Health Information Systems and Accountability in Kenya:a Structuration Theory Perspective

Health information systems (HIS) in most low- and middle-income countries (LMICs) have been often implemented under the international pressure of accounting for healthcare investments. The idea behind robust and efficient HIS is that health information can allow healthcare managers and providers to better plan and monitor health services, which may translate into better health outcomes. Yet, researchers have often criticized the use of HIS as accountability tools as being counterproductive by making health information more meaningful to national governments and international agencies than those in charge of local health services. In this paper, I analyze how HIS influence the emergence of local accountability practices and their consequences for healthcare provision. I build a theoretical perspective from structuration theory and integrate it with the technology domain of HIS. I use this perspective to analyze a case study of HIS in Kenya. This study raises implications for the use of structuration theory in understanding accountability and the role of IT materiality in processes of structuration. It contributes to a better understanding of how HIS can foster improved healthcare and human development. It also contributes to the understanding of IS as means not just for governing people’s behavior but also of socialization through which users can negotiate multiple accountability goals

Panel: Labor importation as the steroid for nations\u27 ICT success: A debate

In the recent years most African countries have embarked on a series of reforms involving the decentralisation and also integration of health information systems in order to allow improved efficiency and effectiveness in the health care. However, although the discourse around these issues are reflected in global policy documents of almost twenty years ago, IS are still fragmented and weak at the lower levels of the health service. The paper takes a multivocal and multilevel institutionalist perspective to analyse the role of information technology in shaping these shortfalls between institutional accounts and enactments of reforms. Based on the case study of two divisions of the ministry of health in Kenya, it aims to better understand the change implications of information technology for the structures of a health information system in Africa. This is meant to improve the understanding of the way technology-mediated human interactions produce variance between planned organisational change envisaged in donor-driven reforms of the health care service and unplanned HIS structures emerging from the local institutionally-embedded usage of IT tools

Challenging Dominant Frames in Policies for IS Innovation in Healthcare through Rhetorical Strategies

Information Systems (IS) innovation in healthcare is a contested area often characterized by complex and conflicted relationships among different stakeholders. This paper aims to provide a systematic understanding of the mechanisms through which competing visions about health sector reforms are translated into policy and action generating contradictions in IS innovation. The paper argues that we can learn more about the source of such contradictions by examining how competing frames can affect IS innovation in healthcare. We adopt frame theory and rhetorical strategies analysis in the case of health sector reforms in Kenya, with a specific focus on the deployment of health information systems. We make the following contributions. First, we demonstrate that policy actors’ adherence to the interests and values represented in a frame is important in determining the choice of a rhetorical strategy and its influence on policy transformation and IS innovation. Second, we develop an understanding of how technology mediates the rhetorical strategies of different actors. In particular, we demonstrate the role of technology in giving continuity to frames, thus affecting policy change and IS innovation

Telecentre Users as Mediators of Empowerment of Rural Communities in Malawi

For over three decades telecentres have been promoted as a means of reducing digital exclusion. However, their relevance is inconclusive. In this paper we investigate how telecentre users empower rural communities in Malawi. We adopt a qualitative approach and report preliminary findings from users and indirect beneficiaries of one telecentre. The findings indicate that empowerment effects of telecentres go beyond users. Specifically, when users use the telecentres, they get empowered and, eventually, empower other community members by, for example, teaching ICT, sharing knowledge, and raising awareness of problems and providing solutions within communities, thus generating collective empowerment. The study further indicates that community empowerment is influenced by such factors as social connections, self-growth, and beneficiaries' willingness to receive help. However, empowerment was also beset with a series of constraints such as limited resources

How do unintended consequences emerge from EHR implementation? An affordance perspective

Drawing upon an affordance‐actualisation perspective, we aim to advance our knowledge of the emergence of unintended consequences from the implementation of Electronic Health Record (EHR) systems. Prior research has not yet deeply understood how these unintended consequences unfold. We investigate how the (non‐)actualisation of affordances produces unintended consequences. Our exploratory case study of an EHR system implemented in Italy reveals four types of actions (flexing, bypassing, avoiding, and reorganising) through which different types of unintended consequences occur with the (non‐)actualisation of affordances. We explain and theorise how interactions among technology features and psychosocial and organisational constraints/enablers contribute to users' perception of affordances and technological constraints. This, in turn, influences different types of user actions, leading to unintended consequences. Our findings and insights contribute to the literature on unintended consequences and help organisations better manage implementing new systems.<br/

Opening of the Mitochondrial Permeability Transition Pore Causes Depletion of Mitochondrial and Cytosolic NAD+and Is a Causative Event in the Death of Myocytes in Postischemic Reperfusion of the Heart

The opening of the mitochondrial permeability transition pore (PTP) has been suggested to play a key role in various forms of cell death, but direct evidence in intact tissues is still lacking. We found that in the rat heart, 92% of NAD(+) glycohydrolase activity is associated with mitochondria. This activity was not modified by the addition of Triton X-100, although it was abolished by mild treatment with the protease Nagarse, a condition that did not affect the energy-linked properties of mitochondria. The addition of Ca(2+) to isolated rat heart mitochondria resulted in a profound decrease in their NAD(+) content, which followed mitochondrial swelling. Cyclosporin A(CsA), a PTP inhibitor, completely prevented NAD(+) depletion but had no effect on the glycohydrolase activity. Thus, in isolated mitochondria PTP opening makes NAD(+) available for its enzymatic hydrolysis. Perfused rat hearts subjected to global ischemia for 30 min displayed a 30% decrease in tissue NAD(+) content, which was not modified by extending the duration of ischemia. Reperfusion resulted in a more severe reduction of both total and mitochondrial contents of NAD(+), which could be measured in the coronary effluent together with lactate dehydrogenase. The addition of 0.2 microm CsA or of its analogue MeVal-4-Cs (which does not inhibit calcineurin) maintained higher NAD(+) contents, especially in mitochondria, and significantly protected the heart from reperfusion damage, as shown by the reduction in lactate dehydrogenase release. Thus, upon reperfusion after prolonged ischemia, PTP opening in the heart can be documented as a CsA-sensitive release of NAD(+), which is then partly degraded by glycohydrolase and partly released when sarcolemmal integrity is compromised. These results demonstrate that PTP opening is a causative event in reperfusion damage of the heart

The synapsin gene family in basal chordates: evolutionary perspectives in metazoans

<p>Abstract</p> <p>Background</p> <p>Synapsins are neuronal phosphoproteins involved in several functions correlated with both neurotransmitter release and synaptogenesis. The comprehension of the basal role of the synapsin family is hampered in vertebrates by the existence of multiple synapsin genes. Therefore, studying homologous genes in basal chordates, devoid of genome duplication, could help to achieve a better understanding of the complex functions of these proteins.</p> <p>Results</p> <p>In this study we report the cloning and characterization of the <it>Ciona intestinalis </it>and amphioxus <it>Branchiostoma floridae </it>synapsin transcripts and the definition of their gene structure using available <it>C. intestinalis </it>and <it>B. floridae </it>genomic sequences. We demonstrate the occurrence, in both model organisms, of a single member of the synapsin gene family. Full-length synapsin genes were identified in the recently sequenced genomes of phylogenetically diverse metazoans. Comparative genome analysis reveals extensive conservation of the SYN locus in several metazoans. Moreover, developmental expression studies underline that synapsin is a neuronal-specific marker in basal chordates and is expressed in several cell types of PNS and in many, if not all, CNS neurons.</p> <p>Conclusion</p> <p>Our study demonstrates that synapsin genes are metazoan genes present in a single copy per genome, except for vertebrates. Moreover, we hypothesize that, during the evolution of synapsin proteins, new domains are added at different stages probably to cope up with the increased complexity in the nervous system organization. Finally, we demonstrate that protochordate synapsin is restricted to the post-mitotic phase of CNS development and thereby is a good marker of postmitotic neurons.</p