Paper Type
Complete
Paper Number
PACIS2026-1461
Description
Open-source health information systems (HIS) are increasingly implemented in countries with developing economies (CDEs). However, many implementations are distressed, persistently experiencing challenges that threaten sustained use and expected service delivery gains. Current literature describes barriers but remains limited in explaining how distress emerges. We conducted a critical realist literature review to identify generative mechanisms, structures, and enabling conditions that plausibly give rise to distress in open-source HIS implementations. A systematic search and quality appraisal produced 70 studies, analysed through retroduction. Eight interacting mechanisms were identified: workforce capacity, stakeholder engagement, workflow alignment, fragmentation, complexity, user satisfaction, integrated planning and development, and data quality, each constrained by characteristic structures and enabling conditions. We integrate these insights into a causal explanatory framework.
Recommended Citation
MOEKETSI, KOPANO FRANCIS; Brown, Irwin; and Thabela, Tendani Mulanga Thabela, "Mechanisms Influencing Distressed Implementation of Open-Source Health Information Systems in Countries with Developing Economies - A Critical Realist Review" (2026). PACIS 2026 Proceedings. 7.
https://aisel.aisnet.org/pacis2026/ishealthcare/ishealthcare/7
Mechanisms Influencing Distressed Implementation of Open-Source Health Information Systems in Countries with Developing Economies - A Critical Realist Review
Open-source health information systems (HIS) are increasingly implemented in countries with developing economies (CDEs). However, many implementations are distressed, persistently experiencing challenges that threaten sustained use and expected service delivery gains. Current literature describes barriers but remains limited in explaining how distress emerges. We conducted a critical realist literature review to identify generative mechanisms, structures, and enabling conditions that plausibly give rise to distress in open-source HIS implementations. A systematic search and quality appraisal produced 70 studies, analysed through retroduction. Eight interacting mechanisms were identified: workforce capacity, stakeholder engagement, workflow alignment, fragmentation, complexity, user satisfaction, integrated planning and development, and data quality, each constrained by characteristic structures and enabling conditions. We integrate these insights into a causal explanatory framework.
Comments
14-Healthcare