Legitimization of data quality management practices in health management information systems: A soft systems methodology perspective

Recognizing the significance of data for policy change to improve population health, many developing countries and Health Partners have invested for decades in Health Management Information System (HMIS). Despite huge investments in technologies and capacity building to support the management of routine health data, there is still a problem in trying to make substantial improvements on gains made so far. A number of researchers have reported on lack of motivation, ownership, data use and work overload as some of the reasons explaining the persistent problem with routine health data quality. However not much has been reported on how legitimacy seekers and providers negotiate for the legitimacy of data quality management practices. We drew on this gap to explore how gaps are negotiated between the legitimacy seekers and the legitimacy providers when seeking legitimacy of data quality management practices in HMIS at micro level. Using institutional theory pillars: institutionalization and legitimation, we framed our qualitative study in soft systems methodology (SSM). We collected data using observations, semi-structured interviews, and study of artifacts to answer our question based on the Malawi's District Health Information System (DHIS2) use case. Our findings revealed three factors shaping the gap negotiation: coercive approach, technical support and social relationship and moral judgment. The paper's contribution is two-fold, (a) from a practical perspective we identify the pertinent context issues that come into play when negotiating a gap between the data cadres and the managers (from the Ministry of Health and partners) in the course of seeking legitimacy of data quality management practices; (b) theoretically we promote the application of SSM models with an institutional perspective in making sense of complex situations relating to legitimation.