Guiding methodological approaches

The adopted methodologies should seek to address research questions such as: What are the different information use cases for multiple stakeholder groups that Expanded PHI needs to support?; How can information requirements for these systems be understood based on appropriately contextualized participatory design techniques?; How can prototyping methods be used to develop HIS which are flexible, locally relevant, and able to evolve with emerging needs?; What are the appropriate governance models for these systems to best support aims of financial inclusion and poverty reduction in accessing healthcare?; and—What are the socio-technical implementation challenges and appropriate strategies needed to address them?

The required methodologies would typically involve combinations of action research, realist evaluation, and comparative case study frameworks with action research at the core. A key principle underlying action research is that we learn better in collectives than as single units, and for this networks of action (Braa et al. 2004) need to be enabled at global and country levels comprising of university departments, Ministries of Health, policymaking bodies, technology providers, and civil society organizations. Action research can help generate theoretical and practical knowledge on how collaborating nodes in the network can be made self-organizing and self-sustaining, contributing to increased learning. Interpretive approaches (Walsham 1993) would be useful in understanding the different stakeholders’ perspectives towards Expanded PHI, and how inter-subjectivity can be achieved.

Realist evaluation methods (Pawson and Tilley 1997) are especially relevant for informing management choices and designing scaled-up strategies. It represents a new form of strategic thinking and critical analysis of public managers’ action with respect to decision-making (Barzeley 2001), and to help identify ‘what works in which circumstances and for whom’? rather than merely ‘does it work’? This perspective helps to analyse the underlying generative mechanisms that explain ‘how’ the outcomes were caused and the influence of context. This approach can help to understand how interventions have implicit programme theories that specify how a set of mechanisms generate key outcomes; intended as well as unintended. This approach helps to analyse particular situations and the kind of knowledge that is entailed, with a specific emphasis on the participation of individuals and how they contribute or not to the success of the programme, as contrasting with adopting scientific experimental methods which seek to be objective and value and context-neutral.

Methodologically, comparative case study analysis with a longitudinal design can help to develop unique research insights across countries, districts, or provinces currently engaged in developing Expanded PHI. Mixed methods of data collection would be required; including secondary data analysis, interviews, observation, participatory design, software prototyping, and realist implementation evaluation. While secondary data analysis will help to understand the contextual conditions of Expanded PHI models, interviews and observations can provide insights to informational priorities of stakeholder groups, existing flows and gaps of information, and challenges of managing the transition to the new HIS. Participatory design techniques, appropriately contextualized, can help to ensure appropriate needs and local knowledge are included as essential inputs into prototyping methods and in evolving the HIS. Data analysis can involve inductively developing research themes from the data for each case; generating cross-theme analyses across the cases; and developing broader theoretical inferences around the themes of use of information, technology choice and innovation, and governance of HIS.

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