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Introducing Digital Health in Post Conflict Mozambique: A Historical Perspective

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Freedom and Social Inclusion in a Connected World (ICT4D 2022)

Abstract

Implementation of digital health in low- and middle-income countries is susceptible to influences of several institutional dynamics, through interactions of technological artefacts, political and other environmental conditions. These dynamics may lead to contradictions, not always obvious nor easily acknowledgeable. History can be valuable to understand and pursue explanations around why and how a technology gets adopted and institutionalized or not in particular settings. This study is part of a project focusing on a longitudinal case, where history is reconstructed over twenty years, in three phases: introducing digital health in post conflict Mozambique (2000–2007), disruption of initial efforts to introduce District Health Information Systems (DHIS) platform (2008–2014) and, adoption and scaling up of DHIS2 nationally (2015–2021). For the purposes of this paper, we conduct analysis to the initial period, with institutionalist lenses, aiming to identify the set of contradictions raised within the context of study and discuss implications for the future.

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References

  1. Aanestad, M., et al.: Strategies for development and integration of health information systems: coping with historicity and heterogeneity. Working paper from the Information Systems Group, University of Oslo, 5, p. 51 (2005)

    Google Scholar 

  2. Aanestad, M., Jolliffe, B., Mukherjee, A., Sahay, S.: Infrastructuring work: building a state-wide hospital information infrastructure in India. Inf. Syst. Res. 25(4), 834–845 (2014). https://doi.org/10.1287/isre.2014.0557

    Article  Google Scholar 

  3. Almeida, E.: Relatório sobre as Boas Prácticas do SIS Moçambique. Ministério da Saúde de Moçambique (2007). [Online] available at https://www.afro.who.int/files/moz-sis_bestpractices.pdf. Accessed on 30 Feb 2019

  4. Asah, F., Nielsen, P.: An Integrated Health Management Information System a Missing block in achieving universal health coverage in Cameroon? Selected Papers of the Information System Research Seminar in Scandinavia (IRIS) 2016, 7(6) (2016). [Online] Available in http://aisel.aisnet.org/iris2016/6. Accessed on 6 Jan 2022

  5. Avgerou, C.: IT and organizational change: an institutionalist perspective. Inf. Technol. People 13(4), 234–262 (2000)

    Google Scholar 

  6. Birn, A.E., Muntaner, C., Afzal, Z.: South-South cooperation in health: bringing in theory, politics, history, and social justice. Cad. Saude Publica 33(2), S37–S52 (2017)

    Google Scholar 

  7. Bouene, F.: Moçambique: 30 anos de independência. In Africana Studia, 8, Edição da Faculdade de Letras da Universidade do Porto, pp. 68–84 (2005)

    Google Scholar 

  8. Braa, J., Muquingue, H.: Health information systems and open source software development: need for cross-country collaboration in Africa – experiences from the HISP/BEANISH network. In: IST-Africa 2007 Conference Proceedings, pp. 1–7 (2007)

    Google Scholar 

  9. Braa, J., et al.: A study of the actual and potential usage of information and communication technology at district and provincial levels in Mozambique with a focus on the health sector. Electron. J. Inf. Syst. Dev. Ctries. 5(1), 1–29 (2001)

    Article  Google Scholar 

  10. Braa, J., Monteiro, E., Sahay, S.: Networks of action: sustainable health information systems across developing countries. MIS Q. 28(3), 337–362 (2004)

    Article  Google Scholar 

  11. Braun, V., Clarke, V.: Using thematic analysis in psychology. Qual. Res. Psychol. 3, 77–101 (2006). https://doi.org/10.1191/1478088706qp063oa

    Article  Google Scholar 

  12. Bryant, A., Black, A., Land, F., Porra, J.: Information systems history: what is history? what is IS history? What IS history? ... and why even bother with history? J. Inf. Technol. 28, 1–17 (2013). https://doi.org/10.1057/jit.2013.3. [Online] available at https://www.researchgate.net/publication/256051208. Accessed on 9 Nov 2018

  13. Chilundo, B.: Integrating Information Systems of Disease-Specific Health Programmes in Low Income Countries: The Case Study of Mozambique, pp. 1–121. Thesis University of Oslo, Oslo (2004)

    Google Scholar 

  14. Clarke, V., Braun, V.: Thematic analysis. J. Posit. Psychol. 12(3), 297–298 (2017). https://doi.org/10.1080/17439760.2016.1262613

    Article  Google Scholar 

  15. Clemens, E.S., Cook, J.M.: Politics and institutionalism: explaining durability and change. Ann. Rev. Sociol. 25, 441–466 (1999)

    Article  Google Scholar 

  16. Department of Mathematics and Informatics – DMI: Currículo de Mestrado em Informática (2011). Available in http://dmi.uem.mz/images/pdfs/curriculo_informatica_2011.pdf. Accessed on 15 Dec 2021

  17. Dobson, J., Nicholson, B.: Exploring the dialectics underlying institutionalization of IT artifacts. J. Assoc. Inf. Syst. 18(12), 848–871 (2018)

    Google Scholar 

  18. Funada-Classen, S.: The Origins of War in Mozambique: A History of Unity and Division. In African Minds, pp. 1–56 (2013)

    Google Scholar 

  19. Garrido, P.I.: Saúde, desenvolvimento e factores institucionais: O caso de Moçambique. WIDER Working Paper No. 2020/131. The United Nations University World Institute for Development Economics Research (UNU-WIDER), Helsinki (2020). Available in https://www.wider.unu.edu/sites/default/files/Publications/Working-paper/PDF/wp2020-131-PT.pdf. Accessed on 18 Dec 2021

  20. Gilio, A., Freitas, G.: A closer look at the Mozambique reality: nursing and health. In Revista Brasileira de Enfermagem, Brasília 61(1), 98–102 (2007)

    Article  Google Scholar 

  21. Hayes, N., Rajão, R.: Competing institutional logics and sustainable development: the case of geographic information systems in Brazil’s Amazon region. Inf. Technol. Dev. 17(1), 4–23 (2011). https://doi.org/10.1080/02681102.2010.511701

    Article  Google Scholar 

  22. Heeks, R.: Information Systems and Developing Countries: Failure, Success, and Local Improvisations. The Information Society, ISSN: 0197-2243 (Print) 1087-6537 (2002). [Online] available at the Journal homepage: http://www.tandfonline.com/loi/utis20. Accessed on 29 Nov 2018

  23. Immergut, E.M.: The theoretical core of the new institutionalism. Polit. Soc. 26(1), 5–34 (1998)

    Article  Google Scholar 

  24. Instituto Nacional de Estatística – INE: Infra-estruturas Hospitalares 1975–2009 (2011). [Online] Available in http://web.archive.org/web/20111114221033/http:/www.ine.gov.mz/sectorias_dir/saude_dir/Document.2010-06-22.0502160683. Accessed on 3 Dec 2021

  25. Jafar, J.S.: Análise Sócio-Histórica sobre a Guerra Civil em Moçambique, 1976–1992. In Revista Kulambela, 2(2), 38–53 (2021). Available in https://www.ceadur.ac.mz/kulambela/index.php/RKCD/article/view/10. Accessed on 3 Dec 2021

  26. Jepperson, R.L.: Institutions, institutional effects, and institutionalism. In: Chapter 3, Institutional Theory: Its Role in Modern Social Analysis, pp. 37–66 (1991). In: Jepperson, R.L., Meyer, J.W. (eds.) Institutional Theory: The Cultural Construction of Organizations, States, and Identities, p. 322, 1st edn., Cambridge University Press, New York (2021)

    Google Scholar 

  27. Kaasbøll, J., Kanjo, C., Kimaro, H.: Sustainable health informatics master programmes in low and middle income countries. In: Proceedings from the Annual NOKOBIT Conference, (26:1), (eds.) Svalbard (2018)

    Google Scholar 

  28. Kaasbøll, J., Macome, E.: Developing sustainable research education in Sub-Saharan Africa. In: Informatics Curricula, Teaching Methods and Best Practice, IFIP Working Group 3.2 Working Conference, pp. 1–9 (2002)

    Google Scholar 

  29. Kaasbøll, J., Nhampossa, J.L.: Transfer of public sector information systems between developing countries: south-south cooperation. Presented at “Social Implications of Computers in Developing Countries”, Bangalore, India (2002)

    Google Scholar 

  30. Khubone, T., Tlou, B., Mashamba-Thompson, T.P.: Electronic health information systems to improve disease diagnosis and management at point-of-care in low and middle income countries: a narrative review. Diagnostics 10(327), 1–10 (2020)

    Google Scholar 

  31. Krishna, S., Walsham, G.: Implementing public information systems in developing countries: learning from a success story. Inf. Technol. Dev. 11(2), 123–140 (2005)

    Article  Google Scholar 

  32. Lune, H.: Understanding Organizations. Polity Press, pp. 216 (2010). [Online] available in https://books.google.co.mz/books?id=T8RqT3CueSEC&printsec=frontcover&dq=concept+of+organization&hl=pt-PT&sa=X&redir_esc=y#v=onepage&q=concept%20of%20organization&f=false. Accessed on 18 Apr 2022

  33. Mahoney, J., Thelen, K.: Explaining Institutional Change: Ambiguity, Agency, and Power. Cambridge University Press, p. 236 (2010). [Online] available in https://books.google.no/books?id=PACmgwrYeRMC&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false. Accessed on 9 Dec 2018

  34. Mignerat, M., Rivard, S.: Positioning the institutional perspective in information systems research. J. Inf. Technol. 24(4), 369–391 (2009)

    Article  Google Scholar 

  35. Mosse, E.: Understanding the Introduction of Computer-Based Health Information Systems in Developing Countries: Counter Networks, Communication Practices, and Social Identity: A Case study from Mozambique, p. 144. Thesis University of Oslo, Oslo (2005)

    Google Scholar 

  36. Muquingue, H.: Understanding and Improving Medical Students’ Exposure to Health Management in Rural Settings of Mozambique. Thesis University of Oslo, p. 289 (2009)

    Google Scholar 

  37. Nawab, A., Kumari, R., Babur, M.: Unrecognized contradictions are opportunities lost: refocusing attention for learning. Learn. Cult. Soc. Interact. 31, 1–9 (2021). https://doi.org/10.1016/j.lcsi.2021.100563

    Article  Google Scholar 

  38. Nedović-Budić, Z., Godschalk, D.R.: Human factors in adoption of geographic information systems: a local government case study. Public Adm. Rev. 56(6), 554–567 (1996)

    Article  Google Scholar 

  39. Newitt, M.: A History of Mozambique, p. 706. Indiana University Press, Bloomington and Indianapolis (1995)

    Google Scholar 

  40. Nhampossa, J.L.: The challenge of “translating” health information systems from one developing country context to another: a case study from Mozambique. In: ECIS 2004 Proceedings, vol. 130, pp. 1–15 (2004). http://aisel.aisnet.org/ecis2004/130

  41. Nhampossa, J.L., Sahay, S.: Social construction of software customization: the case of health information systems from Mozambique and India. In: Bada, A., Adelakun, O. (eds.) Enhancing Human Resource Development through ICT, pp. 339–347. IFIP, Abuja, Nigeria (2005)

    Google Scholar 

  42. Nhampossa, J.L.: Re-Thinking Technology Transfer as Technology Translation: A Case Study of Health Information Systems in Mozambique. Thesis University of Oslo, p. 198 (2006)

    Google Scholar 

  43. North, D.: Institutions. J. Econ. Perspect. 5(1), 97–112 (1991)

    Article  Google Scholar 

  44. Novalia, W., Rogers, B.C., Bos, J.J.: Incumbency and political compromises: opportunity or threat to sustainability transitions? Environ. Innov. Soc. Trans. 40, 680–698 (2021). https://doi.org/10.1016/j.eist.2021.05.002

    Article  Google Scholar 

  45. Oliver, C.: The antecedents of deinstitutionalization. Org. Stud. 13(4), 563–588 (1992). [Online] available at https://journals-sagepub-com.ezproxy.uio.no/doi/https://doi.org/10.1177/017084069201300403. Accessed on 28 Nov 2018

  46. Piotti, B., Chilundo, B., Sahay, S.: An institutional perspective on health sector reforms and the process of reframing health information systems: case study from Mozambique. J. Appl. Behav. Sci. 42(1), 91–109 (2006). https://doi.org/10.1177/0021886305285127

    Article  Google Scholar 

  47. Piotti, B., Macome, E.: Public healthcare in Mozambique: strategic issues in the ICT development during managerial changes and public reforms. Int. J. Med. Inf. 76, S184–S195 (2007). https://doi.org/10.1016/j.ijmedinf.2006.05.020

  48. Powell, W., DiMaggio, P.: The New Institutionalism in Organizational Analysis, p. 478. University of Chicago Press, Chicago and London (1991). [Online] available in https://books.google.no/books?id=jbTbAgAAQBAJ&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false. Accessed on 9 Dec 2018

  49. Sahay, S., Sundararaman, T., Braa, J.: Public Health Informatics: Designing For Change – A Developing Country Perspective, p. 261. Oxford (2017)

    Google Scholar 

  50. Sahay, S., Sæbø, J.I, Mekonnen, S.M. and Gizaw, A.A.: Interplay of institutional logics and implications for deinstitutionalization: a case study of HMIS implementation in Tajikistan. J. Inf. Technol. Int. Dev., 6(3), 19–32, (2010)

    Google Scholar 

  51. Sahay, S., Nielsen, P., Aanestad, M.: Institutionalizing Information Systems for Universal Health Coverage in Primary Health Care and the Need for New Forms of Institutional Work, p. 44. Communications of the Association for Information Systems (2019)

    Google Scholar 

  52. Schreyögg, G., Sydow, J.: Understanding institutional and organizational path dependencies. In: Schreyögg, G., Sydow, J. (eds.) The Hidden Dynamics of Path Dependence Institutions and Organizations, pp. 3–12. Palgrave Macmillan UK, London (2010). https://doi.org/10.1057/9780230274075_1

    Chapter  Google Scholar 

  53. Scott, W.R.: Institutions and Organizations, 2nd edn., p. 255. Sage Publications, London (2001)

    Google Scholar 

  54. Scott, W.R.: Crafting an analytic framework I: three pillars of institutions, chapter 3. In: Institutions and Organizations: Ideas Interests and Identities, 4th edn, p. 360. Sage, Thousand Oaks (2013)

    Google Scholar 

  55. Seo, M., Creed, W.E.D.: Institutional contradictions, praxis, and institutional change: a dialectical perspective. Acad. Manag. Rev. 27(2), 222–247 (2002)

    Article  Google Scholar 

  56. Sharma, U., Lawrence, S., Lowe, A.: Institutional contradiction and management control innovation: a field study of total quality management practices in a privatized telecommunication company. Manag. Account. Res. 21, 251–264 (2010). https://doi.org/10.1016/j.mar.2010.03.005

    Article  Google Scholar 

  57. Sheikh, Y.: Health Information Systems Integration as Institutionalisation: The Case of Zanzibar, p. 266. Thesis from University of Oslo, Oslo (2015)

    Google Scholar 

  58. Sorensen, A.: Taking path dependence seriously: an historical institutionalist research agenda in planning history. Plan. Perspect. 30(1), 17–38 (2015). https://doi.org/10.1080/02665433.2013.874299

    Article  Google Scholar 

  59. Süli, K.M.: The Port of Rotterdam and the Maritime Container: The Rise and Fall of Rotterdam’s Hinterland (1966–2010). Erasmus Universiteit Rotterdam, 290 pp (2014)

    Google Scholar 

  60. Thornton, P.H., Ocasio, W.: Institutional logics, Chap. 3. In: Greenwood, R., Oliver, C., Suddaby, R., Sahlin, K. (eds.) The SAGE Handbook of Organizational Institutionalism, pp. 99–129. SAGE Publications (2008) [Online]. Available in https://sk-sagepub-com.ezproxy.uio.no/reference/hdbk_orginstitution. Accessed on 7 Jan 2022

  61. Thornton, P., Ocasio, W., Lounsbury, M.: The Institutional Logics Perspective: A New Approach to Culture, Structure and Process. Print ISBN-13: 9780199601936 (2012). Published by Oxford Scholarship [Online] available in www.oxfordscholarship.com. Accessed on 8 Nov 2018

  62. Volkow, N.: Interaction between information systems and organizational change: case study of Petroleos Mexicanos. London School of Economics and Political Science, p. 271 (2003)

    Google Scholar 

  63. Walsham, G., Sahay, S.: GIS for district-level administration in India: problems and opportunities. MIS Q. 23(1), 39–65 (1999)

    Article  Google Scholar 

  64. Wanderley, C.A., Soeiro, T.M.: Contradição Institucional e o Balanced Scorecard: Um caso de mudança sem sucesso. Revista Universo Contábil 12(1), 45–65 (2016). Available in: https://proxy.furb.br/ojs/index.php/universocontabil/article/view/5206. Accessed on 9 Jan 2022

  65. Wendt, C.: Introduction to Lepsius’ concept of Institutional Theory. In: Wendt, C. (ed.) Max Weber and Institutional Theory, pp. 1–21. Springer International Publishing, Switzerland (2017). https://doi.org/10.1007/978-3-319-44708-7_1

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Collinson, N., Sahay, S. (2022). Introducing Digital Health in Post Conflict Mozambique: A Historical Perspective. In: Zheng, Y., Abbott, P., Robles-Flores, J.A. (eds) Freedom and Social Inclusion in a Connected World. ICT4D 2022. IFIP Advances in Information and Communication Technology, vol 657. Springer, Cham. https://doi.org/10.1007/978-3-031-19429-0_8

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