Some Political Struggles HISP is engaged with

Sundeep Sahay

Sites for Political Struggles• Centralization-decentralization• Statisticians-public health• Medical-public health• Proprietary systems-Open source• Quick fixes-Long term• Isolated systems-architecture• American hegemony• Corruption• Donor politics

Centralization-decentralization

• India, Cuba, etc• HISP stand “information for local action”• Associated with power – shifts dynamics• Historical legacy• Participation not always a source of

empowerment• Keeps the status quo

Statisticians-public health

• Tajikistan, India, Cuba etc• HISP Stand: “data is a public health event”• “seeing like a state”• “single window of truth”• More is better vs minimum data set• Treatment of outliers• Violate information pyramid hierarchy• Promote upward reporting bias

Medical - public health

• Tajikistan, Sri Lanka, etc• HISP stand: primacy to public health• Medical focus on patient record systems• Promote disease based coding – ICD• Create isolated, Excel based systems that do

not talk with others• Doctors as informaticians not as users• Promote systems of limited scale

Proprietary-open source• India, Ethiopia, Ghana etc• HISP stand: 100% open source• Proprietary systems breeds corruption• Vendor lock-in• Short term with respect to system evolution• Single window of truth• IT people, not public health people in control• Licensing costs• Lack of procurement guidelines

Quick fixes-long term

• Various countries• HISP stance: long term approach to build local

sustainability – linked with education process• Vendors promise short term utopias• Government officials typically short term –

want to be remembered• Aid projects often short term – pilots• Hardware/software emphasized, not people

Isolated systems-architecture

• Nearly everywhere• HISP stance: promoting architecture• Isolated systems promoted by many – donors,

vendors, medical doctors, health programmes• Funding contributed to fragmentation• Contributes to and magnifies fragmentation• Lack of interoperability standards contribute• Architecture thinking is still alien

American hegemony

• Ethiopia, Rwanda, Kenya• HISP Stance: pragmatic• Network of donors, medical doctors,

contractors, technology• Undue influence on government policy, often

because of volume of aid• Often disruptive of local context• Clear distinction with European approach

Corruption

• Mozambique, India etc• HISP stand: no money based favors• Many others are willing to do• “Hard” and “Soft” corruption• Corruption flowing from the “top”• Often linked with the politics – hard to fight• Often linked with donor funding• Supporting of proprietary systems

Donor politics

• Ethiopia, Mozambique etc• Some positive experiences- Kenya, Zanzibar • HISP stance: Building local sustainability• How does it play out?– Promoting systems– ¨Expatriates/experts– Influencing government– Not adopting health systems framework