Title:	POWER IMBALANCES AND IS IMPLEMENTATION: A CASE OF INTEGRATED HEALTH MANAGEMENT INFORMATION SYSTEM IN ZANZIBAR
Author(s):	Yahya Hamad Sheikh
ISBN:	978-972-8939-09-0
Editors:	Miguel Baptista Nunes, Pedro Isaías and Philip Powell
Year:	2010
Edition:	Single
Keywords:	Health information systems, power, integration, institutionalization.
Type:	Full Paper
First Page:	258
Last Page:	266
Language:	English
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Full Contents:	click to dowload
Paper Abstract:	Health Management Information System (HMIS) integration is an extensive exercise that goes beyond the installation of hardware and software. In this research article I discuss the project implementation for the integrated HMIS in Zanzibar, Tanzania. The study explores power relations between main actors involved in the project: the vertical programmes, zonal offices and the HMIS Unit, and how it affects the overall implementation process. Theoretically I draw from the concept of power to analyse the implementation process, unpacking the obstacles met when aligning these multiple stakeholders to accept a common shared HMIS. The study reveals institutional differences from the management bureaucracy of the new HMIS, where a newly established HMIS Unit is put on top of HMIS bureaucracy replacing the historically powerful health programmes. However, the unit fails to acquire supportive power resources such as finance, human and material resources, as well as administrative authority, which are crucial for the exercise of power to institutionalise the new HMIS; consequently lacking legitimacy to preside over the new responsibility, posing a clear challenge to the ‘actual’ integration. The existing system outlines clear distribution of power between the actors. On the one hand, the vertical programmes maintain ‘power to’ which is necessary for creating the social order, accumulated in the resources they posses. On the other hand are the zonal offices that have administrative authority, that is, ‘power over’, which is necessary in keeping order. An alternative strategy is proposed aimed at mobilising the power redistribution between the actors.
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