Edwin Nyella

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University of Oslo

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University of Dar es Salaam

Faraja T Igira

Institute Of Finance Management

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Papers by Edwin Nyella

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

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

Americas Conference on Information Systems, 2010

As part of health sector reform, most developing countries are in the process of standardizing an... more 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.

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Power Tensions in Health Information System Integration in Developing Countries: The Need for Distributed Control

EJISDC: The Electronic Journal on Information Systems in Developing Countries, Sep 1, 2010

As part of health sector reform, most developing countries are in the process of restructuring th... more As part of health sector reform, most developing countries are in the process of restructuring the Health Information Systems (HIS) by way 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 many studies have argued for the heterogeneity of interests and multiple data needs of the donors as the major cause of the problem, this paper argue for more detailed and critical analysis of the problem. To contribute to this, the paper emphasize the need to understand the main actors involved in the process in terms of the resources and rules available to them; and their implication in the HIS integration venture. By drawing on an empirical case study and Structuration Theory concepts, the paper identified the dialectic power relations between the actors resulting from the asymmetric ownership and control of resources and rules. To alleviate the power tensions, the paper proposed i) the need to build shared meaning of the integration process through communication approaches ii) and the need to distribute the control of the integrated HIS using modularization approach facilitating 'the tapping on' of the resources available to each group of actors.

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One country's journey to interoperability: Tanzania's experience developing and implementing a national health information exchange

BMC Medical Informatics and Decision Making, Apr 29, 2021

Background: Robust, flexible, and integrated health information (HIS) systems are essential to ac... more Background: Robust, flexible, and integrated health information (HIS) systems are essential to achieving national and international goals in health and development. Such systems are still uncommon in most low and middle income countries. This article describes a first-phase activity in Tanzania to integrate the country's vertical health management information system with the help of an interoperability layer that enables cross-program data exchange. Methods: From 2014 to 2019, the Tanzanian government and partners implemented a five-step procedure based on the "Mind the GAPS" (governance, architecture, program management, and standards) framework and using both proprietary and open-source tools. In collaboration with multiple stakeholders, the team developed the system to address major data challenges via four fully documented "use case scenarios" addressing data exchange among hospitals, between services and the supply chain, across digital data systems, and within the supply chain reporting system. This work included developing the architecture for health system data exchange, putting a middleware interoperability layer in place to facilitate the exchange, and training to support use of the system and the data it generates. Results: Tanzania successfully completed the five-step procedure for all four use cases. Data exchange is currently enabled among 15 separate information systems, and has resulted in improved data availability and significant time savings. The government has adopted the health information exchange within the national strategy for health care information, and the system is being operated and managed by Tanzanian officials. Conclusion: Developing an integrated HIS requires a significant time investment; but ultimately benefit both programs and patients. Tanzania's experience may interest countries that are developing their HIS programs.

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Journal of Health Informatics in Developing Countries

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Integration of Health Information Systems

Health information system is generally recognized as a tool to significantly address health servi... more Health information system is generally recognized as a tool to significantly address health service delivery problems. This fact is evident from ongoing reform efforts in most developing countries which among many other things, seek to revamp health information systems by ensuring availability of key information to support decision making processes. However, ensuring a working health information system is quite a challenge due to proliferation of of donor funded fragmented disease and service focused vertical systems. This book presents an in-depth theoretically underpinned empirical analysis of the challenges to integrate fragmented health information systems within a health care system of a low income country. Specifically, the book explores the challenges in the processes of achieving integration; and challenges and opportunities emanating from the way users received and related to the newly integrated health information system. Strategies used to curb the challenges are also exp...

Power Tensions in Health Information System Integration in Developing Countries: The Need for Distributed Control

The Electronic Journal of Information Systems in Developing Countries, 2010

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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 ... more 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.

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Challenges in health information systems integration: Zanzibar experience

2009 International Conference on Information and Communication Technologies and Development (ICTD), 2009

The health care milieu of most developing countries is characterized by multiplicity of vertical ... more The health care milieu of most developing countries is characterized by multiplicity of vertical programs supported by myriad of donors. Often, the vertical programs maintain their own uncoordinated information systems which are in conflict with the primary health care goals of integrated district based health information systems. While some countries have managed to integrate the vertical reporting systems into the national HIS, ensuring reliance and continuous use of the integrated HIS by the programs' managers is still a big challenge. The fragmentation of the HIS after integration, ensuing from the non reliance and compliance to the integrated system, has not received much attention empirically or analytically. Most of the contemporary research in HIS integration focused on the challenges in the process of achieving integration. The paper advocates the need to understand the nit gritty of what goes on after implementation which as the case suggests, presents enormous challenges to the HIS integration initiative. By drawing on an empirical case, the study revealed the tensions that exists between the ministry of health which strived to standardize and integrate the HIS and the vertical programs which pushed the agenda to maintain their systems alongside the national HIS. However, as implied from the study, attaining integration entails the ability to strike a balance between the two forces, which can be achieved by strengthening communication and collaboration linkages between the stakeholders and making use of gateways.

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1 Power Tensions in Health Information System Integration in Developing Countries: The Need for Distributed Control

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 an... more 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 ...

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

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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 informat... more 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.

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Exploring the Power of Technology in the Institutionalization of Health Information Systems: An Actor-Network Analysis of Information Systems Integration

Journal of health informatics, 2017

Background and Purpose: Information systems (IS) integration is a complicated exercise. This pape... more Background and Purpose: Information systems (IS) integration is a complicated exercise. This paper discusses the process of IS integration for a healthcare sector in a resource constrained context. In recognition of power play between the different actors involved, the paper underscores the complexity related to coordination of actors and institutionalization of organisational routines in order to achieve the goals of Health Information System (HIS) integration. In particular, the paper explores how artefacts (software, policy guidelines documents) can be used to facilitate coordination of the actors involved. Methods: The study employed actor network theory concepts of inscription and alignment to guide the data collection and analysis. Data collection methods include participant observation, documents review, and interviews, both formal and informal discussion groups. Results: The study reports implementations of an action research project in Tanzania (Zanzibar, and Mainland), whe...

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One country's journey to interoperability: Tanzania's experience developing and implementing a national health information exchange

Background Robust, flexible, and integrated health information (HIS) systems are essential to ach... more Background Robust, flexible, and integrated health information (HIS) systems are essential to achieving national and international goals in health and development. Such systems are still uncommon in most low and middle income countries. This article describes a first-phase activity in Tanzania to integrate the country’s vertical health management information system with the help of an interoperability layer that enables cross-program data exchange. Methods From 2014 to 2019, the Tanzanian government and partners implemented a five-step procedure based on the “Mind the GAPS” (governance, architecture, program management, and standards) framework and using both proprietary and open-source tools. In collaboration with multiple stakeholders, the team developed the system to address major data challenges via four fully documented “use case scenarios” addressing data exchange among hospitals, between services and the supply chain, across digital data systems, and within the supply chain r...

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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 ... more Standardization and integration of Health Information Systems (HIS) in most developing countries haves 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 the 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 the 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 several different actors engaging in HIS integration process in Tanzania. The article stresses the need to coordinate the standardization process through circulation of boundary objects a...

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Implementation in Developing Countries : A Translation Process

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One country's journey to interoperability: Tanzania's experience developing a national health information exchange

Background and purpose: Robust, flexible, and integrated health information (HIS) systems are ess... more Background and purpose: Robust, flexible, and integrated health information (HIS) systems are essential to achieving national and international goals in health and development. Such systems are still uncommon in most low and middle income countries. This article describes a first-phase activity in Tanzania to integrate the country’s vertical health management information system with the help of an interoperability layer that enables cross-program data exchange. Methods: From 2014 to 2019, the Tanzanian government and partners implemented a five-step procedure based on the “Mind the GAPS” (governance, architecture, program management, and standards) framework and using both proprietary and open-source tools. In collaboration with multiple stakeholders, the team developed the system to address major data challenges via four fully documented “use case scenarios” addressing data exchange among hospitals, between services and the supply chain, across digital data systems, and within the ...

Designing interoperable health information systems using Enterprise Architecture approach in resource-limited countries: A literature review

The International journal of health planning and management, Jan 5, 2018

Enterprise Architecture (EA) integrates business and technical processes in health information sy... more Enterprise Architecture (EA) integrates business and technical processes in health information systems (HIS). Low-income and middle-income countries (LMIC) use EA to combine management components with disease tracking and health care service monitoring. Using an EA approach differs by country, addressing specific needs. Articles in this review referenced EA, were peer-reviewed or gray literature reports published in 2010 to 2016 in English, and were identified using PubMed, Scopus, Web of Science, and Google Scholar. Fourteen articles described EA use in LMICs. India, Sierra Leone, South Africa, Mozambique, and Rwanda reported building the system to meet country needs and implement a cohesive HIS framework. Jordan and Taiwan focused on specific HIS aspects, ie, disease surveillance and electronic medical records. Five studies informed the context. The Millennium Villages Project employed a "uniform but contextualized" approach to guide systems in 10 countries; Malaysia, In...

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

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

Download

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

Americas Conference on Information Systems, 2010

Download

Power Tensions in Health Information System Integration in Developing Countries: The Need for Distributed Control

EJISDC: The Electronic Journal on Information Systems in Developing Countries, Sep 1, 2010

Download

One country's journey to interoperability: Tanzania's experience developing and implementing a national health information exchange

BMC Medical Informatics and Decision Making, Apr 29, 2021

Download

Journal of Health Informatics in Developing Countries

Download

Integration of Health Information Systems

Power Tensions in Health Information System Integration in Developing Countries: The Need for Distributed Control

The Electronic Journal of Information Systems in Developing Countries, 2010

Download

Collaborative Knowledge Making and Sharing across sites: the Role of boundary Objects

Download

Challenges in health information systems integration: Zanzibar experience

2009 International Conference on Information and Communication Technologies and Development (ICTD), 2009

Download

1 Power Tensions in Health Information System Integration in Developing Countries: The Need for Distributed Control

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 an... more 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 ...

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

Download

Health Information Systems Implementation in Developing Countries: a Translation Process

Download

Exploring the Power of Technology in the Institutionalization of Health Information Systems: An Actor-Network Analysis of Information Systems Integration

Journal of health informatics, 2017

Download

One country's journey to interoperability: Tanzania's experience developing and implementing a national health information exchange

Download

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

Download

Implementation in Developing Countries : A Translation Process