IT-enabled change into the structures of health information systems in Africa: A case study in Kenya

In the recent years most African countries have embarked on a series of reforms involving the decentralisation and also integration of health information systems in order to allow improved efficiency and effectiveness in the health care. However, although the discourse around these issues are reflected in global policy documents of almost twenty years ago, IS are still fragmented and weak at the lower levels of the health service. The paper takes a multivocal and multilevel institutionalist perspective to analyse the role of information technology in shaping these shortfalls between institutional accounts and enactments of reforms. Based on the case study of two divisions of the ministry of health in Kenya, it aims to better understand the change implications of information technology for the structures of a health information system in Africa. This is meant to improve the understanding of the way technology-mediated human interactions produce variance between planned organisational change envisaged in donor-driven reforms of the health care service and unplanned HIS structures emerging from the local institutionally-embedded usage of IT tools.