UNIVERSITY OF OSLO Department of Informatics Challenges, Opportunities and Strategies for Using Geographic Information Systems for Public Health Management An Action Research Study from Mozambique Zeferino Benjamim Saugene Master Thesis May 2005 Introduction DEDICATED TO The memory of my Sister “Amelita Benjamim Saugene” and the Saugene family for their love, support, encouragement and strength. Zeferino Benjamim Saugene i Challenges, Opportunities and Strategies of Implementing GIS for Public Health Management in Mozambique TABLE OF CONTENTS CHAPTER I INTRODUCTION ................................................................................................................. 1 1.1. INTRODUCTION..................................................................................................................................1 1.2. PUBLIC HEALTH MANAGEMENT IN DEVELOPING COUNTRIES: THE ROLE OF INFORMATION ............3 1.2.1. Public Health and Non-Spatial Information................................................................................4 1.2.2. Public Health and Spatial Information........................................................................................6 1.3. RESEARCH ISSUES ADDRESSED IN THIS THESIS.................................................................................8 1.3.1. Research Domain ........................................................................................................................8 1.3.2. Research Study ............................................................................................................................8 1.3.3. Research Questions .....................................................................................................................9 1.4. ADDITIONAL EXPOSURE TO THE FIELD............................................................................................10 1.5. THE HISP RESEARCH PROJECT .......................................................................................................11 1.6. ORGANIZATION OF THE THESIS........................................................................................................11 CHAPTER II RESEARCH SETTINGS ..................................................................................................... 13 2.1. EMPIRICAL SETTING: THE MOZAMBICAN CONTEXT .......................................................................13 2.1.1. Demographic, Social and Economic Context of Mozambique...................................................13 2.1.2. The Health Information System in Mozambique........................................................................15 2.1.3. ICT Situation in Mozambique....................................................................................................24 2.2. EMPIRICAL SETTING: THE BRAZILIAN CONTEXT.............................................................................28 2.2.1. Demographic, Social and Economic Context of Brazil .............................................................28 2.2.2. Spatial ICT Situation of Brazil ..................................................................................................30 2.3. SUMMARY ......................................................................................................................................33 CHAPTER III LITERATURE REVIEW ..................................................................................................35 3.1. ICT AND GIS IN DEVELOPING COUNTRIES......................................................................................35 3.1.1. ICT in Organizations.................................................................................................................35 3.1.2. ICT in Developing Countries.....................................................................................................37 3.1.3. GIS in Developing Countries.....................................................................................................39 3.2. IMPLEMENTING ICT AND GIS FOR PUBLIC HEALTH IN DEVELOPING COUNTRIES ...........................41 3.2.1. How can ICTs support Health Information System in developing countries?...........................42 3.2.2. How can GIS Support the Health Information System Decision-makers in Developing Countries?................................................................................................................................................43 3.2.3. What are the Challenges in Introducing GIS Systems? .............................................................46 3.2.4. What are the Strategies for GIS Implementation?.....................................................................52 3.3. INFORMATION SYSTEMS AS SOCIAL SYSTEMS.................................................................................55 3.4. ACTOR-NETWORK THEORY AND INFORMATION INFRASTRUCTURE ................................................56 3.5. PARTICIPATORY DESIGN IN HEALTH INFORMATION SYSTEM DEVELOPMENT .................................61 3.5.1. System Prototyping....................................................................................................................61 Zeferino Benjamim Saugene ii Introduction 3.5.2. User Participation .....................................................................................................................62 3.6. THEORETICAL PERSPECTIVE: GIS INTRODUCTION AS AN INFORMATION INFRASTRUCTURE............65 3.6.1. Understanding ICT Innovation..................................................................................................65 3.6.2. Theoretical Framework .............................................................................................................66 3.7. SUMMARY.......................................................................................................................................68 CHAPTER IV RESEARCH METHODS.................................................................................................70 4.1. INTRODUCTION................................................................................................................................70 4.2. RESEARCH APPROACH ....................................................................................................................70 4.2.1. Action Research.........................................................................................................................71 4.2.2. Participation in Action Research...............................................................................................74 4.3. RESEARCH METHODS.......................................................................................................................75 4.3.1. Interviews ..................................................................................................................................75 4.3.2. Survey Questionnaire Administration........................................................................................77 4.3.3. Observations..............................................................................................................................78 4.3.4. Document Analysis ....................................................................................................................78 4.3.5. Prototyping the Geographical Information System Software ....................................................79 4.4. DATA ANALYSIS TECHNIQUES ........................................................................................................80 4.5. SUMMARY OF THE CHAPTER...........................................................................................................81 CHAPTER V CASE STUDY DESCRIPTION ...................................................................................... 82 5.1. SITUATION ANALYSIS: GIS SYSTEM DESIGN AND IMPLEMENTATION IN MOZAMBIQUE..................83 5.1.1. Understanding Social Dynamics ...............................................................................................83 5.1.2. Analysis of User Requirements..................................................................................................84 5.1.3. Design and Prototyping the GIS System....................................................................................89 5.1.4. Evaluation of the Results .........................................................................................................104 5.1.5. Lesson Learned and Future Challenges ..................................................................................110 5.2. LEARNING FROM BRASIL EXPERIENCE ON GIS IMPLEMENTATION ................................................119 5.3. SUMMARY.....................................................................................................................................123 CHAPTER VI ANALYSIS OF FINDINGS...........................................................................................124 6.1. DEVELOPMENT OF A DCH GIS PROTOTYPE..................................................................................124 6.1.1. Inscribing User Needs in the GIS Technology.........................................................................125 6.1.2. Keeping the Users in Focus: The User Challenge...................................................................127 6.2. UNDERSTANDING THE EXISTING WEB OF INFORMATION INFRASTRUCTURE (TECHNICAL AND INSTITUTIONAL INSTALLED BASE) ...............................................................................................................128