High volume/
highly granular
Data
Management
spectrum
Low volume/
low
granularity
Use of
information
Technical
resources
spectrum
Well developed
infrastructure
with access to
computers and
internet
Poor access
to
technology
Staff skills
low and/or
low staff
numbers
Human
resources
spectrum
Highly skilled
staff and
adequate
numbers
The Eastern Cape Province of South Africa
Before 1994:
Homeland boundaries
1994-2000:
Health Regions
4 pilot
Geographic sites
WCape
scaling
Malawi
all
All of
WCape
and ECape
1997
1998
Early
Functionality prototypes
of DHIS in
expansion
pilots
Mozambique
Nigeria
pilot
–3
states
All of ZA
1999
DHISv1.3
used in
roll-out
2000
2001
2002
2003
2004
Zanzibar
& Pemba
Nigeria - +2
states
Namibia - all
2006
Multilanguage
enablement
Survey &
Client
Patient
Audit satisfaction
Module
Major revision
functions
survey
of DHIS1.3 to
DHIS1.4 begins
STI Sentinel
surveillance
dataset
Program
expansion
in South
Africa
PHC
Essential
Dataset
Transport &
EMS
Hospital
Dataset Facility Semipermanent
Dataset
PMTCT HIV
data
National
tertiary
services
Hospital
revitalisation
program
Zambia – all
Ethiopia – Botswana
some
HIV/AIDS
regions
Liberia –
selected
counties
2005
Financial &
District
Health
Expenditure
Review
Datasets
HIV Services
mapping
Strategic
Planning &
Quarterly
Report
Dataset
Mass
Vaccination
Campaign
Dataset
Nigeria - all
Liberia - all
2007
2008
NMC module,
Web-based
reports,
DEBO Module,
Snapshot
viewer
Antiretroviiral
Therapy
Dataset
Additional
semipermanent
data
Environment
al health
dataset
School
health
dataset
From http://en.wikipedia.org/wiki/Complexity on 2009_04_25
Phase 1 (2005-2006) – Paperbased reports from various
sources are used to produce a
report:
Fragmented DHIS databases
(DHIS1.3) plus paper sources
plus other legacy systems as
sources of data for paper based
report
DHIS1.3
PHC Db
DHIS1.3
Hosp Db
Manually
Generated
Report
Other
legacy
Db’s
Phase 2 (2007/08) – Paperbased reports from various
sources are used to produce a
report but integration with the
DHIS has been effected:
DHIS plus paper sources plus
other legacy systems as sources
of data for paper based reporting
Phase 3 (2008/09) – DHIS1.4
data warehouse allows
creation of Report Dataset:
DHIS database as a data
warehouse storing data from a
variety of sources and
integrating them and enabling
automatic production of the
report
Integrated
DHIS1.4
Db
Manually
Generated
Report
Other
legacy
Db’s
Other
legacy
Db’s
DHIS1.4
Data
Warehouse
Electronically
Generated
Report
Degree of disagreement
High
Environment unfamiliar
Task familiar
Chaos
Task unfamiliar
Stability
Environment familiar
Low
Low
High
Degree of uncertainty
Complex
Loosely coupled
Chaos
Tightly coupled
Stasis
Simple
No
computer
Basic
computer
Computer
with dial-up
email
access
Computer
with high
speed
internet
access
Web-based
data storage
and analysis
FMS
database
Paper printout
of financial
data from two
accounts
Accounts
Data physically
combined into
captured in
single values
DHIS
for hospital
(Fin database)
Exported to
stiffy disk,
flash, or
emailed as
comma
delimited file
Imported into
DHIS (Hospital
database) and
included in
integrated
management
report
Infrequent
power
supply +
generator +
UPS
Reliable
power
supply
Infrequent
power
supply
Infrequent
power
supply +
generator
No
computer
Basic
computer
Computer
with dial-up
email
access
Computer
with high
speed
internet
access
Web-based
data storage
and analysis
No
mobile
Basic
mobile
with
infrequen
t access
Basic
mobile with
regular
access
Sophisticate
d mobile
with regular
access
Web-based
data storage
and analysis
No
power
Products characterised by
flexibility and scalability:
Flexible data set
Gateways to support modularity
DHIS as a flexible database
Health Information Practitioner
Hospital
as a medical
service provider and
using information
to manage
resources/services
but struggling in a complex
environment characterised
by rapid change in both
the medical profession
as well as in the
ICT sector
HISP as mediator
Hospital
as a medical
service provider and
using information
to manage
resources/services
And adapting to the
complex environment
Co-evolutionary processes
characterised by:
Attractors to focus resources;
Self-organising groups
Networks and interdependencies
Innovation through integrated
independence
Deepening of
geographic scale
to new levels in the
HS hierarchy
Widening of
geographic scale
across new
geographic areas
Geographic
scaling
Widening of scope by
adopting new
functionality
Scaling the
scope of the
system in use
Deepening of
scope as
evidenced by
increased user
maturity
Individual
Group
Organizational
Feed forward processes
Exploration
Exploitation
Intuiting
Individual
Group
Feedback processes
Interpreting
Integrating
Organizational
Institutionalizing
Feed forward processes
Exploration
Feedback processes
Exploitation
Hospital co-evolving
in response to
changes in the health
sector and in
response to
interaction with HISP
HISP co-evolving
in response to
changes in the ICT
sector and in
response to
interaction with
hospital
Hospital management
information system coevolving in response to
inputs from both
partners
Traditional information needs of managers
Financial information
Group 3
HR information
Billing information
Group 1 Admission
Patient demographics
Separation
Clinical information
Group 2
Throughput information
Radiographic
information
Pharmaceutical
information
Traditional information needs of clinicians
Final Diagnostic
information
Laboratory
information
Outer context:
The hospital as an “isolated”
organisation within the larger
ECDoH
Context
Inner context:
Need for change imposed on
the hospital by a Nationally
driven policy
The hospital with a
fragmented management
team and unco-ordinated
environment
Content
Process
Development of a dataset and
installation of a computer
programme for data capture
and presentation, with
accompanying training of staff
Implementation of a project to
strengthen hospital information
systems
500
80
450
70
400
60
350
300
50
250
40
200
30
150
20
100
50
10
0
0
07-Jan 07Feb
07- 07-Apr 07- 07-Jun 07-Jul 07Mar
May
Aug
Outstanding
07Sep
Reporting rate (%)
07Oct
07Nov
07Dec
Reporting rate (%)
Outstanding reports (No)
Jigawa Reporting Rates 2007
Formal Doctoral studies
Med officer Queenstown
Act Director Hospitals - Province
HISP-SA Manager and team member
Malawi Hosp
PHC Info systems ECP
1992-97
1997
Hosp Information systems ECP
1998
1999
2000
2001
Zambia PHC
ECPHosp
2002
2003
Paper 1
2004
Nigeria PHC
2005
2006
2007
2008
1
2
Paper 2
3
Paper 3
Paper 4
4
Paper 5
Paper 6
5
6
7
Paper 7
Legend
Employment / Role
2009
Research related to thesis
Research / period covered in paper
Publication date
Provincial Head Office
District office
24 in the province
Sub-district unit
2-5 per district
Clinics
~700 in the province
District Hospitals
76 in the province
500
80
450
70
400
60
350
300
50
Average
250
40
200
30
150
20
100
50
10
0
0
07-Jan 07Feb
07- 07-Apr 07- 07-Jun 07-Jul 07Mar
May
Aug
Outstanding
07Sep
Reporting rate (%)
07Oct
07Nov
07Dec
Reporting rate (%)
Outstanding reports (No)
Jigawa Reporting Rates 2007