TY - JOUR
T1 - Examining policy intentions and actual implementation practices
T2 - How organizational factors influence health management information systems in Uttar Pradesh, India
AU - Nigam-Meghani, Ankita Nigam
AU - Rodríguez, Daniela C.
AU - Bilal, Huzaifa
AU - Tripathi, Anand B.
AU - Namasivayam, Vasanthakumar
AU - Prakash, Ravi
AU - Peters, David H.
AU - Bennett, Sara
N1 - Funding Information:
The Bill and Melinda Gates Foundation supported the project (Grant ID# OPP1161434 ) under which this study was conducted. The funder played no role in the study design, data collection, analysis or the interpretation of the data.
Funding Information:
To meet these policy objectives, in 2017, the GOUP first designed and implemented its own data platform known as the Uttar Pradesh HMIS (UP-HMIS), which mandated electronic data entry of paper-based reports at the block level (an administrative unit below the district) and upwards. In addition, the GOUP streamlined the number and content of data collection forms that would be reported to the UP-HMIS. After redesigning the technical features of the UP-HMIS, the GOUP developed organizational policies to guide processes to strengthen data quality review and data use in decision-making at the block and district-levels (detailed below). To support policy implementation, the GOUP in collaboration with the UP-TSU conducted HMIS-related trainings for relevant cadres in the health system.The Bill and Melinda Gates Foundation supported the project (Grant ID# OPP1161434) under which this study was conducted. The funder played no role in the study design, data collection, analysis or the interpretation of the data.
Publisher Copyright:
© 2021
PY - 2021/10
Y1 - 2021/10
N2 - This study investigates the implementation of a recent health management information systems (HMIS) policy reform in Uttar Pradesh, India, which aims to improve the quality and use of HMIS data in decision-making. Through in-depth interviews, meeting observations and a policy document review, this study sought to capture the experiences of district-level staff (street-level bureaucrats) who were responsible for HMIS policy implementation. Findings revealed that issues of weak HMIS implementation were partly due to human resources shortages both in number and technical skill. Delays in recruitment and the presence of inactive staff overburdened existing staff and weakened the implementation of HMIS activities at the block- and district-levels. District staff also explained how inadequate computer literacy and limited technical understanding further contributed to low HMIS data quality. The organizational culture was even more constraining: working within a very rigid and hierarchical organization was challenging for district data staff, who were expected to manage day-to-day HMIS activities, but lacked the discretion and authority to do so effectively. Consequently, they had to escalate minor issues to district leadership for action and were expected to follow their supervisors' directives– even if they contradicted HMIS policy guidelines. High performance pressures associated with achieving top district rankings deviated focus away from HMIS data quality issues. Many district-level respondents described their superiors’ “fixation” with becoming a top-ranking district often resulted in disregard for the quality of data informing district rankings. Furthermore, the review of district rankings only partially encouraged district-level leadership to investigate reasons for low-performing indicators. Instead, low district rankings often resulted in punitive action. The study recommends the importance of incorporating the perspectives of district staff, and recognizing their discretion, and authority when designing policy implementation processes, and finally concludes with potential strategies for strengthening the current HMIS policy reform.
AB - This study investigates the implementation of a recent health management information systems (HMIS) policy reform in Uttar Pradesh, India, which aims to improve the quality and use of HMIS data in decision-making. Through in-depth interviews, meeting observations and a policy document review, this study sought to capture the experiences of district-level staff (street-level bureaucrats) who were responsible for HMIS policy implementation. Findings revealed that issues of weak HMIS implementation were partly due to human resources shortages both in number and technical skill. Delays in recruitment and the presence of inactive staff overburdened existing staff and weakened the implementation of HMIS activities at the block- and district-levels. District staff also explained how inadequate computer literacy and limited technical understanding further contributed to low HMIS data quality. The organizational culture was even more constraining: working within a very rigid and hierarchical organization was challenging for district data staff, who were expected to manage day-to-day HMIS activities, but lacked the discretion and authority to do so effectively. Consequently, they had to escalate minor issues to district leadership for action and were expected to follow their supervisors' directives– even if they contradicted HMIS policy guidelines. High performance pressures associated with achieving top district rankings deviated focus away from HMIS data quality issues. Many district-level respondents described their superiors’ “fixation” with becoming a top-ranking district often resulted in disregard for the quality of data informing district rankings. Furthermore, the review of district rankings only partially encouraged district-level leadership to investigate reasons for low-performing indicators. Instead, low district rankings often resulted in punitive action. The study recommends the importance of incorporating the perspectives of district staff, and recognizing their discretion, and authority when designing policy implementation processes, and finally concludes with potential strategies for strengthening the current HMIS policy reform.
KW - Health management information systems
KW - India
KW - Organizational culture
KW - Policy analysis
KW - Policy implementation
KW - Street level bureaucracy
KW - Uttar Pradesh
UR - http://www.scopus.com/inward/record.url?scp=85112820966&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85112820966&partnerID=8YFLogxK
U2 - 10.1016/j.socscimed.2021.114291
DO - 10.1016/j.socscimed.2021.114291
M3 - Article
C2 - 34418584
AN - SCOPUS:85112820966
SN - 0277-9536
VL - 286
JO - Social Science and Medicine
JF - Social Science and Medicine
M1 - 114291
ER -