How participation at different hierarchical levels can have an impact on the design and implementation of health information systems at the grass root level - A case study from India

To build the effective information systems Scandinavian tradition emphasizes and encourages the participatory design methods which involves both designers and users equally in building the systems. While the main intention of Scandinavian tradition is to refocus the dominant orientation of systems developers by involving users but one really wonders whether it can be applied in the context of developing countries particularly in a country like India where the structures are rigid, hierarchical and strongly bureaucratic in nature. In spite of the fact that health sector being a key social area in India's developmental administration it is highly fragmented and receives low priority. In India, while the general administration is mostly concentrated at the district level, health and family welfare administration has been centralized at state and central levels. This coupled with the excessive concentration of powers in the secretariat system of governance, has considerably centralized planning and monitoring. Keeping in view the above complexities and challenging conditions this paper tries to understand using case study as a method how participation at different levels affects the design and implementation of Health Information Systems in primary health care sector in India.