In 2005, the clinical director of the Batho Pele clinic1 in the Gauteng province in South Africa requested the assistance of the Department of Informatics at the University of Pretoria in addressing their IS issues. This request fitted the department’s research interests in health information systems (HIS), as well the broader research focus and commitment to provide outreach services to the community. Knowing the problems of commencing projects without having planned for sustainability and scalability, the HIS research group elected to use the “networks of action” concept to partner and collaborate with the various role players, institutions, and other ART entities. This process of developing interconnecting networks of human and nonhuman entities in South Africa and beyond its borders raised a number of opportunities, challenges, and tensions in initiating this project. To provide a background to this process, the next section introduces the concept of “networks of action” and a brief description of the ART clinic. The following section develops the main focus of this chapter, which is the process of developing these networks. The last section suggests the necessity of developing networks of action as a future trend for sustainable IS.
TopIntroduction
The South African government has an impressive constitution and legislative framework that recognizes the right of its citizens to quality health care (Government of South Africa, 1996). In South Africa, approximately 80% of the population relies on state-provided health care. Health workers in the public health sector provide services at the formal health facilities and to the various outreach programs in the community (i.e., immunization drives). The effective management and delivery of these diverse services requires regular reporting of routine and exceptional information by health care workers. These workers spend a significant amount of time collecting, recording, storing, and transmitting data in various forms.
With the commencement of the Anti-Retroviral Treatment (ART) program in selected clinics throughout South Africa in 2003 (Department of Health, 2003), treating and supporting clients attending ART clinics places great pressure on the health staff, not only because of insufficient human resources and time, but also with the associated severe emotional strain. Pressure is escalating as the number of clients requesting ART is increasing daily (Stewart, Padarath & Bamford, 2004). An effective Information System (IS) is needed to manage this increase in clients as well as support a variety of reporting requirements.
A national survey in South Africa of health personnel, ambulatory and hospitalized patients, and health facilities substantiates that a weak patient IS (a) was an impediment to ensuring ongoing and correct treatment, (b) increased staff workloads, and (c) led to unnecessary duplication of effort and time. Additionally, Shisana, et al. (2002) argue that ensuring that a single electronic IS is in place to assist in treatment of patients is an essential yet often neglected aspect of the health system.
In 2005, the clinical director of the Batho Pele clinic1 in the Gauteng province in South Africa requested the assistance of the Department of Informatics at the University of Pretoria in addressing their IS issues. This request fitted the department’s research interests in health information systems (HIS), as well the broader research focus and commitment to provide outreach services to the community. Knowing the problems of commencing projects without having planned for sustainability and scalability, the HIS research group elected to use the “networks of action” concept to partner and collaborate with the various role players, institutions, and other ART entities. This process of developing interconnecting networks of human and nonhuman entities in South Africa and beyond its borders raised a number of opportunities, challenges, and tensions in initiating this project.
To provide a background to this process, the next section introduces the concept of “networks of action” and a brief description of the ART clinic. The following section develops the main focus of this chapter, which is the process of developing these networks. The last section suggests the necessity of developing networks of action as a future trend for sustainable IS.