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Some Political Struggles HISP is engaged with

Some Political Struggles HISP is engaged with. Sundeep Sahay. Sites for Political Struggles. Centralization-decentralization Statisticians-public health Medical-public health Proprietary systems-Open source Quick fixes-Long term Isolated systems-architecture American hegemony Corruption

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Some Political Struggles HISP is engaged with

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  1. Some Political Struggles HISP is engaged with SundeepSahay

  2. Sites for Political Struggles • Centralization-decentralization • Statisticians-public health • Medical-public health • Proprietary systems-Open source • Quick fixes-Long term • Isolated systems-architecture • American hegemony • Corruption • Donor politics

  3. Centralization-decentralization • India, Cuba, etc • HISP stand “information for local action” • Associated with power – shifts dynamics • Historical legacy • Participation not always a source of empowerment • Keeps the status quo

  4. Statisticians-public health • Tajikistan, India, Cuba etc • HISP Stand: “data is a public health event” • “seeing like a state” • “single window of truth” • More is better vs minimum data set • Treatment of outliers • Violate information pyramid hierarchy • Promote upward reporting bias

  5. Medical - public health • Tajikistan, Sri Lanka, etc • HISP stand: primacy to public health • Medical focus on patient record systems • Promote disease based coding – ICD • Create isolated, Excel based systems that do not talk with others • Doctors as informaticians not as users • Promote systems of limited scale

  6. Proprietary-open source • India, Ethiopia, Ghana etc • HISP stand: 100% open source • Proprietary systems breeds corruption • Vendor lock-in • Short term with respect to system evolution • Single window of truth • IT people, not public health people in control • Licensing costs • Lack of procurement guidelines

  7. Quick fixes-long term • Various countries • HISP stance: long term approach to build local sustainability – linked with education process • Vendors promise short term utopias • Government officials typically short term – want to be remembered • Aid projects often short term – pilots • Hardware/software emphasized, not people

  8. Isolated systems-architecture • Nearly everywhere • HISP stance: promoting architecture • Isolated systems promoted by many – donors, vendors, medical doctors, health programmes • Funding contributed to fragmentation • Contributes to and magnifies fragmentation • Lack of interoperability standards contribute • Architecture thinking is still alien

  9. American hegemony • Ethiopia, Rwanda, Kenya • HISP Stance: pragmatic • Network of donors, medical doctors, contractors, technology • Undue influence on government policy, often because of volume of aid • Often disruptive of local context • Clear distinction with European approach

  10. Corruption • Mozambique, India etc • HISP stand: no money based favors • Many others are willing to do • “Hard” and “Soft” corruption • Corruption flowing from the “top” • Often linked with the politics – hard to fight • Often linked with donor funding • Supporting of proprietary systems

  11. Donor politics • Ethiopia, Mozambique etc • Some positive experiences- Kenya, Zanzibar • HISP stance: Building local sustainability • How does it play out? • Promoting systems • ¨Expatriates/experts • Influencing government • Not adopting health systems framework

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