Models for Online Computing in Developing Countries: Issues and Deliberations

The implementation of computerized health information systems (HIS) across the African continent has had mixed success over the past 20 years. Many countries have been left with non-functional systems which cannot be adapted to meet current health information demands because funding is exhausted, the source code for legacy systems is not available and the challenge of maintaining complex and distributed systems in resource-poor environments has simply proved too great. The expansion of Internet connectivity in Africa has enabled a new model of provisioning systems using the web which may prove to be more robust and scalable. This paper uses the case of a new web-based HIS in Ghana to illustrate the opportunities and challenges of this new model. We discuss how the HIS in Ghana was materialized through an act of "improvized outsourcing" according to Ciborra [(1999). Notes on improvisation and time in organizations. Accounting, Management and Information Technologies, 9 (2), 77-94], improvization is called upon in urgent situations "when plans and procedures fail" (p. 77). Such an urgent situation took place in Ghana when the data center intended for hosting of the HIS server was not operational in time for the national rollout. Through an act of improvization, hosting of the server was outsourced to a private company in Accra. Silva (2002) [Outsourcing as an improvisation: A case study in Latin America. The Information Society, 18 (2), 129-138] argues that power is essential in understanding why outsourcing improvizations succeed or fail, and in light of this we discuss what empowering factors that enabled the successful improvization in Ghana and the role of improvization and outsourcing for the long-term sustainability of system.