Plans and “off‐plan activities”: Exploring the roles of data and situated action in health planning in Burkina Faso

Abstract

AbstractImplementation of health management information systems (HMIS) has gone hand in hand with a growing global demand for high‐quality data. While this has sustained HMIS implementation, it has also promoted a data‐centric assumption that better data leads to better action on health. An example is health managers envisaged using HMIS data to make action plans for health service delivery. The paper draws on an in‐depth study of practices of health data use in Burkina Faso to explore this relationship further. In this context, deviation from the agreed plan is not seen as problematic. Local action plans are often overruled because of requirements of higher levels, unexpected developments in diseases, or sudden provision of fresh funding. Health managers organize work under these uncertain circumstances through situated action. The concept of “off‐plan activities” is used to handle unforeseen events. Mobile phones are used extensively to make and remake plans. It is argued that the findings invite us to consider a less data‐centric approach to the role of HMIS data in health service delivery, where HMIS data are seen less as a tool to discipline local practices than as one element of the dynamic practices undertaken by individuals in the organization of daily work.