Information support for district health care planning and decision making in The Gambia: A holistic approach

This research builds upon a body of previous research on health informatics in developing countries. Early research on this area was motivated by a desire to understand the role of different health informatics applications for an effective and efficient health care delivery in developing countries. These applications range from the use of medical expert systems for clinical diagnosis to epidemiological systems at the central level. None of these looked at health information systems at the district level, especially in relation to the information needs of district health staff. Therefore, this research differs from earlier studies in three aspects. First, it looks at the planning and decision-making processes at the district level and how information support could play a crucial role in these processes. Second, it provides a critical evaluation of the existing vertical reporting systems, and through action-research demonstrates the use of an integrated health information system at the district level. Third, it applies multiple perspectives to analyse the research findings in relation to information support for district health care planning and decision making. These three perspectives are the functional perspective, organisational perspective, and the political perspective. To achieve this, the research: • uses a systemic approach to examine the health care system in The Gambia; • uses action-research to design, develop and implement an integrated district health information system in The Gambia; • uses an interpretive evaluation framework to evaluate the impact of the system development efforts in this research; • uses the theory of contextualism to reflect on the research findings over the three year period. Various themes emerged during the research. These themes would be introduced here as the contributions to knowledge arising from the completion of this research project. These include: • a demonstration of the suitability of using a systemic approach for the design, development and implementation of an integrated information system for district health care planning and decision making; • the development of a conceptual implementation framework suitable for the unique characteristics of developing countries; • a manifestation of the implications of an integrated information system for management development, decentralisation, intersectoral coordination and community participation at the district level; • suggestions for further work especially on the need to evaluate the socio-political impact of this research on the existing political and cultural structures in The Gambia