Informality and Fuzzy Complexity in Public Health Information Systems and Low and Middle-Income Countries

In this section, we discuss how computerization is historically based on longterm structuring of processes of formalization and institutional development. We argue that complexity is linked to levels of formalization, and low levels of formalization, such as in public health in LMICs, are characterized by high levels of complexity and uncertainty.

Formalization and general development

Computerization typically takes place within formalized and closed domains, where the programmer selects which objects and their properties are needed in order to perform a particular task. ICT development builds on historical processes of formalization in society (Jervell 1991; Greenbaum 1998; Berg 1997), resulting from a dynamic interplay between the use of formalized and closed descriptions, which contributes to the building of artificial environments, which again make it possible to further formalize and close. Formalization tends to create artificial environments in an otherwise untamed world. In the

Case Study 7.2 Central Server and Scaling in Ghana: Managing Complexity and Creating an 'Attractor in the Cloud'

Ghana implemented a web and central server based data warehouse in 2012 called DHIMS, based on the DHIS 2 platform (Poppe et al. 2013). This replaced an earlier MS Office-based proprietary system called DHIMS, implemented in 2008 in all districts and hospitals in the country. Data was submitted on paper forms to the districts where data were captured, checked for quality, and sent to the province as email attachments, and from there to the national level. The decision to go for DHIS 2 on a central server solution was taken, first of all, because internet had reached all districts and the MoH wanted to go ‘online, and wanted to adopt an open source approach.

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