Beyond pilotitis: taking digital health interventions to the national level in China and Uganda.
Beyond pilotitis: taking digital health interventions to the national level in China and Uganda.
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DOI：
10.1186/s12992-017-0275-z
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发表时间：
2017-07-31
影响因子：
10.8
通讯作者：
Lucas H
中科院分区：
文献类型：
--
作者：
Huang F;Blaschke S;Lucas H
创新理论关注的是个人对新产品或服务的采用，以及它们在市场驱动下向大众扩散的过程。然而，卫生部门的重大创新通常来自不同利益攸关方之间的谈判，这些利益攸关方竞相实施或至少优先考虑其首选的创新版本。因此，虽然许多数字卫生干预措施在被大量提供者和患者采用方面取得了成功，但它们通常未能获得将其纳入国家卫生系统所需的接受程度，从而促进可持续性和在人口范围内的应用。本文所讨论的创新领域涉及越来越多的成功案例，这些成功案例使捐助者、国际机构和政府对信通技术在改造中低收入国家薄弱的国家卫生信息系统方面的潜在作用产生了极大的热情。本文使用案例研究方法来考虑这种热情背后的假设，包括制度上的和技术上的，并探讨了可能改善结果的方法。文献回顾与个案分析。所考虑的两个系统在获得和维持政府支持以及在不损害其核心要素的情况下解决提供者的关切方面取得了相当大的成功。在乌干达，尽管资源受到严重限制，但该系统仍然蓬勃发展，采用了鼓励社区高度参与的参与性方法。在中国，对过去失败的关注产生了建立高质量监测系统的政治意愿，使用最新技术并利用高技能的人力资源基础。这两个例子都强调了认识到信息系统必须在其中发挥作用的政治、社会和历史背景的重要性。实现者需要像关注技术一样关注涉众的看法、态度和需求。执行者应区分可能影响机构一级参与的因素和旨在支持和监督这些机构内个人的因素。最后，我们建议从一开始就将互操作性设计到系统中，而不是假设这可以在将来的某个时刻实现，从长远来看可能会容易得多。
Innovation theory has focused on the adoption of new products or services by individuals and their market-driven diffusion to the population at large. However, major health sector innovations typically emerge from negotiations between diverse stakeholders who compete to impose or at least prioritise their preferred version of that innovation. Thus, while many digital health interventions have succeeded in terms of adoption by a substantial number of providers and patients, they have generally failed to gain the level of acceptance required for their integration into national health systems that would promote sustainability and population-wide application. The area of innovation considered here relates to a growing number of success stories that have created considerable enthusiasm among donors, international agencies, and governments for the potential role of ICTs in transforming weak national health information systems in middle and low income countries. This article uses a case study approach to consider the assumptions, institutional as well as technical, underlying this enthusiasm and explores possible ways in which outcomes might be improved. Literature review and case study analysis. The two systems considered have had considerable success in terms of gaining and maintaining government support and addressing the concerns of providers without compromising their core elements. In Uganda, the system has flourished in spite of severe resource constraints, using a participatory approach that has encouraged a high level of community engagement. In China, concern with past failures generated the political will to build a high quality surveillance system, using the latest technology and drawing on a highly skilled human resource base. Both example stress the importance of recognising the political, social and historical context within which information systems have to function. Implementers need to focus as much on the perceptions, attitudes and needs of stakeholders as on the technology. Implementers should distinguish between factors which may influence engagement at an institutional level and those aimed at supporting and supervising individuals within those institutions. Finally, we would suggest that designing interoperability into systems at the outset, rather than assuming that this can be achieved at some point in the future, may prove far easier in the longer term.
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DOI：
10.1162/itid.2008.00025
发表时间：
2008-09-01
影响因子：
--
作者：
Best, Michael;Kumar, Rajendra
通讯作者：
Kumar, Rajendra
影响因子：
--
作者：
Huntington, J;Gillam, SP;Rosen, R
通讯作者：
Rosen, R
影响因子：
15.8
作者：
Cao J;Sturrock HJ;Cotter C;Zhou S;Zhou H;Liu Y;Tang L;Gosling RD;Feachem RG;Gao Q
通讯作者：
Gao Q
影响因子：
0.7
作者：
Cummins, Matthew;Huddleston, Barbara
通讯作者：
Huddleston, Barbara
DOI：
10.1136/amiajnl-2013-002001
发表时间：
2014-09-01
影响因子：
6.4
作者：
Huang, Fei;Cheng, ShiMing;Wang, Lixia
通讯作者：
Wang, Lixia