Leveraging on Cloud Technology for Reporting Maternal and Child Health Services at the Community Level in Ghana
DOI:
https://doi.org/10.12856/JHIA-2017-v4-i2-146Abstract
Background and Purpose: The millennium development goals (MDG) have served as a catalyst in galvanizing governments and ministries to refocus their development agenda to meet set MDG targets. Similarly the Ghana Health Service (GHS) recognizes the importance of an efficient health information system (HIS) for generating quality data for monitoring progress towards achieving set targets of the health related MDGs 4, 5 and 6. This paper is therefore about the GHS effort in using electronic health record system called the e-Tracker to support the provision and reporting of primary healthcare in the area of maternal and child health services at the community level.
Methods: The research approach was case study of selected facilities in one pilot district. Empirical data was collected using qualitative methods such as participant observations, interviews and supplemented by secondary data sources such as training manuals and other official documents. Philosophically the research was informed by interpretive paradigm through subjective meaning for understanding the sociotechnical complexities of implementing the e-Tracker in the health domain. Actor-Network theory (ANT) was considered as an appropriate theoretical lens to conceptualize and investigate the dynamics of introducing a technological artefact into a social system such as the health domain.
Results: Findings were that there was realignment of work practices with resultant reflexive effects (positive and negative) on the working environment as a result of introducing information technology artefact into the health domain. And that the sociotechnical effects are emergent and cannot be determined a priori because of the multiplicities in complexity when the social reacts with the technical.
Conclusions: These findings corroborates findings in similar studies in the IS literature in that effects of technological artefacts in complex social-technical system are emergent and cannot be predetermined due to their unpredictability. Furthermore in sociotechnical systems such as the health domain best practice is for the coexistence of electronic and paper systems. Therefore an attempt to completely replace the paper system with the electronic may result in system challenges.
Keywords: e-Tracker, Electronic Health Record, Maternal and Child Health
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References
AbouZahr, C. & Boerma, T, 2005. Health Information Systems: the foundations of public health, Bulletin of the World Health Organization, 83(8).
Anadach Group, 2012. Nairobi conference on eHealth sees high-level participants discuss rapidly growing African eHealth platforms and say no to "pilotitis".
ATO, 2014. Africa Telecoms Outlook (ATO), 2014. Maximizing Digital Service Opportunities.
www.informatandm.com.
Asangansi, I., & Braa, K. (2010). The Emergence of Mobile-Supported National Health Information Systems in Developing Countries in Proceedings fromThe 13th World Congress on Medical and Health Informatics Medinfo 2010 Cape Town, South Africa.
Ash, J, Berg, M, Coiera, E, 2004. Some Unintended Consequences of Information Technology in Health Care: The Nature of Patient Care Information System-related Errors. Journal of the American Medical Informatics Association Volume 11 Number 2 Mar / Apr 2004.
Berg, M, 1999. Patient care information systems and healthcare work: a sociotechnical approach. International Journal of Medical Informatics 55 (1999) 87–101
Berg, M, & Goorman, E, 1999. The contextual nature of medical information. International Journal of Medical Informatics 56 (1999) 51–60
Berg, M, 2001. Implementing information systems in healthcare organizations: myths and challenges. International Journal of Medical Informatics 64 (2001) 143–156
Black, A. D., Car, J., Pagliari, C., Anandan, C., Cresswell, K., Bokun, T., McKinstry, B., Procter, R., Majeed, A. & Sheikh, A., 2011.The Impact of eHealth on the Quality and Safety of Healthcare: A Systematic Overview. PLoS Medicine, 8,1.
Blaya, J., Fraser, H., & Holt, B., 2010. E-Health Technologies Show Promise In Developing Countries. Health Affairs 29, NO. 2 (2010): 244–251.
Braa, J., Monteiro, E., & Sahay, S., 2004. Networks of Action: Sustainable Health Information Systems Across Developing Countries. MIS Quarterly, 28(3), 337-362
Braa, J., & Hedberg, C. (2002). The Struggle for District-Based Health Information Systems in South Africa. The Information Society, 18, 113-127.
Braa, J., & Sahay, S. (2012). Integrated Health Information Architecture: Power to the
Users. New Delhi: Matrix Publishers.
Braa, J., Hanseth, O., Mohammed, W., Heywood, A., & Shaw, V. (2007). Developing Health Information Systems in Developing Countries. The "Flexible Standards" Strategy. MIS Quarterly, 31.
Chib A, Cheong Y.J, Lee L.C.L, Ng C.H.C, Tan C.K, Vlv K, 2012. The Hope of Mobile Phones in Indian
Rural Healthcare. Journal of Health Informatics in Developing Countries. 2012;6(1):406-21.
Chan, M, Kazatchkine, M, Lob-Levyt, J, Obaid, T, Schweizer, J, Sidibe, M, Veneman, A, Yamad, T, 2010. Meeting the Demand for Results and Accountability: A Call for Action on Health Data from Eight Global Health Agencies. PLoS Medicine | www.plosmedicine.org 1 January 2010 | Volume 7 | Issue 1
Chetley, A. 2006. Improving Health, Connecting People: The Role of ICTs in the Health Sector of Developing Countries. InfoDev.
Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E, Morton SC, Shekelle PG, 2006. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med 2006, 144:742-752
Calandro, E, Gillwald, A, Moyo, M, Stork, C, 2011. Comparative ICT Sector Performance Review 2009/2010. Towards Evidence-based ICT Policy and Regulation Volume Two, Policy Paper 5, 2010
GHS CHPS, 2005. Community-based Health Planning and Services (CHPS). The Operational Policy. Ghana Health Service Policy Document No. 20. May 2005.
GHS CHPS Manual, 2013. Strengthening Community-based Health Planning and Services. Manual for Community Health Management Committee. USAID|Ghana|JICA Project.
Hanseth, O., & Lyytinen, K. (2010). Design theory for dynamic complexity in information infrastructures: the case of building internet. Journal of Information Technology, 25, 1-19. doi: 10.1057/jit.2009.19
Heeks, R, 2002. Information Systems and Developing Countries: Failure, Success, and Local Improvisation. The Information Society, 18, 101-112.
Tolly K, Nembaware V, Skinner D, 2011. Encouraging HIV testing through SMS: Can it work, and do content and dosage impact?. South African AIDS Conference, Durban, South Africa.
Germann, S., Jabry, A., Njogu, J., & Osumba, R. (2012). The Illness of “Pilotitis” In mHealth – Early Lessons from the KimMNCHip Partnerships in Kenya. Paper presented at the Geneva Health Forum, Geneva, Switzerland.
Ellingsen, G., & Monteiro, E. (2008). The organizing vision of integrated health information systems. Health Informatics Journal, 14(3), 223-236.
MOH MAF, 2011. MDG Acceleration Framework and Country Action Plan for Maternal Health
Mechael, P., 2009. MoTECH: M-Health Ethnographic Report.
Mahmood, S, Ayub, M, 2010. Accuracy of Primary Healthcare Statistics Reported by Community Based Lady Health Workers in District Lahore. Journal of the Pakistan Medical Association. 2010;60(8):649-53.
Matavire , R., Chidawanyika, H., Braa, J., Nyika, P.,Katiyo, J., 2013. Shaping the Evolution of the Health Information Infrastructure in Zimbabwe. 8thHELINA 2013 Conference.
Mechael, P, Batavia H, Kaonga N, Searle S, Kwan A, Goldberger A, Fu L, Ossman J, 2010. Barriers and Gaps . Affecting mHealth in Low and Middle Income Countries: Center for Global Health and Economic Development Earth Institute, Columbia University, New York.
Miles, M.B. & Huberman, A.M. (1994). Qualitative Data Analysis. Thousand Oaks: Sage Publications
Mishra, S. & Singh, I. P., 2008. m-Health: A Developing Country Perspective
Myers, M. D. (1997). Qualitative Research in Information Systems. MISQ Discovery. Retrieved from http://www.qual.auckland.ac.nz
Klein, H. K., & Myers, M. D. (1999). A set of principles for conducting and evaluating interpretive field studies in information systems. MIS Quarterly, 23(1), 67-93
Kiragga, B. Castelnuovo, P. Schaefer, T. Muwonge, J. Easterbrook, 2011. Quality of data collection in a large HIV observational clinic database in sub-Saharan Africa: implications for clinical research and audit of care. J. Int. AIDS Soc. 14 (2011) 3.
Kaghan, W, N, Bowker GC, 2001. Out of machine age?: complexity, sociotechnical systems and actor network theory. Journal of Engineering and Technology Management 2001, 18:253-269.
Kvale, S., (2009). Learning the Craft of Qualitative Research Interviewing. Sage Publication Inc.
Latour, B, 2005. Reassembling the Social: An Introduction to Actor-Network Theory. Oxford University Press.
Law, J, 1992. Notes on the Theory of the Actor-Network: Ordering, Strategy and Heterogeneity.
Systems Practice 1992, 5:379-393.
Leon, N, Schneider, H, & Daviaud, E, 2011. Applying a framework for assessing the health system challenges to scaling up mHealth in South Africa. BMC Medical Informatics and Decision Making 2012, 12:123
Oluocha, T, Santas, B, Kwaroc , D, Were, M, Biondichd, P, Baileye, C, Abu-Hannaf, A, Keizer, N, 2012. The effect of electronic medical record-based clinical decision support on HIV care in resource- constrained settings: A systematic review. International Journal of Medical Informatics
Research ICT Africa, 2011. http://www.researchictafrica.net
Skinner D, Rivette U, Bloomberg C, 2007. Evaluation of use of cellphones to aid compliance with drug therapy for HIV patients. AIDS Care 2007, 19:605-607.
Tohouri, R, 2009. Building e-Health Information Infrastructure in Mali. IIMC International Information Management Corporation, 2009 ISBN: 978-1-905824-11-3
UNFPA, 1996. Support to Traditional Birth attendants (TBAs). Issue 7
UN MDG Report, 2013. The Millennium Development Goals Report.
UN, 2007. Compendium of ICT Applications on Electronic Government. Volume 1: Mobile Applications on Health and Learning. IN DESA (Ed.). New York.
Unicef, 2008. Countdown to 2015:Maternal, Newborn & Child Survival. Tracking Progress in Maternal, Newborn and Child Survival: The 2008 Report. New York, UNICEF.
Vikkelsø, S, 2005. Subtle Redistribution of Work, Attention and Risks: Electronic Patient Records and Organisational Consequences. Scandinavian Journal of Information Systems:Vol. 17:Iss.1,Article10
Wilson, R. (2000). Using Computers in Health Information Systems. Design and Implementation of Health Information Systems. World Health Organization
Wilson, R. G. and Smith, D. L. (1991). Microcomputer Applications for Primary Healthcare in Developing Countries. Infectious disease clinics of North America 5(2): 247.
WHO, 2011. mHealth: new horizons for health through mobile technologies: second global survey on eHealth. WHO, Geneva; 2011.
WHO, 2010. Antiretroviral Therapy for HIV Infection in Infants and Children: Towards Universal Access,
WHO, 2013. Improving maternal and newborn access to services in Ghana. Grameen Foundation‘s MOTECH
WHO-UHC, 2013. Universal Health Coverage: Supporting Country Needs.
WHO Report, 2015. Strengthening the Capacity of Community Health Workers to Deliver Care for sexual, Reproductive, Maternal, New-born, Child and Adolescent Health. Technical brief by the H4+ (UNAIDS, UNFPA, UNICEF, UN Women, WHO and the World Bank)
Yin, R, 2009. 4th Edition. Case Study Research: Design and Methods. Newsbury Park, California: Sage.