Mutemwa Richard I
Centre for AIDS Research, University of Southampton, Southampton SO17 1BJ, UK.
Health Policy Plan. 2006 Jan;21(1):40-52. doi: 10.1093/heapol/czj003. Epub 2005 Nov 30.
At the onset of health system decentralization as a primary health care strategy, which constituted a key feature of health sector reforms across the developing world, efficient and effective health management information systems (HMIS) were widely acknowledged and adopted as a critical element of district health management strengthening programmes. The focal concern was about the performance and long-term sustainability of decentralized district health systems. The underlying logic was that effective and efficient HMIS would provide district health managers with the information required to make effective strategic decisions that are the vehicle for district performance and sustainability in these decentralized health systems. However, this argument is rooted in normative management and decision theory without significant unequivocal empirical corroboration. Indeed, extensive empirical evidence continues to indicate that managers' decision-making behaviour and the existence of other forms of information outside the HMIS, within the organizational environment, suggest a far more tenuous relationship between the presence of organizational management information systems (such as HMIS) and effective strategic decision-making. This qualitative comparative case-study conducted in two districts of Zambia focused on investigating the presence and behaviour of five formally identified, different information forms, including that from HMIS, in the strategic decision-making process. The aim was to determine the validity of current arguments for HMIS, and establish implications for current HMIS policies. Evidence from the eight strategic decision-making processes traced in the study confirmed the existence of different forms of information in the organizational environment, including that provided by the conventional HMIS. These information forms attach themselves to various organizational management processes and key aspects of organizational routine. The study results point to the need for a radical re-think of district health management information solutions in ways that account for the existence of other information forms outside the formal HMIS in the district health system.
作为初级卫生保健战略的卫生系统分权化是发展中世界卫生部门改革的一个关键特征，在其启动之时，高效且有效的卫生管理信息系统（HMIS）被广泛认可并作为加强地区卫生管理项目的关键要素加以采用。人们主要关注的是分权化地区卫生系统的绩效和长期可持续性。其基本逻辑是，有效且高效的HMIS将为地区卫生管理人员提供做出有效战略决策所需的信息，而这些决策是这些分权化卫生系统中地区绩效和可持续性的载体。然而，这一观点植根于规范性管理和决策理论，缺乏明确有力的实证支持。事实上，大量实证证据不断表明，管理人员的决策行为以及组织环境中HMIS之外其他形式信息的存在，显示出组织管理信息系统（如HMIS）的存在与有效战略决策之间的关系要脆弱得多。在赞比亚两个地区进行的这项定性比较案例研究，重点调查了战略决策过程中五种正式确定的不同信息形式的存在情况和行为，包括来自HMIS的信息。目的是确定当前关于HMIS的观点的有效性，并确定对当前HMIS政策的影响。该研究追踪的八个战略决策过程中的证据证实，组织环境中存在不同形式的信息，包括传统HMIS提供的信息。这些信息形式与各种组织管理过程和组织日常工作的关键方面相关联。研究结果表明，需要从根本上重新思考地区卫生管理信息解决方案，要考虑到地区卫生系统中正式HMIS之外其他信息形式的存在。
