Health Information Systems Programme: Participatory Design within the HISP network

Abstract

This chapter seeks to contribute to the ongoing debates in the domain of Participatory Design by discussing the various trends and questions within the context of the Health Information Systems Programme (HISP) initiative ongoing globally over the last 15 or so years (see Braa et al. 2004). The empirical basis for this chapter is provided by the efforts – technical, educational and political – in developing and evolving the HISP network with a key focus on the design, development, implementation and scaling of the DHIS (District Health Information Software) within an action research framework for the public health sector in developing countries. HISP can be described as a global research, development and action network around healthinformation systems (HIS) for the Global South, enabled through South-South-North collaboration. The network is by no means homogeneous and static, nor in harmony following a single goal, including how Participatory Design techniques have been and should be used. HISP was initiated through the efforts of a few as a bottom-up Participatory Design project in South Africa in 1994/5, and has today evolved into a global and thriving network spread across multiple countries and contexts. This development has been non-linear and followed different trajectories, experiencing successes and setbacks, as well as radical technological changes: the Internet and mobile network revolutions in Africa and Asia and the shift from stand-alone desktop application to networked web applications. HISP evolution has gained further impetus through increased focus on global health, including on the achievement of the Millennium Development Goals (MDGs). During times of rapid policy, technological and other changes, HISP has all along tried to be ‘on top of ’ the changing environment, but has many times been victim to changing policies; as an example, being literally thrown out of Ethiopia after years of work as a result of political decisions at the national level. At no point in time have the HISP actors been able to foresee moves into the future, as the context of funding and politics has been constantly changing and uncertain. Maybe the only consistent element in the history of HISP has been a stubborn willingness to apply participatory approaches in designing HIS in cooperation with various levels of users in a variety of contexts. A key focus of the application of Participatory Design techniques has been around the designand development of the DHIS software. The DHIS is a tool for collection, validation, analysis and presentation of aggregate statistical data, tailored to supporting integrated health information management activities. It is designed to serve as a district-based country data warehouse to address both local and national needs. DHIS is a generic tool rather than a pre-configured database application, with an open meta-data model and a flexible user interface that allows the user to design the contents of a specific information system without the need for programming. DHIS development has evolved over two versions. The first – DHIS v1 – has been developed since 1997 by HISP in South Africa on MS Access, a platform selected because it was at that time a de facto standard in South Africa. The second – DHIS v2 – building on the v1 data model is a modular web-based software package built with free and open source Java frameworks, developed since 2004 and coordinated by the University of Oslo. The flexible and modular DHIS software application has all along been the pivotal elementin the HISP approach; both as a tool with which to communicate design to users and as a software application suite which may provide results from day one and thereafter expand while in full production, as more functionalities, datasets and other elements are added. This chapter attempts to describe this rather complex movement over the last 15 years of theHISP network and its associated dimensions of software development and Participatory Design processes in a multiplicity of contexts. We have interpretively developed a historical reconstruction of this movement to depict the following three broad phases of HISP development. Inaddressing the first phase (1995-2000), we discuss HISP in relation to ‘traditional’ Participatory Design based primarily on the experience in South Africa. In the second phase (2000-6), which was characterised by pilot projects and ‘networking Participatory Design’, we focus on how networks of action were created outside South Africa, also encompassing educational programmes. In the third phase (2006-10), development of the fully open source and web-based DHIS platform gained momentum and challenges were experienced in applying distributed Participatory Design and scaling HISP during a time of significant technological change, including rapid spread of Internet and mobile networks in developing countries. Finally, we discuss the future direction for HISP and Participatory Design in the age of cloud computing. In our coverage of HISP, we highlight the important role that context plays in each country, which we illustrate through cross-country comparisons.