Making the connection - decentralising the management of health information in low-income countries

How does the shift towards decentralisation of health services in low-income countries affect the way in which health information is managed? Researchers from the University of Sheffield investigated the effects of the introduction of a new health management information system (HMIS) into primary healthcare (PHC) and how it affected the role of local managers. How successful was the systems introduction? Does this process offer further opportunities for future transitions to the decentralisation of information in healthcare?

According to the World Health Organisation (WHO), the introduction of HMIS in low-income countries has produced little improvement in the management of health information, and in some cases has made matters worse. The Aga Khan Foundation (AKF) has created a training package for PHC managers called the primary healthcare management advancement programme (PHC MAP). Researchers followed the introduction of this package in an east African country and the process of development of HMIS.

The researchers used observation and interview techniques to investigate the response of potential users - PHC managers and policy makers - to the information management package. The research found that:

• Most of the users thought that PHC MAP did not take account of the organisational structure of health services and was thus inappropriate to their needs.
• The management teams for whom the PHC MAP was designed lacked the skills to use the information management techniques.
• Most of the potential users thought that PHC MAP did not reflect the management tools they used in their work, such as financial data at district and health unit level.
• Some participants found that the introduction of PHC MAP would create disruption in the health management processes.

The potential users of PHC MAP thought that the developers had not assessed their needs. Consequently, they thought that this suggested new ways of managing were not appropriate for their country’s health system. However, an improvement in information management among health managers could have been achieved by:

• relating information management tools to existing management practices
• reflecting the training approach, policy and the organisational and management style used in the particular setting
• identifying common problems and possible solutions
• drawing on existing experience and research in the introduction of HMIS.

Source(s):
'Rejection of innovation: health information management training materials in east Africa', Health Policy and Planning 17(4): 354-361, by J. Gladwin et al, 2002

Funded by: The University of Sheffield, UK; British Council

id21 Research Highlight: 22 July 2003

Further Information:
Jean Gladwin
52 Burcot Road
Sheffield
S8 9FE
UK

Tel: +44 (0)114 2555 763
Contact the contributor: jgladwin_99@yahoo.co.uk

University of Sheffield, UK

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