Shaping the Evolution of the Health Information Infrastructure in Zimbabwe

Abstract

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.