Multiplicity and temporality of rationality: Constructing information for meningitis surveillance and response in Burkina Faso

Currently, better data is called for around the world to strengthen detection and response to epidemics. Health information systems are envisioned to provide such data in a coherent manner, but different rationalities of those engaged in the collection and use of data, often lead to fragmentation. In this article we present a socio-technical analysis of the multiple flows of information construction for disease surveillance. Our study is based on fieldwork done in Burkina Faso in West Africa during 2015-2017. The case concerns meningitis control in Burkina Faso focusing on two flows in its meningitis surveillance and response system: (1) data flow from health worker's initial record on the first contact with the patient to the national level statistics compilation office, (2) substance and related data flows from the sample extracted by the health worker to the laboratories and their reporting of the test results. Drawing from the field of sociology of knowledge and technology, we base our analytical framework on four key concepts: circulating reference, multiplicities, rationalities, and temporalities. While circulating reference and multiplicities concern the "how" of information construction, rationalities and temporalities focus the attention on the "why", reflecting the positions of different actors. Our findings show that viewed over time, fragmentation also gives rise to coherence in the information system. Providing "good" data follows a "temporality of rationality", where data which are considered useful are highly affected by when they are needed, by whom, and for what purpose. Taken together, this framework provides for the development of sociologically grounded research on the how and why of information construction, which is also critical for improving the practice of disease surveillance.