Countering the “dam effect”: the case for architecture and governance in developing country health information systems

ABSTRACT

This paper presents a case for enterprise architecture (EA) and IT governance for driving techno-organizational change and coordination of health information systems (HISs) in developing countries. We support our claim with analyses of a large-scale electronic HIS in Ethiopia by tracing the logic of actors’ decisions and conduct within and beyond the organizational boundaries of the Ethiopian Federal Ministry of Health to understand how the information system innovation process is designed, legitimized and imposed by internal and external organizational forces. In the absence of formalized institutional arrangements throughout the HIS development and implementation, an international development agency fills a key gap forming an obligatory passage point which we conceptualize as “the dam effect.” Drawing on actor-network theory, we identify three important implications of EA and IT governance: (1) to help achieve an alignment of interests within the enterprise; (2) to serve as a tool for protecting the interests of the enterprise in external negotiations; and (3) to serve as a pragmatic approach to carrying out techno-organizational change.

KEYWORDS:

• Health information systems
• IT governance
• enterprise architecture
• techno-organizational change

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Mikael Gebre-Mariam is a PhD Research Fellow in the Information Systems Research Group at the Department of Informatics, University of Oslo. His research interests are focused on the social and management aspects of the development and implementation of health information systems in developing countries.

Elisabeth Fruijtier is a PhD Research Fellow in the Information Systems Research Group at the Department of Informatics, University of Oslo. She received her MSc in Global Health from Trinity College Dublin. Research interests include knowledge-sharing practices in distributed (digital) development and innovation.

Notes

1 WoredaNet is a terrestrial and satellite-based network services installed by the Ethiopian Telecommunication Corporation at districts to provide Internet connectivity.