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Managing misinformation - introducing a new health management information system in Uganda

How can health management information systems (HMIS) be successfully introduced in low-income countries? Research coordinated by the University of Sheffield examined the introduction of HMIS in Uganda and identified the problems experienced in the process. Can the introduction of HMIS support the decentralisation of the Ugandan health service? Can it assist real organisational change at the local level?

The transition to primary healthcare (PHC) oriented health systems in many low-income countries has influenced need for more health information to be effectively collected from health units and made accessible at the local level. In response, HMIS is a tool that allows for the decentralised local level management of health systems. The World Health Organisation (WHO) has identified this area as a priority in low-income countries.

Researchers used two theoretical models to explain the process of implementation. The first - the diffusion of innovation framework - is useful for identifying factors that aid or hinder the introduction of technological change. The second is based on the idea that organisations always seek to maintain equilibrium of forces and that introducing changes in one aspect of the organisation leads to counterbalancing changes elsewhere. The research found that:

Developers did not explain the implications that the new HMIS would have on the Ugandan health system. The main consequence was that a new management style should follow the introduction based on local decision-making processes that would be the result of the information gathered by HMIS.
Many staff were required to perform tasks in information collection for which they had been poorly trained. As a result, using the information gathered proved to be difficult and targets continued to be set at the district and national level, instead of the local level.
There was a lack of tools and management systems that could be used to monitor the implementation of HMIS.
As a result of the introduction of HMIS, organisational changes did take place. These, however, happened against the constraints of existing structures as the necessary process of decentralisation was either misunderstood or resisted by the health units situated at various points in the health service hierarchy.
As local level data was not being properly collected, there was a lack of alignment between the new technology (HIMS) and the overall organisational strategy.

In sum, it appears that the introduction of HMIS in Uganda did not follow either of the models used by researchers to explain the implementation process. Instead, researchers suggest that technological issues were paramount in explaining the way in which the introduction of HIMS took place. The research has implications for future practice:

The two explanatory models can still be used to identify potential problems in the introduction of HMIS in other low-income countries.
Information system developers must acknowledge that the introduction of HIMS necessarily leads to different management approaches. This needs to be made clear before introduction is made so that the organisational structure can be transformed adequately.

Source(s):
'Implementing a new health management information system in Uganda', Health Policy and Planning 18(2): 214-224, by J. Gladwin, R.A. Dixon and T.D. Wilson, 2003

id21 Research Highlight: 18 November 2003

Further Information:
Jean Gladwin
Health Services Research Unit
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
UK

Tel: +44 (0)20 7636 5669
Contact the contributor: jean.gladwin@lsthm.ac.uk

University of Sheffield, UK

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