Negotiating Multiple Rationalities in the Process of Integrating the Information Systems of Disease-specific Health Programmes

The topic of this paper is the integration of different information systems, and in our case study we analyse information systems in the Mozambican health care sector. The context is a health care sector reform that involves the integration of separate, stand-alone, or so-called vertical health programmes. These programmes are usually disease-specific, i.e. targeted towards malaria, HIV/AIDS, or other major diseases. The reporting and monitoring systems for the activities within these programmes are organised differently, in terms of which data elements are collected, to whom and how frequently they are reported etc., but in general they are all paper-based, at least at the peripheral level. The multitude of different systems places an unnecessary high workload on the health care personnel who do the initial data collection. However, the practical challenges related to the integration of the diverse information systems have not yet been the focus for the decision makers. Our aim with this paper is to describe some of the differences between the systems. Our claim is that these differences are not arbitrary. On the contrary, they may be significant indicators of different realities and different interests. Integration of these systems will thus not be a purely technical or practical issue, but will entail a political negotiation of interests. We employ the notions of multiple rationalities as a theoretical tool to discuss this issue. In particular we find tensions between rationalities ‘on the ground’, i.e. in the health care facilities, and ‘on the top’, among the policy makers, the government and the donor organisations.