An informational approach to health management in low-income countries.

This thesis investigates the introduction of new information management strategies intended to promote an informational approach to management at the operational health service level in low-income countries. There is a lack of in-depth empirical research into the health information systems planning and implementation process in low-income countries which develops an understanding based on existing theory and research. Furthermore, a training package for managers, which is intended to strengthen health information management in low-income countries, has been introduced without independent evaluation. In order to understand the practice and attempts at improving information support to district level management in low-income countries, two ethnographic case studies are presented. The first follows the introduction of PHC MAP, the package mentioned, and the second follows the implementation of a non- computer-based health management information system in Uganda. The research methodology is informed by several approaches which fit within the interpretative, rather than the positivist tradition. Hence, the research question developed from the desire to understand and examine empirical situations. Furthermore, an exploratory approach was utilised rather than identifying theoretical frameworks prior to the field investigation. After the initial fieldwork, the diffusion of innovation framework, the concept of organisational forces existing in dynamic equilibrium, and different information systems development methodologies proved useful in interpreting the evidence collected. My research indicates that the design of PHC MAP and the health management information system focused on technological issues, to the detriment of the wider issues of technological innovation management, and organisational change. The implications of this research, for the practice of introducing new information strategies in order to develop an informational approach to management, are explored.