This abstract has been accepted at the 2024 DHIS2 Annual Conference
An analysis of health management information system implementation processes on data-use - A case-study of a technical implementing organisation amongst iNGOs
Background: International Non-Government Organisations (iNGOs) are demanding and generating greater volumes of data. Information systems are important tools managing this data for iNGOs to make evidence based decisions. However, data often fails to reach the decision making stage, instead being used to fulfil requirements, show that an organisation is trustworthy for valuing accountability, or even to legitimise decisions already taken. DHIS2 is an open source, cloud based information system increasingly used by iNGOs to manage their data. DHIS2 requires customisation to the specific needs of the organisation using it, and there are a growing number of organisations offering services of implementation. The extent to which these implementation services enhance or detract from the use of data for decision-making within iNGOs is unknown. This study uses Normalisation Process Theory (NPT) to understand the barriers and facilitators to data use for decision-making within iNGOs during implementation of DHIS2 with a technical implementing organisation. This study is a piece of research undertaken at the London School of Hygiene and Tropical Medicine toward a Doctorate of Public Health. Method: A retrospective, cross-sectional case-study was conducted across three iNGO DHIS2 implementations in partnership with a single technical implementing organisation. Qualitative methods (document reviews and interviews) explored the artefacts of implementation along with the views of iNGO and technical implementer staff involved. Data were analysed by thematic analysis and mapped onto the constructs of NPT for identifying barriers and facilitators to data use. Results: (1) Data use was valued rhetorically but seldom acted toward in the deliverables of implementation; (2) Implementations focused almost exclusively on the deployment of a technical artefact at the expense of people and process considerations; (3) External factors in the iNGO environment incentivise alternative activities in preference over data-use for decision-making; (4) Technical implementing partners with considerable experience across implementations stuck to a technical-only focus; (5) Contextual barriers within iNGOs acted against data-use, such as competing organisational priorities, staff turnover, managerial commitment, and time- and budgetary-scarcity. Conclusions: Five main factors were identified as barriers to data use spanning NPT constructs, highlighting an interconnectedness and need to address these factors from the outset and throughout implementation. Recommendations to iNGOs and technical implementers are made, grounded in NPT, for the facilitation of data use during implementation and beyond.
Primary Author: Blake Hansen
Keywords:
Data-for-action, Data-use, Implementation, iNGO, Technical parters, International Development, DHIS2
Can’t wait to present the poster. If you’re there in person, swing-by and I’ll have some more info/handouts, including a series of “recommendations” for facilitating data-use through implementation.
An analysis of health management information system implementation processes on data-use - A case-study of a technical implementing organisation amongst iNGOs
Background: International Non-Government Organisations (iNGOs) are demanding and generating greater volumes of data. Information systems are important tools managing this data for iNGOs to make evidence based decisions. However, data often fails to reach the decision making stage, instead being used to fulfil requirements, show that an organisation is trustworthy for valuing accountability, or even to legitimise decisions already taken. DHIS2 is an open source, cloud based information system increasingly used by iNGOs to manage their data. DHIS2 requires customisation to the specific needs of the organisation using it, and there are a growing number of organisations offering services of implementation. The extent to which these implementation services enhance or detract from the use of data for decision-making within iNGOs is unknown. This study uses Normalisation Process Theory (NPT) to understand the barriers and facilitators to data use for decision-making within iNGOs during implementation of DHIS2 with a technical implementing organisation. This study is a piece of research undertaken at the London School of Hygiene and Tropical Medicine toward a Doctorate of Public Health. Method: A retrospective, cross-sectional case-study was conducted across three iNGO DHIS2 implementations in partnership with a single technical implementing organisation. Qualitative methods (document reviews and interviews) explored the artefacts of implementation along with the views of iNGO and technical implementer staff involved. Data were analysed by thematic analysis and mapped onto the constructs of NPT for identifying barriers and facilitators to data use. Results: (1) Data use was valued rhetorically but seldom acted toward in the deliverables of implementation; (2) Implementations focused almost exclusively on the deployment of a technical artefact at the expense of people and process considerations; (3) External factors in the iNGO environment incentivise alternative activities in preference over data-use for decision-making; (4) Technical implementing partners with considerable experience across implementations stuck to a technical-only focus; (5) Contextual barriers within iNGOs acted against data-use, such as competing organisational priorities, staff turnover, managerial commitment, and time- and budgetary-scarcity. Conclusions: Five main factors were identified as barriers to data use spanning NPT constructs, highlighting an interconnectedness and need to address these factors from the outset and throughout implementation. Recommendations to iNGOs and technical implementers are made, grounded in NPT, for the facilitation of data use during implementation and beyond.
Primary Author: Blake Hansen
Hi Blake, very interesting. That resonated strongly with my experience.
I recently started working on the maps app at UiO. I would be curious to hear if you have thoughts on how the maps app could froster data-use.
Now getting around to reading posters that interested me. Your findings are similar to what I experienced in working with INGOs, they were interested in the system, but not in all that bits that go with it for DHIS to be a vital tool for decision making. Getting data in was the only objective.
Hi Bruno,
That’s really kind of you and thanks for getting in touch. I did have a number of recommendations that came out of the results (which I hope to be able to share once I am able to publish this 
) However DHIS2 performed very well as a software in the research. i.e. users found it very easy to use. And even where they worked around a newly implemented DHIS2, it wasn’t because of DHIS2 itself, but rather their comfort with what they already knew. So I’m sorry that I can’t recommend anything to you on this question directly, because there were no “faults” with DHIS2 or the analysis/maps.
Two thoughts occur, but both I think are either already solved or in progress following the conference:
- To make it possible to have the use of maps in push analysis. (I think this is part of the improved push analysis coming) This would put data (maps) right under people’s noses, and make it easier to start conversations.
- To be able to better move data from DHIS2 in geoJSON. (Again, I think this is happening, and also better links with ArcGIS are too - which most people seem to want regards maps.) ArcGIS and QGIS seemed widely used by NGOs and their internal teams, so making interoperability easier may help with the production of maps.
It’s so exciting to hear you’re asking these questions Bruno and only sorry not to have more to share. Much of data-use struggles are people and process related, and in this case, the technology is all good. Thank you!
Norah!
I was walking past TGI Fridays in Aker Brygge the other evening and I was thinking of you. I hope you are doing really well!
Thank you so much for the encouragement of how the research resonates. I don’t intend to lay it all at the NGO’s door as a multi-faceted problem, but there were certainly areas for consideration. If you’re interested, I could share my handout with you directly, which contained the recommendations coming out of the identified problems.
So wonderful to hear from you! IT REALLY IS