A critical analysis of the implementation of health information systems for public healthcare service delivery in resource-constrained environments: a South African study

The use of technological solutions is argued to offer quality enhancing efficiencies in the delivery process of healthcare services. For this to be realized certain objectives of these technological solutions have to be achieved. The public health system in South Africa faces various challenges such as poor coordination of most technological solutions therefore fragmented; a lack of interoperability between different systems, haphazard procurement processes and poor information management capabilities. The argument in this study establishes that the causes are not purely logistical but also linked to gaps in the adequacy of the health information systems (HISs) and the implementation process of these technological solutions. A case study strategy, whose empirical home is rural South Africa, was employed using qualitative methodology. Activity Analysis and Development (ActAD) framework was used as a theoretical lens within critical realist paradigm. The study was conducted in a public healthcare facility within a resource constrained environment. Semi-structured interviews was used as data collection method and analysis of data was through narrative and explanatory analyses, employing thematic analysis tool. The paper intends to come up with a framework that can be used to inform the implementation process of HIS(s) across board. With a focus on the context of a divergent national service delivery reality that impacts the right to healthcare service in under-served communities.