FOSS HIS in Public Health Domain: Case Study of Design-Reality Gap and Local Improvisa-tion in Global South

Abstract

Background and Purpose: Health Information Systems (HIS) are an integral in health reform agendas even in developing countries, although technological and financial limitations found to be the major barriers. Hence, free and open source software (FOSS) plays an enabling role in global south. FOSS HIS are developed based on generalized domain requirements and, FOSS implementations faces challenges of discrepancy between global design and local requirements. This is known as design-reality gap. The disagreement between abstract requirements and local actuality was found to be crucial for the sustainability of HIS, and design and actuality improvisations were coined as remedial measures. Methods: This comparative case study encompassing empirical experience of introducing FOSS HIS to Sri Lankan public health sector, expects to discuss health managers' awareness of possible design-reality gaps in embarking on FOSS HIS implementation decisions. It also tries to explore to what extent health managers are ready to accept a design-reality gap and to change the business actuality of health organization to accommodate functional restrictions of FOSS HIS. A series of semi-structured interviews and focus group discussions with health programme managers and public health experts were major source of data for this discussion. Results: It was revealed that the health programme managers were aware of possible design-reality gap in considering FOSS artefact as a HIS implementation candidate. Also, in Sri Lankan context, health managers preferred design improvisation over actuality improvisation with a conservative view towards business process revision. Conclusions: Abstract functionalities of FOSS HIS required to be extended to suit the business contexts of health programmes. The specific business routines demanded FOSS artefact to be further customized and the level of customization required ranged up to the source code level. Ability to reach consensus over design improvisation was successful than proposing for business process revision. Keywords: Health Information Systems, Open Source, Requirement Abstraction, Design-Reality Gap, Local Improvisation