Challenges, opportunies and strategies for using geographic information systems for public health management : an action research study from Mozambique

Public health systems rely on many different components: the institutions of Ministry of Health; the health staff and the information and communication systems used by these organizations to collect, analyze and disseminate relevant data, and use these to help to improve health care delivery. This thesis focuses on understanding the challenges proposed by the current health information system on decision-making process. Specifically, the thesis analyses the drawbacks of the information system for decision-makers. Studies were performed in three provinces aiming at understanding the questions that guide this study, namely: (i) what are the major limitations of the information systems for decision-makers?; (ii) what challenges are there when using spatial information to address challenges of public health decision-makers with focus on maternal mortality?; (iii) what approaches can be used to address these challenges?; and (iv) what strategies can be developed to implement Geographical Information System (GIS) technology for health management in Mozambique? Studies carried out show that for several reasons (such as the data needed for decisions are incomplete, not reliable or timely enough), health planners rarely use health-related data for their decision-making. Many problems within the health sector are related to the question “where”. For example, where do we find the highest BCG or measles coverage, where is malaria most prevalent, or where are TB medicines required, or where should a new health facility be located? The questions around “where” are location-based and can be effectively represented using maps. As part of the study, a practical framework was developed aiming at bridging the gap between the location of various problems and their management through the use of GIS. This framework comprised building a GIS prototype in order to promote health community awareness about the availability, use and benefits of spatial data within the health sector. For that, data were migrated from Excel and paper-based databases to the DHIS, and then related to spatial databases and results showed in maps. By allowing the linkage between routine health data being collected, various kinds of data that are associated with locations (on maps) as ‘spatial data’, GIS can potentially serve as a useful tool for understanding health-related problems, including other spatial factors such as catchment population + incidence of illnesses, socio-economic, environmental, topographic (related to vulnerabilities to malaria, cholera) location of facilities, infrastructural elements and infrastructure availability (e.g. health facilities providing Emergency Obstetric Care). However, the adoption of GIS involves a heterogeneous network comprised by, for example, representation of diseases (e.g. health indicators, etc.), people (e.g. decision-makers, planners, donors, health workers, etc.), socio-political structures and artifacts (e.g. forms, software systems, etc.), which are socially constructed involving the use of information system. Alignment of this heterogeneous network required the development of a social-technical framework. Theories such as (i) Actor-Network Theory and (ii) Information Infrastructure were the basis of this framework. This thesis makes contributions to both theoretical and practical domains. In terms of the knowledge and new insights that this research generates to the field of health information system and perhaps also to the software development field, one of the most important contributions concerns the entire purpose of this study, “to promote awareness of the availability, use and benefits of spatial data from the health community perspective”. A cultivation approach is proposed to highlight the need for the formation and operation of knowledge sharing culture in public sector information technology innovations. The research sought to identify the dimensions and dynamics of inter-organizational networks as the frameworks of knowledge exchange in information system development and implementation. In this thesis it is argued that innovations depend on the sharing of knowledge, culture, experience, etc, in order to create information systems that span organization boundaries. Thus, specific recommendations are presented to strengthen the information systems