This community innovation has been accepted at the 2025 DHIS2 Annual Conference
Coexisting Realities: DHIS2 and Paper based tools
Coexistence of paper based Health Information Systems (HIS) and digital systems like DHIS2 HMIS has created significant utilization tensions in healthcare settings, leading to redundancies, duplication of work, and underutilization of digital tools. Facility level users often remain reliant on paper based systems due to their familiarity and alignment with established workflows. While digital health transformation aims to enhance data collection, analysis, and use, challenges persist in transitioning fully to digital systems. This study explores the tensions between paper based and digital HIS, emphasizing the need to balance their coexistence for improved healthcare delivery. The study employed interviews, observations, and document reviews to examine healthcare workers’ experiences with Tanzania’s MTUHA paper based system and DHIS2 HMIS. Using Socio Technical Systems theory, it analyzed how social components (people, processes, organizational structure, and culture) influence the utilization of these systems. Findings reveal that social components strongly favor paper based systems due to their familiarity, ease of use, and alignment with workflows, ensuring their continuity. In contrast, digital systems face resistance due to their complexity, requiring advanced skills and stable infrastructure, which are often lacking. However, digital solutions remain more relevant and can be strengthened by being complemented with paper based systems. Paper tools can serve as transitional aids, helping users adapt to digital systems, or coexist as backups. The study highlights the opposing influence of social components on paper based and digital systems, making one strong and the other weak. It emphasizes the complementary role of paper based tools in supporting the transition to and coexistence with digital solutions like DHIS2 HMIS. By balancing continuity and relevance tension, healthcare facilities can achieve a smoother digital transformation
Primary Author: Merina Marcellino
Keywords:
Health Information Systems (HIS), DHIS2 HMIS, paper-based systems, digital health transformation, Tanzania, MTUHA, Socio-Technical Systems Theory, data collection, data analysis, Data use, healthcare workers, resource-constrained settings, digital tools, system coexistence, data quality, system resilience, workflow alignment, digital literacy, infrastructure challenges, transitional tools, complementary systems, data redundancy, system continuity , system relevance, tensions
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