Wednesday, May 13, 2009

Realpolitik of Health Management Information System

HMIS or Health Management Information System has been quite a buzz-word around the Indian health machinery for sometime now. Its just that health-workers are now starting to understand. From the lay-man’s point-of-view, HMIS is a system of managing health related information. It is the process of collecting health-related data, making sense of that data to become information, understanding the relevance of information and making plans on how to use the information.

HMIS being an information system, surely has the scope of being managed through computers and it is done pan-India using an application called DHIS 2 (District Health Information Software v2). DHIS2 is an open-source Java web application and it is free for anyone to use. Free as in Freedom and free as in beer. And this has caused a stir of sorts because there aren’t a lot of things that you get free in life. I am sure some philosopher’s would be quick to tell me that nothing in life is free and so its true with DHIS as well!! But its for fact, cheaper than most other pieces of software competing in the HMIS space.

But we are not here to talk about DHIS, we are here to know the realpolitik of HMIS. Since NRHM (National Rural Health Mission) has poured in money into the health sector, lot of things have changed. It has improved health infrastructure, changed government’s outlook towards public health, generated employment and done a lot more. But it has also brought in realpolitik.

Realpolitik is a theory of politics that focuses on considerations of power, not ideals, morals, or principles. Its “real” instead of “idealistic” and that is sometimes not a bad thing. Politics, in-fact isn’t a bad thing at all!! Health forever has been idealistic, doctors forever revered as people who save lives and government health machinery thought as part of goodwill governance. With these ideals, the Constitution of India enlists “Health as a state matter”. But who has the money and who gives the money, when we are talking about health??

Software systems have enormously increased the reach and speed of information exchange and data collection for health. DHIS2 and pro-HMIS crowd has created a nation-wide awareness on the usefulness of software systems for health monitoring. This has led to a power struggle within different groups not just within the government, but NGOs working in the health sector and consulting groups that work with the states. The power game has just begun with software and technology proving as powerful weapons for whosoever wants to use it. In this hype for HMIS, simple portals that capture data for national level have fetched huge chunks of money and each day additional money is spent on building many more such systems. Then there is the power struggle to capture the market on who trains the cadre of health workers on these new technological advances that has somehow no relevance on health services.

I am just starting to see the “realpolitik”, which is definitely not bad as an ideology... Its just that health always seemed like a noble cause. I am now seeing it as a realist.