The Impact of an ICT Project (Health Information Systems Programme) on the Work Practices of Health Workers in Primary Health Sector: A Case Study from India

摘要

Health care sector is very complex and different from other sectors due to the high level of unpredictability in processes. For ex, an epidemic might break out, or emergency situation may suddenly occur and totally change the schedules of trajectories. The available resources in terms of drugs and equipments might also affect the articulation of work. Articulation here refers to collaboration and reaching common understanding(Strauss et al 1985) which is imperative in this field. Hence trajectories are not simple and linear. Introducing computers and implementing health information management systems requires new work routines and practices which are quite challenging(Boulus,2004). As pointed out by Nina Boulus(2004) changing work practices and improving management information systems are not singular elements but rather part of a large heterogeneous socio-technical network that includes arte facts, tools, people and other socio - cultural factors etc. Also she views the transformation process as a mutual, dynamic and reflexive transformation of both information infrastructures and situated practices of use. While the typical focus of training programs during the process of implementation of HIS is their technical content, many practitioners have demonstrated that social factors could be instrumental in the target system s success as the positive outcomes afforded by user training and adoption of the system are improveduser attitudes, behavior, and performance. Thus to make the ICT projects sustainable it is essential that social factors along with technical issues are given importance during the process of implementation as ultimately the technology intervention has to get integrated into the existing work practices of the people in the organization thus leading to the establishment of new routines which will support the institutionalization of this technology- induced change. Using narrative method this paper will not only highlight the work culture that existed before the intervention of an ICT project but also how the work practices changed slowly during the process of an ICT intervention, and the different challenges (technical, social, geographical and political) faced both by the implementation team and the users in bringing about a change in the work culture of health workers based at the community level is described.