Challenges in Moving to 'Health Information for Action': An Infrastructural Perspective From a Case Study in Tajikistan

摘要

Health information systems (HIS) in developing countries are mainly characterized as being "data led," with vast amounts of data being routinely collected, but with limited evidence of them being used "for action." While past research and practice have made significant progress in understanding issues contributing to this situation, limited advancement has been made as to how to redress the situation. Further, infrastructure issues impeding data use have also not been significantly highlighted in existing research. Drawing on a longitudinal case of the design, development and implementation of HIS in Tajikistan, we argue that a reason for this weak progress has been the rather narrow focus on technology, ignoring the broader issues that influence its uptake and use. We explore this through an "infrastructure" lens to enable a more holistic perspective to understand complex socio-technical networks with a multiplicity of interests, actors and technologies in play which need to be aligned. A key contribution of this paper is the identification of facets of a health information infrastructure which helps to identify both the constraints and opportunities in making a transition from a data-led to an action-led system.