Power Tensions in HIS Integration in Developing Countries: The Need for Distributed Control

As part of health sector reform, most developing countries are in the process of standardizing and integrating various vertical reporting systems. Nevertheless, the pressure resulting from the vertical systems supported by donors renders the integration goal challenging and unachievable. While studies have argued for the heterogeneity of interests and donors’ multiple needs as the major causes, this paper argue for more critical analysis of the problem. The paper contribute by arguing for the need to understand the main actors involved, in terms of their resources and rules as they are implicated in HIS integration. Using an empirical case and Structuration theory concepts, we identified dialectic power relations between the actors resulting from control of resources and rules. The need to build shared meanings of the integration process through communication approaches; and to distribute control of the integrated HIS, facilitating ‘tapping on’ the resources available to the actors is discussed.