“Developed in the South”: An Evolutionary and Prototyping Approach to Developing Scalable and Sustainable Health Information Systems

The expansion of ICT across Africa is influenced by many factors including political imperatives, donor priorities, private sector and NGO needs, and economic interests and as a result takes place in a haphazard and largely uncontrolled fashion. The health sector is no exception. The challenge, as in many developing countries, is to provide a robust and reliable health information system while effecting a transition between paper-based systems and computerized systems. The transition involves not only the introduction of new ICT, and the accompanying social and educational transformations of people and processes that accompany the introduction of ICT, but also the development of scalable health information systems that can facilitate a smooth transition as ICT expansion and development takes place. This chapter draws on 10 years of experience of the Health Information Systems Programme (HISP), an action research orientated network of public health practitioners and academics who initiated a pilot project in health information systems development in the post-apartheid transformation of South Africa, and which has subsequently had a profound effect on the development of health information systems in Africa and Asia. Through an exploration of health information systems development in numerous countries in Africa, we highlight insights into approaches and methodologies that contribute to successful and sustainable health information systems in resource constrained settings.