Work in progress Do not site without author’s permission ANALYSING THE PROBLEM OF UNSUSTAINABLE HEALTH INFORMATION SYSTEMS IN LESS DEVELOPED ECONOMIES: CASE STUDIES FROM TANZANIA AND MOZAMBIQUE

Most of donor supported information technology (IT) based projects developed or implemented in Less Developed Economies (LDEs) end up as a complete or partial failures or unsustainable. Notably, a number of intraorganizational and external factors are associated with this problem including inadequate infrastructure and human resource capacity, fragmented donor policy and lack of policies to manage the sustainability problem. Accordingly, IT initiatives are often donor driven, top down and hijacked by top managers who (normally) do not have adequate skills but have enormous power to enforce such initiatives across organizational hierarchies. In analysing the concepts from sustainability and institutionalization, the article develops key insights towards a better understanding of the problem of unsustainability. It is argued that Health Information Systems (HIS) become sustainable if they are institutionalized in the sense of being integrated into the everyday routine of the user organization. However, sustainable HIS need not only to be institutionalized, but also be flexible to allow changes as the user needs change. Moreover, introduction of new HIS is not only a technical change, but requires the cultivation and institutionalization of a new kind of culture. Through a comparative case analysis of the HIS development and implementation processes in Tanzania and Mozambique, we have identified two sets of relationships, between the Ministry of Health (MoH) and donor agencies and between the MoH and software development agencies as critical and contributing factors to the unsustainability of HIS. Given this setting, we highlight three key strategies for dealing with the problem of unsustainability in LDEs: (1) Integration of HIS, (2) local shaping of new cultures, and (3) cultivation approach to systems development.