Digitalization mechanisms of health management information systems in developing countries

The developmental potential of IT in developing countries continues to be confronted by enduring problems that hamper both the sustainability of digitalization initiatives and the realization of their expected benefits. Using a critical realist perspective, this paper examines the underlying causal chain of health management information system (HMIS) digitalization in a developing country. The study develops a mechanism-based explanation of the digitalization process drawing on Archer's morphogenetic approach (1995). Four generative mechanisms of HMIS digitalization were identified: projectification, informatization, embedded inscription and scaling. Theoretically, the paper demonstrates the joint value of Archer's structurational theory and the dynamics of interrelated causal mechanisms of digitalization. We offer three insights for ICT4D practice: First, projects as primary modalities for digitalization have created partnership asymmetries between NGO and local institutions hindering sustainable development. Second, lack of formalized arrangements around multi-stakeholder collaboration has led to poor accountability and regulatory environments. Finally, total dependency on external partners as NGO assumes a gap-filling role thereby replacing rather than building local institutional capacity.