HEALTH INFORMATION SYSTEMS IMPLEMENTATION IN DEVELOPING COUNTRIES: A TRANSLATION PROCESS

This paper takes a look at the political issues involved in the implementation of health information system (HIS) in resource constrained countries. By doing a comparative case, we attempted to understand how two different implementation processes took shape in two countries – Tanzania and Vietnam using Actor network theory (ANT) as our analytica lens. The study suggests that by mobilizing an appropriate number of actors, the HIS implementation as a network building process can earn its effect as a hub to attract other important actors that are still reluctant to join the initiative. Furthermore, the paper argues for the need to make use of detours and pay special attention to the marginal groups of actors as siginificant approaches in the network building process in resource constrained settings

Power Tensions in HIS Integration in Developing Countries: The Need for Distributed Control

As part of health sector reform, most developing countries are in the process of standardizing and integrating various vertical reporting systems. Nevertheless, the pressure resulting from the vertical systems supported by donors renders the integration goal challenging and unachievable. While studies have argued for the heterogeneity of interests and donors’ multiple needs as the major causes, this paper argue for more critical analysis of the problem. The paper contribute by arguing for the need to understand the main actors involved, in terms of their resources and rules as they are implicated in HIS integration. Using an empirical case and Structuration theory concepts, we identified dialectic power relations between the actors resulting from control of resources and rules. The need to build shared meanings of the integration process through communication approaches; and to distribute control of the integrated HIS, facilitating ‘tapping on’ the resources available to the actors is discussed

HIS Standardization in Developing Countries: Use of Boundary Objects to Enable Multiple Translations

Standardization and integration of Health Information Systems (HIS) in most developing countries has been reported as a complex undertaking due to poverty, multiplicity of diseases and diverse actors working in various initiatives within the healthcare context. The need for collaborative investments in HIS strengthening is highlighted by major actors such as WHO, as significant to achieve an integrated HIS. However, despite the fact that involvement of multiple partners is desirable as a vehicle to attain an integrated HIS, entailed challenges should be understood and well managed. By drawing on the concept of translation from actor network theory supplemented by the notion of boundary objects, we examine the HIS standardization challenges and the strategies to curb them in the context of multiple divergent actors engaging in HIS integration process in Tanzania. The article stresses the need to coordinate the standardization process through circulation of boundary objects across the involved multiple actors

Transaction Dollarization in Tanzania

Some observers in Tanzania have suggested that a significant portion of Tanzania’s businesses and service providers are using the U.S. dollar for pricing purposes as well as carrying out transactions.  However, very little evidence has been put forward to support these claims.  This study examines the evidence of dollarization in Tanzania, focusing mainly on the use of U.S. dollar as a medium of exchange and unit of account.  The evidence presented in this study suggests that many of the concerns that have been expressed by some observers about significant use of the U.S. dollar as a medium of exchange in Tanzania are not well founded.  The findings indicate that about 3.2 percent of the businesses in Mainland Tanzania and 4.5 percent in Zanzibar quote prices in U.S. dollar, but most of these businesses were willing to accept payments in Tanzanian shilling.  Only 0.1 percent of the businesses in the Mainland and none in Zanzibar indicated that they would prefer payments exclusively in U.S. dollar.  The findings also indicate that quotation of prices in U.S. dollar is limited to specific locations and applies to specific products/services, and in most cases is done for bona fide reasons.  It is important to appreciate the influence of increased trade openness on demand for and attitude towards U.S. dollar, which is the dominant currency of foreign trade. The fact that Tanzanians hold a small portion of their wealth in U.S. dollar and insignificant number of prices are quoted in foreign currency may not be surprising in an economy where foreign goods and services account for a significant portion of what a typical household consumes.  This may simply be a natural phenomenon resulting from the fact that Tanzanian economy has become much more open and outward oriented than it was some 20 years ago. In addition, this experience is not unique to Tanzania.  Many countries in the region and across the world are experiencing a similar situation. We urge the authorities to avoid the use of direct measures in their quest for limiting dollarization in the economy because international evidence suggests that enforcing de-dollarization can potentially be counter-productive. Instead, we recommend the use of gradual market-oriented measures aimed at enhancing the attractiveness of the domestic currency

COLLABORATIVE KNOWLEDGE MAKING AND SHARING ACROSS SITES: THE ROLE OF BOUNDARY OBJECTS

A number of researchers on Science and Technology Studies (STS) have criticized the western view treating knowledge as objective and universal, with the argument that all knowledges are locally situated. In this article we draw on this view of decentring of scientific knowledge and on the concept of boundary objects to discuss an empirical case of a ‘global’ collaborative network called Health Information System Programme (HISP) involving a number of countries in a process of knowledge creation and sharing. The network consists of knowledge objects with seemingly universal characteristics shareable across sites. The paper discuss the ‘localness’ of the knowledge produced by looking at its originality and how it is made mobile, thereby giving it the seemingly universal characteristics. The article further, discuss how the involved multiple social worlds characterized by different knowledge practices, cultures and visions, participate through boundary objects shareable across the network and thereby contribute new knowledge in the network. The collective boundary objects created and shared within the network play a significant role in creating synergies which in turn sustains the involved countries’ local initiatives

Challenges and Opportunities in the Integration of HIS : Case Study from Zanzibar

This thesis presents an in-depth theoretically underpinned empirical analysis of the challenges to integrate the fragmented health information systems within the Zanzibar health care system. The research is situated in the broader topic of health sector reforms, which advocate and implement a number of healthcare organizational changes in which decentralization and integration of the disparate health information systems is one of them. The study sought to meet three objectives: 1) to understand the challenges in the processes of achieving integration; 2) to study the challenges and opportunities emanating from the way users received and related to the newly integrated health information system and 3) to study the strategies used to curb the integration challenges. In meeting the stated objectives, the research employed qualitative research methods namely, semi-structured interviews, participant observation in meetings and trainings, and document and software analysis, in an indepth case study. Content analysis was drawn upon to write up and analyze the empirical materials. Theoretically, the study drew on the concept of installed base from the socio-technical conceptualization of large, integrated systems called information infrastructures and the user enactment concept based on the human agency perspective to analyse the empirical materials. In addition, the analysis was informed by the literature from health information systems’ discourse covering integration issues in developing countries. The study identified challenges in two major integration processes as follows. The first is the standardization process, in which the installed base presented the following challenges: heterogeneity of interests among health care stakeholders, inadequate knowledge on indicators and public health issues, and use of multiple languages in the previous data sets and tools standards. The second process is institutionalization of the standards which also faced a number of challenges from the installed base, which included lack of clear management structure, inadequate skills in computer, inadequate human resources, institutionalized work practices hampering training initiatives and relatively low education levels of health workers at the health unit level of the health system. The study found different ways in which users enacted the integrated health information system standards, which in turn presented both challenges and opportunities to the integration initiatives. The challenges came to play as some users such as vertical program managers, district officials and health unit staff enacted limited and non-use technologies in practice towards the new system. Conversely, the opportunities came as some users enacted different applications of the new standards, where some were able to reinvent different ways of using the standards as an attempt to workaround some misfits. Cultivation strategies which advocate on a piecemeal incremental process in the change attempts, to give room for experimentation and revision of strategies were drawn upon to curb the challenges. Specifically, the cultivation strategies included use of participatory approaches and modularization. However, the study suggests the need to build and strengthen communication and collaboration linkages between the stakeholders in the attempt to curb the inertia of the vertical and parallel reporting systems. Theoretically, the study contributes to information systems knowledge base on the use of the installed base and user enactment concepts to analyze the use of the integrated health information system. Furthermore, the research contributes through theoretical implications drawn from the use of the user enactment and user participation. The study shows that user participation does not always lead to compliance due to the power that users have to apply agency and enact different ways to respond to the new technology, irrespective of their participation

Establishment of saving and credit scheme in Charambe community

A study was conducted in Charambe Ward at Temeke Municipal through Charambe Development Association (CHADEA). The aim of the study was to conduct needs assessment in order to come up with a proposal to solve some of the existing and pressing community problems. Various problems were mentioned by the CBO leaders, members and some community members; but two problems appeared to be more serious according to the large population of the community. Those problems were unemployment and lack of capital for running and/or expanding the income generating activities. Specific objectives of the study were to conduct needs assessment in order to ascertain the mentioned/ prioritized needs or problems. The study also aimed at establishing whether the large proportion of the population thought that saving and credit scheme can have positive results. Secondly it was to explore the potential of CHADEA to establish and run the scheme in collaboration with the community members. Thirdly it was to establish if the community members had any idea concerning saving and credit schemes. The CHADEA leaders, members and some community members were interviewed. The interview was done using questionnaires to obtain important information about the characteristics (personal data) and other vital information that can assist in the implementation of the project. The findings had it that, the community's population which was estimated to have 700 people, 53.3% was women and 46.7% were men. It was also revealed that, the community is poor in the sense that about 81% of the total population earned an income below 50,000 shillings per month on average. Therefore the problem of lack of capital to majority of the community members became evident. It was also established from the survey results that only 15% of the total population were employed, while 59% were engaged in small business undertakings, 12.5% had nothing to do at all and 12.5% were laborers. The problem of unemployment also became obvious. About education level, the findings revealed that 64.9% had primary education level, 30.3%secondary education (ordinary level) 5.2% went to some collages after secondary school and 4.1% had no education at all. The results indicated that CHADEA is well accepted by the community and the projects are run transparently. About the acceptability of the project the survey results indicated that 56.9% said the scheme would be very useful, 29.8% said the scheme would be useful, 9% said it would be useless and 4.3% said they do not know. Therefore these facts indicated that the large proportion of the community's population thought the project could have a positive impact into their lives. Given these indications of the existence of poverty, and acceptability of the project by a large proportion of the community's population; a project proposal was prepared by the author. The proposal for establishing a saving and credit scheme has been sent to some development partners for grant/loan. The project proposal has been submitted to the African Development Foundation (ADF) to request for Tz shillings 8,720,000 while savings mobilizations is underway to raise some funds internally for the establishment of the project and our target is to collect 600,000 by August 2005. We intent to start up slowly with the little money that would be internally mobilized in case ADF would not give the loan/grant. After we have started we can request for a loan from SELF because one of their condition is that we must start operations and gain experience before borrowing from them. The project outcomes being the improvement of entrepreneur practices, access to financial services among community members. Also to increase the capacity and commitment of CHADEA to encourage savings and borrowing to large number of entrepreneurs and ensure repayment and effectiveness. (Author abstract)Nyella, P. L. (2005). Establishment of saving and credit scheme in Charambe community. Retrieved from http://academicarchive.snhu.eduMaster of Science (M.S.)School of Community Economic Developmen

Beyond the Crisis: Irish Aid’s Approach to Nutrition in Tanzania during the Covid-19 Pandemic

Malnutrition remains a major public health challenge in Tanzania, driven by complex factors such as water stress, gender inequality, and poor access to services. Irish Aid in Tanzania supports nutrition through a multisectoral approach to address nutrition-sensitive and specific challenges in regions of focus. After the first case of Covid-19 was reported in Tanzania, Irish Aid adapted a two-pronged approach to ensuring continuity of nutrition services before and during the Covid-19 pandemic. Through adapting its existing partnerships and engaging new partnerships, Irish Aid contributed to (1) mitigating the impact of the pandemic in Tanzania, and (2) safeguarding essential services, including nutrition. This article summarises Irish Aid’s approach and provides recommendations for building back better.Irish Ai