The focus of my work, pursued in external projects and published academically, has been on the design, development, integration, use and sustainability of health information architectures in developing countries, with a primary focus in the Indian public health system. Further, a focus is to create organizational models which can provide technical support and make systems sustainable and scalable in various countries in Asia, Africa and Latin America.
My academic work is empirically grounded primarily within an action research framework working closely with public health managers, policy makers, health programme managers and field level health functionaries. I have an extensive experience with management of research projects involving partners from universities, public health sector, and also running an NGO. Currently I am supervising 10 PhD students and was principal supervisor for more than 10 PhD students in the past.
Key areas of interest:
- Integrated health information architectures within a social systems perspective
- Standardization processes of technology and work practices in public health
- Integration strategies for portfolios of health information systems and the underlying platforms such as web based, offline, paper, and mobile based
- Processes of institutionalization of health information systems and related processes
- Enabling processes of networking within south-south-north universities, researchers, and practitioners
- Building capacity around free and open source software applications for the public health sector within the domain of developing countries
Some concrete findings from my research over the years have been:
Integration as a political challenge
Historically, in India and in most other countries, health programme data are reported through channels independent of the routine district systems. This creates various duplications, overlaps and also gaps. In the action perspective we have, we approach the integration challenge in a gradual and incremental manner in firstly designing integrated formats, participating in orienting and training to these forms in a manner where the institutional legacies are gradually addressed. Political aspects of integration are notoriously hard to overcome, even when technical solutions are available.
Scaling is more than about numbers
Scaling has often been treated as a mechanical exercise of about increasing numbers and geography. My empirical engagement over the years points to the learning that scaling should be treated as scaling of design principles and processes, rather than of boxes. A guiding principle here is scaling is most about managing complexity. Scaling is an ongoing process because as the systems and use scales, user demands and needs also expand. There must be then processes in place where there is a clear, iterative and agile process of managing design, development and use where scaling is inbuilt not an afterthought.
An architecture approach provides a basis for “good design”
A health information architecture should not be viewed as an end-solution – as there is nothing like a perfect architecture – and should merely be seen as an approach to manage complexity. An architecture should be regarded as a process tool, which at any point would represent the current understanding and knowledge, which by definition will be inadequate and incomplete, and while at the same time should enable the incorporation of new developments. The point of departure, thus, is to conceptualize architecture as a verb – a collective; always in the making - rather than a noun; representing an end solution. The concept of architecture provides a map or compass and a form of direction for “good” design of the overall integrated HIA, as well as, the phased implementation of its various sub-systems.
The fundamental importance of a social systems perspective to health information systems
The health system comprises of many thousands of health workers, engaged in routine collecting, registering, collating, and reporting of data in a large number of formats. Data and information are analyzed and used in a variety of ways by different people, to make informed decisions and to improve health services delivery. These represent “good” ways of applying information, or to only collect data to legitimate various positions, as some would claim. Since HISs are deeply embedded in the socially shaped work practices of staff in the health system, they can be seen as being barely separable from the social context of which, they are a part. Seen from this perspective, HIS are conceptualized as “human activity systems,” involving multiple activities around the HIS, constituting important parts of the institutional structures in health organizations. Such routine work and repetitive activities across time and space have regularizing consequences, including unintended ones by those engaged in the activities.
Braa, Jørn and Sahay, Sundeep (2012). Integrated health information architecture: power for the users : design development and use. New Dehli : Matrix Publishing. ISBN: 978-93-81320-06-8
Braa, Jørn; Heywood, Arthur; Sahay, Sundeep (2012) Improving quality and use of data through data-use workshops: Zanzibar's experience. Bulletin of the World Health Organization. Volume 90, 5, pp. 376-381.
Braa, Jørn; Monteiro, Eric; Sahay, Sundeep. (2004). Networks of action: sustainable health information systems across developing countries. Management Information Systems Quarterly, 28, 3, pp. 337-362
Sahay, Sundeep, Nicholson, Brian, Krishna, Srinavas. (2003) Global IT Outsourcing: Software Development Across Borders, Cambridge, Cambridge University Press.
Walsham, Geoff and Sahay, Sundeep. (1998). GIS technology for district administration in India: some problems and opportunities, MIS Quarterly, 23, 1, pp. 39-66
Sahay, Sundeep. (1997). Information systems in organizations: A time-space perspective. Organization Studies, 18, 2, pp. 229-260
Robey, Daniel and Sahay, Sundeep. (1996). Transforming work through information technology: A comparative case study of geographic information systems in county government. Information Systems Research, 7, 1, pp. 93-110
Sahay, Sundeep. and Robey, Daniel. (1996). Organizational context, social interpretation, and the implementation and Consequences of Geographic Information Systems. Accounting, Management and Information Technologies, 6, 4, pp. 255-282