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Health information systems reform in Kenya : an institutionalist perspective

By Roberta Bernardi


The development outcome of ICT and information systems in developing countries\ud is often influenced by international development policies and the action of\ud international actors such as donor agencies. In particular, ICT adoptions and\ud implementations in developing countries may be influenced by the contradictions\ud arising mainly from the tension between international managerialist development\ud policies and the main rationalities of actors in the local implementation context.\ud Based on the case study of health information systems in Kenya, the objective of\ud this thesis is to increase the understanding of how these contradictions may affect\ud the development and change potential of health information systems and ICTs in\ud developing countries in relation to international development policies.\ud Drawing on a dialectical perspective on institutional work, the thesis argues that the\ud change and development trajectories arising from the implementation and usage of\ud health information systems depend on how actors involved in the restructuring of\ud health information systems – i.e. donor partners, national decision makers and local\ud health information systems managers and users – respond to the ongoing dialectic\ud between global and local pressures of institutional change and stability.\ud The main findings of the research presented in this thesis point to the importance of\ud analysing political donor relations and the institutional entrepreneurship of local\ud actors in order to understand the change and development outcomes of health\ud information systems and ICT in developing countries

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