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Information Systems Research and DHIS2

DHIS2 is not just a software platform. It is also part of a decades-long participatory action research project on health information system strengthening led by the Health Information Systems Programme at the University of Oslo

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    HISP research and DHIS2

    DHIS2 is currently developed and maintained by the software development group within the Health Information Systems Programme at the University of Oslo (UiO), Department of Informatics. Academic research has played a key role in the HISP movement since the original DHIS software was created as a research project on health information system strengthening in South Africa in the 1990s. The scope of HISP research extends beyond the DHIS2 software, however, to the broader socio-technical ecosystem of health information systems, including their materials, people, competencies, institutions and practices.

    HISP is also a global movement to strengthen Health Information Systems in Developing countries. HISP at UiO is one of the leading organizations in this movement and our contribution includes in-country capacity building and implementation support, research, a PhD program, and hosting the core DHIS2 software development team.

    Within HISP, we design, implement and sustain health information systems following an action oriented and participatory approach. Our core aim is to support local management of health care delivery and information flows in selected health facilities, districts, and provinces, and its further spread within and across developing countries. We provide our software, DHIS2, as a digital global public good.

    Participatory Action Research

    DHIS2 is the product of a 20-year longitudinal participatory action research project that has its origins in the Scandinavian tradition of workplace democracy and South African anti-apartheid activism. Action research involves collaborative activities carried out between users and researchers together with developers and other stakeholders to enable system design, development, capacity strengthening, system testing and more, linking research with practice with the goal of generating new scientific knowledge along with relevant practical knowledge related to system design, development and use.

    Participatory action research informs the HISP UiO capacity strengthening and software platform teams and thus directly impacts the broader development and enhancements of DHIS2. New functionality is tested out in small-scale applications on the ground before being scaled up and, if successful, absorbed, implemented and shared across the generic global platform. In parallel, these important implementation experiences are documented in the academic literature and shared at practitioner events such as DHIS2 Academies.

    At UiO, DHIS2 activities constitute a “living lab” where research, innovation and software development are integrally aligned. Collaboration across and within the broader HISP network, exploration of new use cases (for example disease surveillance or applications in the education sector) and experimentation with new functionalities and technologies (for example cloud and smartphones) drives the continuous evolution and dissemination of DHIS2.

    DHIS2 Design Lab

    The DHIS2 Design Lab explores how researchers and practitioners working within the DHIS2 software ecosystem can facilitate and promote the design and innovation of tools that are usable and provide value to the work of end-users.

    The design lab sees DHIS2 and the surrounding resources, people, and practices as a design infrastructure, rather than a standard software solution. The aim of the design infrastructure is to support the design of usable and relevant systems during implementation into concrete user organizations. The primary focus of the design lab is on strengthening the implementation-level design and innovation capacity of the DHIS2 design infrastructure so that it better supports designers in locally building the software that is right for particular contexts of use.

    The design lab consists of researchers and post-graduate students at the Department of Informatics at the University of Oslo, working in collaboration with DHIS2 core developers and implementation specialists around the world including India, Mozambique, Malawi, and Tanzania.

    Video: History of HISP & DHIS

    In this video from 2021, Professor Jørn Braa of HISP-UiO discusses the history and future of the Health Information Systems Programme and District Health Information Software (DHIS) project.

    HISP network: collaboration & capacity building

    UiO initiated an integrated Masters Program at Eduardo Mondlane University (UEM) in Mozambique in 2000, which has since spread to other countries through the HISP network. This program provides a vehicle for integration of the disciplines of informatics and public health, and is based on the following pedagogical and developmental principles:

    • Engage students in local practical development to ensure both the local relevance of education and research as well as contributing to local systems development.
    • Establish synergetic collaboration between the academic disciplines of informatics and public health to ensure that the informatics students learn about the health domain and how IT could be applied there and vice versa.
    • Establish collaboration with the Ministry of Health, both for education and applied research; Ministry of Health staff taking part in teaching, and staff from the Ministry of Health also being enrolled as students, and student research projects being designed as to support Ministry of Health by developing HIS in pilot provinces contributing to the larger national strategy.

    To help run and sustain this Masters program, a corresponding PhD program was also established in Mozambique. Six staff members from the UEM University were enrolled as PhD students at the University of Oslo in a ‘sandwich’ mode, meaning that they carried out their research in Mozambique while also helping to supervise the Masters students, while taking courses and attending their PhD related seminars in Oslo.

    Since our start in Mozambique, UiO has collaborated with national universities to establish in-country Masters programs in South Africa, Malawi, Tanzania, Ethiopia, Sri Lanka, and Bangladesh. With funding and scholarship support from the Norwegian government — supplemented in some cases by national funding — more than 500 students have been awarded Masters degrees, more than 60 of whom have gone on to register for doctoral programs at UiO. Several of these former students now lead HISP groups in our global HISP network.

    Both the research and Masters students have also actively contributed to the teaching of the Masters programs and in-service courses in different countries. Since individual students come from countries where such Health Information System reform initiatives are ongoing, this model has contributed to the development of sustainable capacity at the institutional levels within these countries’ Ministries of Health and the Faculties of Public Health and Informatics of their national universities. These individuals become critical contributors and leaders of local and regional organizations in the South, supporting and strengthening implementation and further development of DHIS2.

    Select HISP UiO Research Publications

    Research on DHIS2 and the global HISP project is instrumental in helping assess the impact of DHIS2 in strengthening health information systems in low- and middle-income countries, and the outcomes of this research feed back into the DHIS2 development and implementation processes.

    HISP UiO generates high-quality research outputs through faculty researchers, as well as PhD and Master’s candidates. Their work frequently appears as published research in international journals. HISP researchers have produced widely cited scientific outputs such as the “networks of action” approach, which has been adopted globally by researchers and practitioners.

    Below, you can find a selection of featured HISP publications on DHIS2 and health information systems. For an updated list of recent publications that present research and analysis related to DHIS2 and Health Information Systems, visit the research library on the HISP UiO website.

    TitleAuthor(s)KeywordsLink
    The Dynamics of a Global Health Information Systems Research and Implementation Project Eric Adu-Gyamfi

    Petter Nielsen

    Johan Ivar Sæbø
    HISP, DHIS2, health information systems implementation, participatory action research, open-source softwareDownload PDF
    Institutionalizing Information Systems for Universal Health Coverage in Primary Health Care and the Need for New Forms of Institutional WorkSundeep Sahay

    Petter Nielsen

    Margunn Aanestad
    Universal Health Coverage, Health Information Systems, Primary Health Care, Institutional WorkDownload PDF
    Making Usable Generic Software. A Matter of Global or Local Design?Magnus Li

    Petter Nielsen
    Usability, Generic Software, Implementation-level design, Meta-usabilityDownload PDF
    Digital Empowerment for Health Workers and Implications on EMRs UtilisationChipo Kanjo

    Joshua Hara

    Jens Kaasbøll
    Electronic Medical Record, Digital Empowerment, Computer Literacy, Keyboard Typing
    Download PDF
    The social and technical conditions enabling innovations in information infrastructures: A case study from public health in TanzaniaMasoud Hussein Mahundi

    Petter Nielsen

    Honest Kimaro
    DHIS2, health, innovations, information infrastructure, social and technical conditionsDownload PDF
    Challenges and opportunities of using DHIS2 to strengthen health information systems in the Eastern Mediterranean Region: A regional approachSundeep Sahay

    Arash Rashidian

    Henry V. Doctor
    EMRO, DHIS2, regional approachDownload PDF

    For more information, contact the HISP research group

    If you are interested in collaborating with HISP researchers, you can contact the head of the HISP-UiO research group, Petter Nielsen, by email.

    You can also join the discussion on DHIS2-related research on the DHIS2 Community of Practice and learn more about the Health Information Systems Program at the University of Oslo on the UiO website.