Integration of health information systems in Tanzania mainland: complexities and approaches

Fragmentation has for long been a characteristic of Health Information Systems (HIS) in the developing countries with many studies expounding about a variety of drawbacks brought by the same. There have been, so far, many fronts through which fragmentation has been addressed, but this study addresses fragmentation and eventually integration through the Vertical Health Programmes (VHP). These have, more than once, contributed largely to the failure of integration in Tanzania health sector. The study went back to find out about the right prerequisites for an effective integration process in the developing countries as learned in Tanzania. It capitalises on optimally taping the existing contextual advantages, including those posed by the availability of the VHP. Empirical data for this study were extracted from an on-going implementation of the project to strengthen Health Management Information System in Tanzania, in which this qualitative study was involved in the three regions of implementation. Data collection was through supervision visits, meetings, discussions, structured and unstructured interviews and observations. It was found out that of the advantages is the existence of several shared elements across programmes which only require streamlining to achieve integration. Reproductive and Child Health programme, for example, shares 19 data elements with Malaria and 17 with Expanded Programme of Immunisation. There are also shared procedures and routines and even donors. Another pivotal advantage is that most of these VHP are using MTUHA registers, differences only emanating from report form generations. This work argues that the approach to integration has to include harnessing the existing contextual advantages. The study goes further to introducing an approach relevant for integration in developing countries which takes into account the features of the prospective components. This approach has been dubbed CADCO, for Consensus, Assessment, Design, Consensus and Orientation.