively involved in shaping the implementation of the information system. It occurs within the broader context of the Health Information Systems Programme (HISP), where an AR approach, the Networks of Action, has been developed for sustainable interventions in developing nations. The work is also informed by the grounded theory methodology, whereby empirical data was the basis for making a theoretical contribution.

Results: An interorganisational network consisting of actors interacting at the administrative level of the public health system plays a central role in determining the trajectory of the health information infrastructure. Collaborative challenges at this level are demonstrated to lead to further fragmentation of the health system thereby increasing the inertia of the installed base. At the user level, numerous strategies to cope with the challenge of supporting the health information system are described.  The development of capabilities at this level is shown to be key in increasing the adaptability of the installed base.



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Woelk G, Moyo I, Chisvo D, Mbengeranwa O. A health information system revised. I: The computerization of primary care clinic returns. Central African journal of medicine. 1987;33(7):161-70.

Woelk G, Moyo I, Ray C. A health information system revised. Part II: Improving data quality and utilization. The Central African journal of medicine. 1987;33(7):170.

Jaravaza V, McCoy M, Jonsson U. Unified National Health Information System. The Central African journal of medicine. 1982;28(7):167.

Korpela M. Two decades of HELINA Conferences: A Historical Review of Health Informatics in Africa. Year book Med Inform. 2013;197:205.

Braa J, Sahay S. Integrated Health Information Architecture. New Delhi, India: Matrix Publishers; 2012. 362 p.

Atun RA, Bennett S, Duran A. When do vertical (stand-alone) programmes have a place in health systems?: World Health Organization; 2008.

Hornnes E, Jansen A, Langeland Ø. How to develop an open and flexible information infrastructure for the public sector? Electronic Government: Springer; 2010. p. 301-14.

Van Dijk J. The network society: SAGE Publications Limited; 2012.

Kanjo C, Moyo C, Galimoto M, Braa J, Muyepa-Phiri A. Towards Harmonisation of Health Information Systems in Malawi: Challenges and Prospects. Proceedings of the IST for Africa. 2009.

Lungo J, Sheikh YH, Igira F, Titlestad OH, Mahundi M, Suleiman OM, et al. Building Health Management Information System for Zanzibar: Opportunities and Challenges.

Sanner TA, Roland LK, Braa K. From pilot to scale: Towards an mHealth typology for low-resource contexts. Health Policy and Technology. 2012.

Njihia JM, Merali Y. The broader context for ICT4D projects: a morphogenetic analysis. MIS Quarterly. 2013.

Adam T, de Savigny D. Systems thinking for strengthening health systems in LMICs: need for a paradigm shift. Health Policy and Planning. 2012;27(suppl 4):iv1-iv3.

Aanestad M, Jensen TB. Building nation-wide information infrastructures in healthcare through modular implementation strategies. The Journal of Strategic Information Systems. 2011;20(2):161-76.

Hanseth O, Lyytinen K. Design theory for dynamic complexity in information infrastructures: the case of building internet. Journal of Information Technology. 2010;25(1):1-19.

Matavire R, Manda TD. Design Breakdowns As Opportunities For Articulating Mobile Health Information Infrastructures. 12th International Conference of IFIP working group 94 on Social Implications of Computers in Developing Countries; 19-22 May; Ocho Rios, Jamaica, 2013.

Lee CP, Dourish P, Mark G, editors. The human infrastructure of cyberinfrastructure. Proceedings of the 2006 20th anniversary conference on Computer supported cooperative work; 2006: ACM.

Star SL. The ethnography of infrastructure. American behavioral scientist. 1999;43(3):377-91.

Bowker GC, Baker K, Millerand F, Ribes D. Toward information infrastructure studies: ways of knowing in a networked environment. International handbook of internet research. 2010:97-117.

Ribes D, Finholt TA. The long now of technology infrastructure: articulating tensions in development. Journal of the Association for Information Systems. 2009;10(5):375-98.

Braa J, Monteiro E, Sahay S. Networks of action: sustainable health information systems across developing countries. Mis Quarterly. 2004:337-62.

Ciborra C. The labyrinths of information: Challenging the wisdom of systems: Oxford University Press, USA; 2002.

Swyngedouw E. Globalisation or ‘glocalisation’? Networks, territories and rescaling. Cambridge review of international affairs. 2004;17(1):25-48.

Beck U, Bonss W, Lau C. The theory of reflexive modernization problematic, hypotheses and research programme. Theory, Culture & Society. 2003;20(2):1-33.

Mahoney J. Path dependence in historical sociology. Theory and society. 2000;29(4):507-48.

Giddens A. The Constitution of Society. Outline of the Theory of Structuration. Cambridge, UK: Polity Press; 1986. 402 p.

Heeks R. Information systems and developing countries: Failure, success, and local improvisations. The Information Society. 2002;18(2):101-12.

Sein M, Henfridsson O, Purao S, Rossi M, Lindgren R. Action design research. MIS Quarterly. 2011;35(2).

Constantinides P, Barrett M. Large-Scale ICT Innovation, Power, and Organizational Change The Case of a Regional Health Information Network. The Journal of Applied Behavioral Science. 2006;42(1):76-90.

Silva L, Hirschheim R. Fighting against windmills: Strategic information systems and organizational deep structures. MIS Quarterly. 2007:327-54.

Humphry J. Making an Impact: Cultural Studies, Media and Contemporary Work. M/C Journal. 2011;14(6).

Strauss A. The articulation of project work: An organizational process. The Sociological Quarterly. 1988;29(2):163-78.

Baskerville RL. Investigating information systems with action research. Communications of the AIS. 1999;2(3es):4.

Matavire R, Brown I. Profiling grounded theory approaches in information systems research. European Journal of Information Systems. 2011;22(1):119-29.

Glaser BG, Strauss AL. The discovery of grounded theory: Strategies for qualitative research: Aldine de Gruyter; 1967.

Baskerville R, Pries-Heje J. Grounded action research: a method for understanding IT in practice. Accounting, Management and Information Technologies. 1999;9(1):1-23.

Klein HK, Myers MD. A set of principles for conducting and evaluating interpretive field studies in information systems. MIS quarterly. 1999:67-93.

Vangen S, Huxham C. Nurturing collaborative relations Building trust in interorganizational collaboration. The Journal of Applied Behavioral Science. 2003;39(1):5-31.




How to Cite

Shaping the Evolution of the Health Information Infrastructure in Zimbabwe. (2013). Journal of Health Informatics in Africa, 1(1).