The author is trying to use action research to critically analyze the conditions for developing sustainable as well as scalable health information systems in third world countries alongside the scalability as well as sustainability of the action research process itself. The author acknowledges that providing health services to individuals in deprived situations particularly in developing countries is a complex task. In his thoughts supported by previous research studies, he asserts that improved health information systems can significantly lead to curbing the complex health delivery issues. Through the world health organization, the vision aimed at providing health for all by the beginning of the millennium through decentralization of management of health issues has not yet been achieved (Braa, 2004). The reason according to the researcher rests on unsuccessful efforts to utilize health information systems in developing countries. This brings two main problems that he sought to research; challenge in making HIS work (sustainability) as well as the challenge of making HIS to spread to other site (scalability).
Context
Establishing sustainability and how an initiative can spread successfully is of significance in health information system. Considering that third world countries have encountered a myriad of problems regarding healthcare provision, it would be rational to evaluate the challenges facing HIS and its sustainability and scalability. It has been shown that successful HIS has the potential of saving lives of those who are poor and are entangled in poverty by providing them with proper health care services.
It is in this context that the researcher has embarked on studying and exploring health information system programs that were ongoing by the time he was doing the research. The countries of interest were South Africa, Ethiopia, Mozambique, China, Nigeria, Tanzania, India, Cuba, Malawi and Mongolia. Additionally the researcher engaged in tracing the evolution of HISP since 1994-2004.
Action research approach used
It is worth noting that after reviewing the various possible research approaches, the author of the article decided to utilize action research approach developed by Baskerville & Wood-Harper, 1998. This approached included the following sections discussing primary goals, structure, and process and researcher involvement. According to the model developers, action research process is iterative, reflective and linear.
Literature review
It is in the literature review where the researcher engages in reviewing works of other scholars related to his study. The author managed to use subheadings in this section to make it easy for the readers to capture relevant sectors. The author cited majority of existing literatures that were not too old considering the year the study was done. It is worth noting that majority of the references he used were from 1996-2002. I have to admit that the author managed to use simple language and still conveyed the intended meaning; this made the work to be outstanding.
Participative process
The researcher identified 10 countries that had in place HISP that were ongoing and were willing to take part in the study. The 10 countries took part in the study and critically reviewed how the HISP was running; the gains as well as the challenges being faced were brought to light. The researcher used a network of students and other officials to realize the goals of the study. It is also worth to note that to accomplish this various interviews, workshops and observation were carried out.
Ethical issue
One of the major ethical issues in this study was the researcher and his assistance not to engage in political issues since health matters are sometimes meddled with politics. To avoid any possible ethical issues during the study, the researcher opted not to engage in politics related to HISP but rather strictly follows the laws, guidelines and procedures of each country when handling information related to health. He also sought to be neutral and not to show support on political issues relating to HISP (Braa, 2004).
Diagnosis
The problem was lack of Health Information Systems Programs to be sustainable and spread out to other regions such as provinces and districts. This made it a challenge when trying to provide better health care services to individuals particularly from developing countries. The goal was thus to “design implement and sustain HIS following a participatory approach to support local management of healthcare delivery and information flow in selected health facilities… and its further spread within and across countries” (Braa, 2004, p. 340)
Data gathering and analysis
Concerning data collection the researcher employed interviews, workshops as well as observation. Through selective data coding, there major areas were brought to light; gaining political support, HIS development and finally training and education. Data was analyzed by 3 researchers who drew their findings from analysis and understanding of a network of students (Braa, 2004).
Trustworthiness/validity of the data
To ensure data validity or trustworthiness the researcher collected information and data from different countries. This kind of triangulation helped to deal with issues relating to researcher’s bias. Additionally data was analyzed by three researchers, the earlier drafts were circulated and used by students for a period of 2 years and feedbacks which were varied helped validate the results.
Feedback
There are indeed various kinds or forms of feedback and may include regular updates on various activities, data as well as results. In this study, the author managed to have an avenue where he shared information with the participants through face to face meeting as well as through writings.
Action planning
The 10 countries actively engaged together with the researcher to create an environment in which the study could be successfully carried out. For instance, they were able to provide relevant information about the HISP and tried to incorporate the changes proposed by the researcher as the study was being carried out.
Action
All the 10 countries seek for political support as well as train and educate their staff on successful implementation of HISP.
Evaluation
The research used the codes and themes to evaluate the action. Through discussions with the relevant authorities, the researcher was able to identify challenges facing HISP and together with the respective participants engaged in taking corrective measures.
Lesson learnt
One thing I have learnt is with regards to the time it take for an action research to be carried out. It ideally calls for more time so that issues of concern can be adequately addressed. Similarly participation is key and there is need to always keep everyone at par so that the goals of the research can be realized (Braa, 2004).
References
- Baskerville, R. & Wood-Harper, A. (1998). Diversity in action research methods. European Journal of Information Systems, 7(2): 90-107.
- Braa, J. (2004). Network of action: Sustainable health information system across developing countries. MIS Quarterly, 28(3): 337-362.