Design and development of spatial GIS application for primary healthcare sector : case studies from India and Mozambique

This thesis is drawn from an ongoing large-scale action research project Health Information Systems Program (HISP), which aims to develop sustainable computer based Health Information Systems (HIS) in and for developing countries. This study attempts to build an internationalized GIS application for the primary healthcare sector. The overall aim in this study is to develop a deeper understanding of the socio-technical aspects complexities and challenges emerging during the design, development and customization of internationalized GIS application for primary healthcare sector in the context of developing countries. I adopt a social systems approach to this research problem, and, draw upon concepts from Actor Network Theory (ANT) and the Information Infrastructure (II) perspective which are useful to study the design, development and use aspects of large, complex and interconnected systems. I argue in this thesis that HIS for the primary health care sector in general, and GIS applications in particular display infrastructural characteristics and can be analyzed drawing upon the above mentioned theoretical perspectives. I especially focus on the heritage of installed base and the flexibility of a cultivation approach drawn from the II perspective for this purpose. The cultivation approach is further enriched by incorporating the approach of social construction of software customization which helps to emphasize that cultivation is a socio-technical challenge which is influenced by the very nature of the customization process itself. In addition, I use theoretical concepts from software internationalization to get further insights to the challenge of adopting this cultivation strategy across national settings. The research was based on a participatory action research approach within a comparative case study design covering two developing countries, India and Mozambique. This comparative approach helped to provide insights into how different contextual conditions, especially the existing installed base and cultivation strategies adopted, provide significant influences on the design, development and customization process of the GIS application. The empirical data collection was carried over a one year period of intensive field study, involving the use of qualitative methods for data collection, and systems development through a prototyping approach. The thesis is described over two cases. The first concerns the development of a non spatial application and how that was cultivated and grown over time through its linking with the GIS application for the healthcare sector in India. The second case, set in Mozambique, describes how the Indian GIS application was then subjected to a customization process along with other Mozambican master’s students to develop an application for the national level of the Department of Community health, within the Ministry of Health. This customization process involved both the non-spatial application and its subsequent linkage with the GIS component. The varying installed base and cultivation strategies involved in the two contexts gave rich insights into the design and development challenges that arise, and also helped to develop implications on how the GIS application can be internationalized and integrated with the global District Health Information Systems (DHIS) software that has been developed through the HISP action research project. More specifically, the following theoretical implications are drawn from the study • Design, development and customization of GIS application should be viewed as socio-technical process, with focus on preparing the existing II for its integration with the new GIS application through cultivating the installed base. • The cultivation approach could be extended towards design and modification of the GIS application to be ‘infrastructural’ in nature by enabling its shared and diverse use in other contexts. • The need to practice hybrid approaches for the development of internationalized software that seeks to balance between the global and local needs. Also, the following practical implications have been developed: • Building gateways is an easier and cheaper solution to link between already existing large networks. • The change required by the new system should be minimized in order to reduce the resistance from the existing installed base, thus reducing the chances for failure. • Apart from the standard reports of an internationalized application, importance should be given towards the development of locally driven reports, which provides a greater value for the application in that particular context