Scaling of HIS in a global context: Same, same, but different

摘要

Scaling of information systems is a field of research with growing importance. This paper presents the story of scaling of an artifact (called District Health Information Software - DHIS) and associated principles and practices around a health information system that has taken place over 15 years, both within and between multiple developing countries. Through the lens of the story of the artifact over its trajectory of development and implementation in multiple contexts and time, we develop insights that challenge traditional thinking around scaling. Scaling is not about constant gains and expansion, as is often assumed, but involves a dichotomy of losses and gains, associated with each step or translation in its process of movement. We draw upon Latour's insights on circulating references to analyze this dichotomy of loss and gains, conceptualizing the process as circulating translations. We contribute to the technology transfer literature in arguing that the process of transfer is not about a "parachuting" from point A to B, or a "design from nowhere" but something which occurs in a series of small steps, where with each step new socio-technical configurations are created which not only shape subsequent steps, but also redefine the content of the artifact. In this way, we are in line with findings from the social studies of technology, but differ in that our artifact of study - software - is more "virtually immaterial" than machines which had been primarily earlier objects of study. This property of software, coupled with growth of web-based and mobile infrastructure, allows relative ease of circulation across contexts, where it gets redefined and embedded at the same time at the interconnected levels of the global and local. We conceptualize this process of global scaling as being "same, same, but different". We discuss both the characteristics of this process of global scaling, and the channels and mechanisms through which it takes place. Four overlapping conditions that shape this process include the software itself, the infrastructure, institutional practices, and ideas - these form the basis for a general framework to understand global scaling of health information systems. Empirically, the story of DHIS is told from its birth in the mid-nineties in South Africa developed on a Microsoft platform to its transformation to a web-based platform, built using Java based open-source frameworks, and now moving through multiple countries. We focus on these dynamics primarily within three countries namely India, Sierra Leone and Kenya.