Healthcare Information Systems Implementation Causal Mechanisms in Resource-constrained Environments

Abstract Background: The implementation of healthcare information systems has regained new interest among scholars, policy makers and governments over the past decades. This is as a result of undesired outcomes of the existing implementation processes which has produced outcomes such as lack of integration between existing systems, uncoordinated thus fragmented silo systems and many more. The implications of such outcomes have been that in most public healthcare facilities, medical information are either never captured, or captured incorrectly or ineffectively. Consequently, the retrieval of such information for decision making purposes at various levels of the healthcare system, becomes a challenge.Objectives: This paper sought to establish causal mechanisms and context-based mediators that influence the implementation of healthcare information systems in public healthcare facilities in resource constrained environments. As such having negative implications of the delivery of healthcare services to people in need.Methods: A case-study strategy approach was employed using a critical realist methodology. Data collection was done through semi-structured interviews and document analysis.Results: The findings in this paper indicate that context-based mediators such as leadership and management, maldistribution of resources and health policies have enabling and impeding effects on the implementation of HISs for public healthcare service delivery. Further the results of this paper highlight generative mechanisms such as misinterpretation of polices from paper to practice at operational level of healthcare systems of policies and strategies trigger causal effects that may generate the outcomes experienced in public healthcare service delivery process.Conclusions: The results in this paper suggests that mediating factors and generative mechanisms with inhibiting causal powers in the implementation of healthcare information systems requires more focus during the pre-implementation phase.