Standardising Through Software

Since its inception in 1948, the World Health Organization (WHO) has been instrumental in setting standards for monitoring and evaluation of public health interventions and health service delivery. This paper focuses on the way in which these standards are operationalized through health indicators and analytical tools. We describe and discuss a concrete attempt by WHO to achieve this by embedding indicators and analytical outputs in a health information software that is used in a majority of the world’s least developed nations. We analyse this phenomenon by using a concept of fluid standards, and challenge the ‘conventional’ perspective on standards as fully specified and unequivocal outputs of formal standardisation processes

Digital Platforms for Standardisation in Global Health: The Case of the Digital Health Packages

This thesis is a study of standardisation within the global health field, investigating the potential role of digital platforms in facilitating such standardisation. It describes and analyses an eort of the World Health Organisation (WHO) to disseminate its standards and guidelines on health information to countries by embedding them in digital health packages, which can be implemented in a widely used digital platform. Part of the mandate of WHO is to provide standards and guidance on health information management and use for its 194 member states. However, disseminating these standards and guidance to countries and ensuring their implementation in national health information systems has proven challenging in practice. This points to broader themes discussed in the literature on standards and standardisation, such as barriers to the adoption of standards, tensions arising when implementing global, universal standards in diverse local contexts, and the #exibility of standards. Using the WHO-led digital health packages initiative as a case, the thesis discusses these challenges guided by the research question: What is the potential of digital platforms to support standardisation in global health? The empirical data presented in this thesis was collected through an action research approach. This included involvement in activities related to the implementation of health information systems based on digital platform technolo!y in several countries in West Africa, and in the WHO-led standardisation initiative at the global level. This two-levelled research design allowed a study of the standardisation initiative from the perspective of both standards developers and standards adopters. Analysis of the empirical data is guided by organising vision theory, developed originally to explain the adoption of IT innovations in organisations. Organising vision theory provides concepts that help analyse how dierent stakeholders, with a shared vision of disseminating global health standards, could be coordinated and mobilised in support of the digital health packages initiative. The findings in this thesis indicate that characteristics of digital platforms can facilitate and support standardisation in global health. These digital platform characteristics include a modular architecture that can be extended with platform complements, the ability to facilitate transactions between groups of users, and an ecosystem of actors around the platform. The thesis, in itself and through the six research papers that constitute a major component of it, includes theoretical, methodological, empirical and practical contributions. Theoretically, it makes the potentially fruitful connection between digital platforms and standardisation, and discusses how di$erent digital platform characteristics can serve to support standardisation in global health. Methodologically, the thesis presents a novel research design for studying large-scale digital phenomenon, based on doing in-depth, qualitative research at two levels, e.g. the national and the global. Empirically, it constitutes a longitudinal digital platform study, of which there are relatively few. Finally, for practitioners, it o$ers concrete advice on how digital platforms can be leveraged in support of standardisation within global health

Health Information Systems in West Africa : Implementing DHIS2 in Ghana

Health Information Systems (HIS) are a critical component of a health system, but have often been neglected in most developing countries. The Health Information Systems Programme (HISP) tries to remedy this, by working closely with end users to improve HIS and thereby increasing the use of information. Its main vehicle for this is the District Health Information System, version 2 (DHIS2), a flexible open source software tool based on web technologies, that can be used for collecting, validating, analysing and presenting health data. The objective of this thesis is to study how a complex information system like DHIS2 can be implemented in a developing country. My main focus is West Africa, where I have spent about four months doing fieldwork. Most of the time I have been in Ghana, assisting and studying the implementation of DHIS2 there. As part of this, I have evaluated the Ghana health information system in general, and participated in the implementation of DHIS2 there. While Ghana is the main focus of my research, I have also worked with other countries in the region, in particular with Liberia. Consequently, I also discuss and evaluate the situation in terms of health information for the region as a whole. I show how the internet can play a huge for the ICT development in Africa in the coming years. Contrasting the implementations in Ghana and Liberia, the former using the internet and the latter using standalone installations, demonstrates the many benefits internet can have when implementing a system like DHIS2, for example by increasing the possibility of user participation in the design of the system and reducing the need for local human capacity to support software installations

Cloud Computing for Development – Improving the Health Information System in Ghana

The health sector in many developing countries is undergoing restructuring to meet set goals, especially the health related Millennium Development Goals. To be able to monitor the performance of the health sector, an efficient Health Information System (HIS) is essential. This paper describes the process of implementing an online data warehouse based on the open source District Health Information Software 2 (DHIS2) in Ghana, integrating existing vertical reporting systems run by various health programmes. We discuss how an online deployment has solved many of the challenges facing the previous HIS in Ghana, and how it is an example of how cloud computing can be leverage to great effect in developing countries. IST-Africa 2013 Conference Proceedings

Manual for the DHIS2 quality tool. Understanding the basics of improving data quality

A Health Management Information System (HMIS) is important for a country’s capacity to Monitor health, and for evaluating and improving the delivery of health-care services and programs. Many developing countries struggle with data quality problems in their HMIS systems resulting in incomplete, inaccurate and untimely information. As a result, the systems do not provide a good basis for knowledge-based decisionmaking on health. The newly developed DHIS2 quality tool is a contribution to a practical approach for improvement of HMIS data quality. By using the quality tool, potential errors in the data are identified. This knowledge can be used to take appropriate action for improving data quality. In many cases, this will be to either edit the data or to improve the data collection system. Implementing modern statistical methods and technology, like the DHIS2 quality tool, are important factors in achieving good quality in data/statistics. This is a manual for basic use of the DHIS2 quality tool. The manual is aimed at explaining the possibilities of the quality tool, but also to be an input to capacity building and workshops. The data quality tool does not only display potential data errors, but also contributes to improved understanding of the data quality. The manual is a meant as a practical guide to use the DHIS2 quality tool. Actual screenshots from DHIS2 and a realistic test data set are used to explain and visualize (which is available on the DHIS2 training server). The DHIS2 Data Quality Tool requires an initial configuration for much of the functionality, and this initial setup is the best way to get started.Norwegian Agency for Development Cooperation (NORAD)publishedVersio

Strategies for Standardizing Health Information Analysis

Part 2: Digital Platforms for DevelopmentInternational audiencePurpose: This paper analyses an initiative led by WHO within the health information domain to standardise analysis of health information through the use of analytical dashboards, using the concept of flexible standards. We focus on the implementation of these standards within existing, working information systems, analysing the implementation strategies used, and how these are enabled by the flexibility of the standards. Design/methodology/approach: The study follows an action research approach, where the authors have been involved in the development and implementation of the initiative being discussed. Findings: By analyzing the approaches taken by several countries to implement these standards we show how these different approaches are enabled by the flexibility of the standards. Practical implications: This paper demonstrates the potential importance of flexibility in standardisation initiatives around health information, with particular relevance to voluntary standardisation efforts involving independent actors, in this case Ministries of Health. Originality/value: The flexible standards concept is employed to study a multi-country initiative involving WHO and several national governments. We contribute to the literature on flexible standards by showing that beyond flexibility in the standards, flexibility in the software platform in which the standards are implemented, and the variation allowed in the standardisation process at an organisational level, are important factors that facilitate standards implementations