Enable incentives from the system for all
All stakeholders down the value chain have to be taken on board and should benefit directly from the system. Given the importance of primary data collection, additional importance needs to be given to how the system would benefit the service providers, facility managers, and mid-level managers in terms of new functionalities for use and reduced burden of work related to data collection.
Redefine rules of procurement
The rules of contracting and procurement in Ministries of Health represent deep-rooted institutions which are difficult to change, and adversely impact the nature of new systems that can be introduced. These institutions need to be modified to provide space for open source solutions and standards, encourage small and niche players which may provide better products for lower costs, bring in stronger domain knowledge of public health and systems development, and enable effective support and investment in long-lerm capacity building initiatives.
Decentralized systems are more effective than centralized ones
Health systems that are decentralized adaptive learning systems are more successful than centralized rigid hierarchical systems. The more decentralized and adaptive a system is, the greater is its potential for learning, and the more likely it is to make use of information.
The reverse may turn out to be true as well—that centralized health systems that make better use of information and have information systems better designed to support use of information will, over time, become more decentralized, adaptive, and learning—and therefore achieve better performance.