Abstract
Health information systems in low- and middle-income countries frequently operate as fragmented ecosystems. This qualitative multiple-case study examines how fragmentation shapes performance in Rwanda's child nutrition and growth monitoring ecosystem, where the Civil Registration and Vital Statistics system and the District Health Information Software 2 (DHIS2) immunisation e-Tracker share an interoperability layer but child nutrition data — recorded predominantly on paper — remains disconnected. Drawing on interviews and focus groups with 54 health workers across three districts and using the Human–Organisation–Technology Fit (HOT-Fit) framework as an analytical lens, the study finds that information quality, system use, user satisfaction, and net benefits function as ecosystem-level phenomena. Three cross-system mechanisms — technical interoperability, data synchronisation capability, and cross-programme governance — emerge as performance determinants that evaluation confined to individual systems cannot detect. Grounded in these patterns, three design implications are proposed as a pathway toward integration, subject to empirical verification.
Recommended Citation
Rukundo, E.,
Dueholm Müller, S.,
Tumusiime, D. K.,
Papadopoulou, E.,
Venkateswaran, M.,
Michael, M.,
Uwera, T.,
&
Frøen Froen, J.
(in press).
Data Fragmentation in Multi-System Child Health Information Ecosystems: Evidence from Rwanda’s Child Nutrition and Growth Monitoring Programme.
Information Technology for Development.
Available at:
https://aisel.aisnet.org/itd_forthcoming/31