An analysis of health management information system implementation processes on data-use - A case-study of a technical implementing organisation amongst iNGOs

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

Data-for-action, Data-use, Implementation, iNGO, Technical parters, International Development, DHIS2