This thesis is drawn from an ongoing action research project, Health Information Systems Program (HISP) which aims at developing sustainable, computerised Health Information Systems (HIS) in developing countries in order to improve the quality of health service delivery and to create local action and analysis. The research in this thesis is conducted in Kerala in India, where the use of participatory practices is studied in a developing country perspective. Participatory Design is generally seen as a precondition of the development of successful systems. However, the PD tradition has been criticised for being outdated and incomplete. With basis in these critiques, this thesis addresses the need for a re-conceptualised PD which is more adaptable to the development of large and complex information infrastructures rather than single, locally-based systems. From this area of interest, the following research questions arose: i) How has PD been used in the HISP project in Kerala, and how has it been helpful? ii) What aspects of social, political and cultural context shapes participatory processes in a developing country context like that in Kerala, India? iii) How do participatory processes in contexts like India differ from those in Scandinavia?
I have approached the problem domain using an action research approach and draw upon the theories of PD and Information Infrastructure (II). In order to carry out the research, a thorough understanding of the HIS in Kerala had to be obtained, and hence the II theory provided a functional socio-technical perspective to study the HIS. Further I use PD theory to understand the participatory processes used in Kerala and how this theory can be further improved to suit the complex contexts of HIS in developing countries.
The main research contributions of this thesis are the building of participatory networks which involves networks of stakeholders both multi-sectoral and multi-leveled. Also the context-sensitivity of PD is emphasised and it is argued how the context of which the system is introduced highly influences the use of PD. Additionally, a need for shifting focus from PD techniques to the outputs of such processes is discussed, as well as the need to focus on structural as well as behavioural changes when conducting PD processes.
|  Download
Design and Development of Spatial GIS Application for Primary Health Care Sector: Case Studies from India and Mozambique. John Lewis |
This thesis is drawn from an ongoing large-scale action research project Health Information Systems Program (HISP), which aims to develop sustainable computer based Health Information Systems (HIS) in and for developing countries. This study attempts to build an internationalized GIS application for the primary healthcare sector. The overall aim in this study is to develop a deeper understanding of the socio-technical aspects complexities and challenges emerging during the design, development and customization of internationalized GIS application for primary healthcare sector in the context of developing countries.
The research was based on a participatory action research approach within a comparative case study design covering two developing countries, India and Mozambique. This comparative approach helped to provide insights into how different contextual conditions, especially the existing installed base and cultivation strategies adopted, provide significant influences on the design, development and customization process of the GIS application.
The empirical data collection was carried over a one year period of intensive field study, involving the use of qualitative methods for data collection, and systems development through a prototyping approach.
The thesis is described over two cases. The first concerns the development of a non spatial application and how that was cultivated and grown over time through its linking with the GIS application for the healthcare sector in India. The second case, set in Mozambique, describes how the Indian GIS application was then subjected to a customization process along with other Mozambican master’s students to develop an application for the national level of the Department of Community health, within the Ministry of Health. This customization process involved both the non-spatial application and its subsequent linkage with the GIS component. The varying installed base and cultivation strategies involved in the two contexts gave rich insights into the design and development challenges that arise, and also helped to develop implications on how the GIS application can be internationalized and integrated with the global District Health Information Systems (DHIS) software that has been developed through the HISP action research project.
| Download Sensible Solutions or Technology Fetishism?
AN ANTHROPOLOGICAL STUDY OF ICT-ENABLED DEVELOPMENT IN SOUTH INDIA Maria Røhnebæk
|
This thesis focuses on the use of information and communication technology (ICT) for development ends. The main purpose is to explore divergences between ideals and realities within ICT-enabled development. The analysis is based on a six-month fieldwork carried out in Kuppam, a rural community in the state of Andhra Pradesh in South India. Kuppam comes under Chittoor district and is located in the southern part of Andhra Pradesh, intersecting with the two neighbouring states Karnataka and Tamil Nadu (see map in appendix, fig 1). The fieldwork was conducted over two periods of time from January to June 2002, and then for another month during November / December the same year.
The research is empirically grounded in two pilot projects initiated in Kuppam in 2001. In the first part of the fieldwork I mainly followed the implementation of Health Information System Program (HISP). The Department of Informatics, University of Oslo, in collaboration Andhra Pradesh Government are implementing this project.
The second project examined has sought to establish community information centres (CICs) in the five village headquarters in Kuppam. World Corps, a non-governmental organization (NGO) based in Seattle, has initiated and monitors this project with financial support from the Andhra Pradesh government.
| Download Software development with limited resources in a developing country
A study of the effects of limited resources on the development of a person-based family health-system in India
Svein-Gunnar Johanse |
Software development with limited resources is a challenge encountered by most developers at one time or another. The limited resources in question can involve many things like: Time, money, manpower, knowledge etc. Developing countries, due to their general lack of resources are particularly well suited as arenas for the study of this concept
The research questions we aim to explore are:
1) How can limited resources affect one’s work organizationally?
2) How can technological decisions affect the resource pool?
Our case involves a study of the effects of limited resources on the development process of a person-based family health system in India. Our results indicate that a lack of most specific resources often manifests itself into a more general lack of the resource: Time. Technological decisions can influence time through alteration of the resource pool. Making a technological decision in a limited resource environment should therefore be motivated by the management of time for facilitating the execution of critical tasks.
| Download Implementing a health information system in India: Challenges and opportunities for scaling and sustainability
Jørgen Darre |
Health Information Systems (HIS) are used to collect and analyze health data in order to support the improvement of health care services. Public health care in third world countries are often based on a poor functioning HIS. Simply put, data collection processes tend to be extensive, often of poor quality and typically failing to be used for practical purposes such as for effectively allocating resources. Thus, exploring ways of improving existing HIS is evidently a fruitful approach to strengthen public health care. As a part of health sector reform, governments in many developing countries are in the process of strengthening their HIS through the introduction of computer based systems.
This thesis describes and discusses the implementation of the Health Information System Program (HISP) in the Indian state of Andhra Pradesh. The study was done using an action research approach over a five month period spread over two years. The challenges were to work with political, infrastructural, human resources, geographical, and cultural issues to get the system developed, implemented and institutionalized. The results show that to institutionalize a HIS into the everyday working of the health department in Andhra Pradesh, it is important to recognise the interdependency between scaling and sustainability. Scaling indicates the need for the HIS to reach a certain geographic and functional scope so as to become of interest to the higher levels. Small pilot projects have problems in reaching such scale, and will therefore end up more as interesting academic exercises, unless they manage to reach a certain scope and scale.
Theoretically, concepts from information infrastructure theory have been used to better analyze the complexities of scaling and sustainability, and their interdependencies. An important research focus has been to explore how the smaller scale project in India that was studied could be extended – scaled up – so as to become of interest to health managers at different levels, and thereby, eventually, become institutionalised. Three key processes have been identified to achieve this goal of institutionalization. These are the processes of cultivation, the creation of gateways to enable integration between the “installed base” and the “new system”, and the choice relating to the level at which data-entry and report generation should take place. To achieve institutionalization, in addition to the above focus on these processes, equal emphasis needs to be also placed on obtaining political support, thus emphasizing the need to combine topdown and bottom-up strategies.
| | Download Application of Open Source GIS in District Health Information Systems
Lars Gunnar Vik and Trond Andresen |
This thesis considers issues surrounding use and development of open source geographical information systems (GIS) as a part of the district health
information systems in developing countries. The base for this thesis is field work done by the two authors in three different states in India in cooperation with the Health Information System Program India. The thesis looks into the general concepts of open source and geographical information systems in the Indian context, and present a GIS application created for a district health information system. Issues concerning open source GIS are discussed with observation done by the two authors. Based on the discussion the thesis will conclude that some reflection in the discussion may be of interest for developers of open source GIS. |
