Affiliated Organization

University of Oslo, Norway


This document describes the efforts to reform the Health Management Information System (HMIS) of Tajikistan. The authors were involved in proposing and piloting a computerized HMIS, based on a complete overhaul of the current data collection tools. This proposal was based on experiences from a global HMIS project (called Health Information System Programme, or HISP), and advocated supporting local decision making by employing a flexible, decentralized system to collect, process, and analyze essential primary health care data. Having been a Soviet Republic for 70 years, the institutional logics underlying the current HMIS in Tajikistan were heavily influenced by the tenets of central planning, quite alien to the ideas proposed. This paper explores the institutional logics of what existed and what we proposed, and the interplay between them over the course of the project. The implications of this interplay on deinstitutionalization as an implementation strategy is sobering; first, it is clear that a complete deinstituionalization, amounting to a paradigm shift, is necessary to overcome the differences in institutional logics, but at the same time this account shows how achieving this can be a remarkable challenge in a context of strong, centralized control. This study makes some interesting contributions to the field of IS. It introduces a study from a country which until now has been almost invisible to the IS community, in contributes to the debate about bottom up and top down implementation, and provides a conceptual framework of institutional logics, their interplay and implications for deinstitutionalization.