Data flows in health information systems : An action research study of reporting routine health delivery services and implementation of computer databases in health information systems

This study evaluated the reporting of routine health delivery services and prototyped a computer database, district health information software (DHIS), in the health information systems in Tanzania and Mozambique using case study sites in Bagamoyo district and Gaza province in Tanzania and Mozambique, respectively, from March to August 2002. The purpose of the study was to assess and determine the quality and quantity of reporting of health delivery services; and the benefit, challenges, and conditions for implementing a computer database at the district level of the health information systems in both countries. The study falls under the framework of action research, where the phases of action research (diagnosis, action planning, action taking, evaluation, and specifying learning) were executed in sequence and cyclically. The diagnosis phase of the study was carried out through interviews, questionnaire, analysis of texts and documents, and participant observations. Appropriate actions were planned. In the action phase, software was developed in order to migrate data from existing computer databases to the DHIS; data were migrated from paper-based databases to the DHIS; and the DHIS was translated into Swahili while adopted in Tanzania. Evaluation of the actions taken was conducted through group discussions and workshops with health workers. To specify learning, reports of the results were prepared and presented to the Ministries of Health for review. The results were analysed using the DHIS, SPSS computer software, and using content analysis. The findings were presented quantitatively and qualitatively using tables, graphs, figures, photos, and elaboration. The findings indicated that the health data being reported were not sufficient to support informed decision-making and health planning. The causes of the low quality of the data identified include incomplete, inaccurate, and untimely reporting; lack of resources and office space; existence of legacy information systems; and the existence of parallel reporting systems in the health information systems. The findings also indicated the major challenges in introducing computer databases to be the participation of users and the existing computer database systems. The study demonstrated that the DHIS is suitable software for the health information systems, and that data locked in legacy information systems can be safely extracted and migrated to new information systems

Tensions in Rural Water Governance: The Elusive Functioning of Rural Water Points in Tanzania

Public water services are still failing rural Tanzanians. Emboldened by advances in information communication technologies, the Ministry of Water has been developing computing, financial and administrative technologies to update and visualise the status of rural water points. This amalgam of technologies marks the emergence of an information infrastructure for rural water governance. The information infrastructure will enable the ministry to “see” the functionality status of all rural water points and to plan and budget for their repair and maintenance. In this paper, we examine three administrative technologies, which aim to standardise the functionality status of water points, and to prescribe how the information flows within the government hierarchy, and who is a legitimate recipient of this information. We analyze qualitative data, collected over a period of four years, in the framework of an interdisciplinary research program, funded by the Netherlands Organisation for Scientific Research—Science for Global Development (NWO-Wotro). In contrast to other researchers who study how information infrastructure evolves over time, we study what infrastructure evolution reveals about water governance. Our analysis of the practices of participants in rural water governance reveals tensions between formal and informal processes, which affect rural water services negatively

If citizens protest, do water providers listen?: Water woes in a Tanzanian town

Tanzania’s urban citizens are still insufficiently supplied with safe drinking water by their water utilities. However, instead of collectively clamouring for improvements, citizens channel their protests individually to water authorities. This paper aims to shed light on citizens’ protest strategies and the responses they elicit from the water authorities. It draws on extensive fieldwork carried out in a Tanzanian town, which revealed four protest strategies employed by citizens: “stay and speak up”, “speak up and leave”, “resignation” and “leave and remain silent.” The study reveals a substantial mismatch between citizens’ protest strategies and the formal/informal complaint mechanisms of the water authority. This has negative implications for underprivileged citizens and for broadly defined “access to water”

Sensors, empowerment, and accountability: a Digital Earth view from East Africa

Several innovative ‘participatory sensing’ initiatives are under way in East Africa. They can be seen as local manifestations of the global notion of Digital Earth. The initiatives aim to amplify the voice of ordinary citizens, improve citizens' capacity to directly influence public service delivery and hold local government accountable. The popularity of these innovations is, among other things, a local reaction to the partial failure of the millennium development goals (MDGs) to deliver accurate statistics on public services in Africa. Empowered citizens, with access to standard mobile phones, can ‘sense’ via text messages and report failures in the delivery of local government services. The public disclosure of these reports on the web and other mass media may pressure local authorities to take remedial action. In this paper, we outline the potential and research challenges of a ‘participatory sensing’ platform, which we call a ‘human sensor web.’ Digital Africa's first priority could be to harness continent-wide and national data as well as local information resources, collected by citizens, in order to monitor, measure and forecast MDG