Integration of Health Information Systems : Case Study from Malawi

This research falls under the domain of design and implementation of Health Information Systems (HIS) mainly in developing countries. The study was motivated by previous research conducted on HIS which have revealed that fragmentation of HIS is a common feature in most developing countries and this fragmentation contributes to the general poor performance of the health sector. The objective of this study was to assess the HIS in Malawi to identify where fragmentation exists, understanding why it exists with a purpose of making conclusions and recommendations on whether and how the identified fragmentation could be reduced. To achieve this objective, the study investigated the HIS at several levels of the health system with the purpose to understand the flow of health data/information in the system. Once the information flow was determined, the study aimed to identify the information requirements and information use of the specific programmes and the district health management to understand how these contributed to the information flow that was revealed; and therefore how the system could be modified to meet these requirements. To achieve this, the study inquired on the responsibilities and duties of the district programme managers and the district health managers. The empirical fieldwork was conducted over a period of 14 weeks from July – November 2006, at national, zonal, district and facility level. Two districts, Chikwawa and Chiradzulu were visited during the study and because the main focus of the research was the district level, most of the time was spent at the District Health office and District Hospital. The study used qualitative research methods such as semi-structured interviews; document analysis; participant observation of activities such as meetings and facility supervision; and software analysis. Analysis of the empirical data was informed by literature reviewed on health management, the components/aspects of HIS, the factors causing fragmentation in HIS and the proposed strategies for reducing fragmentation in order to improve the overall health system performance. The research revealed that fragmentation existed in the HIS even though commendable efforts had been made by the Ministry of Health to achieve an integrated HIS through the implementation of the HMIS. The fragmentation existed in that, in addition to the HMIS, parallel programme-specific reporting systems were operating. This parallel reporting was attributed to various reasons including the fact that the HMIS did not meet the information requirements of the programmes because: it did not provide data on a monthly basis; and it did not collect all the data elements required by the district programme coordinators and by national level programme managers. Additionally, parallel reporting existed because some coordinators were not aware that their programme-specific reporting systems had been abolished due to the introduction of the HMIS. Furthermore, fragmentation also resulted from the fact that certain programmes had been introduced after the HMIS had already been implemented hence; it did not collect the data specific for these programmes. The study, additionally, revealed that fragmentation existed because the programme coordinators´ duties had been defined with a vertical reporting system in mind and that is why the HMIS did not meet the related information requirements for those duties. Thus, the study re-emphasises on the importance of the interactive relationship between the technical and social aspects of a HIS and how these influence the outcome of the structure and performance of the overall HIS. With this perspective, I make recommendations in the end on possible ways for addressing the aspects contributing to the observed fragmentation in order to achieve a more integrated HIS