IFGH 2012: Geography, Dependency and Hidden Labour in National Health Management Information Systems (HMIS)

January 31, 2012

Authors:Jolliffe B., Staring K.

Author Affiliations:University of Oslo

Option 2– lessons from the field; project and programme evaluations; and syntheses or analyses Presented as – Oral Presentation


When realizing HMIS as computer hardware, software, communication infrastructure and operational personnel, it is hard to avoid falling into vendor entrapments and other, often-hidden, dependencies. Implementations of complex ICT architectures have a politics, a sociology and a geography which changes in response to new trends, innovations, opportunities and challenges. For example, “Cloud computing” has (like open source, open standards before it) been offered as holding keys to mitigating some of the risks of strengthening national HMIS in developing countries.


We consider implementation of a national HMIS in four different African national settings, two in a “production” stage and the other two at advanced stages of rollout. Each has taken different approaches to the geographic architecture of the system. The first is implemented in a distributed manner, with semi-autonomous systems operating at the district level and interoperating with a system at national level. The other three have taken advantage of mobile internet connectivity to offer a single centralized system at the national level, accessible to facilities and districts via the web. But they have each chosen different geo-locations of the servers (and hence data): (i) Internally in the ministry of health, (ii) within a local national internet service provider data centre and (iii) using a “cloud computing” provider. Each is receiving technical support from the University of Oslo. All are struggling with a skills deficit for operating the system.

Lessons learned:

Choices about geo-location and centralization of HMIS bring particular risks and requirements regarding the location and the nature of skills required to sustain the system. Further, location of data outside of MOH exposes an urgent (and existing) need to develop policy regarding access to data. Resolution of these two can be understood in terms of the dependencies created.



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