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Background Robust, flexible, and integrated health information (HIS) systems are essential to achieving national and international goals in health and development. Such systems are still uncommon in most low and middle income countries. This article describes a first-phase activity in Tanzania to integrate the country’s vertical health management information system with the help of an interoperability layer that enables cross-program data exchange. Methods From 2014 to 2019, the Tanzanian government and partners implemented a five-step procedure based on the “Mind the GAPS” (governance, architecture, program management, and standards) framework and using both proprietary and open-source tools. In collaboration with multiple stakeholders, the team developed the system to address major data challenges via four fully documented “use case scenarios” addressing data exchange among hospitals, between services and the supply chain, across digital data systems, and within the supply chain reporting system. This work included developing the architecture for health system data exchange, putting a middleware interoperability layer in place to facilitate the exchange, and training to support use of the system and the data it generates. Results Tanzania successfully completed the five-step procedure for all four use cases. Data exchange is currently enabled among 15 separate information systems, and has resulted in improved data availability and significant time savings. The government has adopted the health information exchange within the national strategy for health care information, and the system is being operated and managed by Tanzanian officials. Conclusion Developing an integrated HIS requires a significant time investment; but ultimately benefit both programs and patients. Tanzania’s experience may interest countries that are developing their HIS programs.

Background and purpose: Robust, flexible, and integrated health information (HIS) systems are essential to achieving national and international goals in health and development. Such systems are still uncommon in most low and middle income countries. This article describes a first-phase activity in Tanzania to integrate the country’s vertical health management information system with the help of an interoperability layer that enables cross-program data exchange. Methods: From 2014 to 2019, the Tanzanian government and partners implemented a five-step procedure based on the “Mind the GAPS” (governance, architecture, program management, and standards) framework and using both proprietary and open-source tools. In collaboration with multiple stakeholders, the team developed the system to address major data challenges via four fully documented “use case scenarios” addressing data exchange among hospitals, between services and the supply chain, across digital data systems, and within the supply chain reporting system. This work included developing the architecture for health system data exchange, putting a middleware interoperability layer in place to facilitate the exchange, and training to support use of the system and the data it generates. Results: Tanzania successfully completed the five-step procedure for all four use cases. Data exchange is currently enabled among 15 separate information systems, and has resulted in improved data availability and significant time savings. The government has adopted the health information exchange within the national strategy for health care information, and the system is being operated and managed by Tanzanian officials. Conclusion: Developing an integrated HIS requires a significant time investment; but ultimately benefit both programs and patients. Tanzania’s experience may interest countries that are developing their HIS programs.

Background Enterprise Architecture (EA) integrates business and technical processes in health information systems (HIS). Low-income and middle-income countries (LMIC) use EA to combine management components with disease tracking and health care service monitoring. Using an EA approach differs by country, addressing specific needs. Methods Articles in this review referenced EA, were peer-reviewed or gray literature reports published in 2010 to 2016 in English, and were identified using PubMed, Scopus, Web of Science, and Google Scholar. Results Fourteen articles described EA use in LMICs. India, Sierra Leone, South Africa, Mozambique, and Rwanda reported building the system to meet country needs and implement a cohesive HIS framework. Jordan and Taiwan focused on specific HIS aspects, ie, disease surveillance and electronic medical records. Five studies informed the context. The Millennium Villages Project employed a "uniform but contextualized" approach to guide systems in 10 countries; Malaysia, Indonesia, and Tanzania used interviews and mapping of existing components to improve HIS, and Namibia used of Activity Theory to identify technology-associated activities to better understand EA frameworks. South Africa, Burundi, Kenya, and Democratic Republic of Congo used EA to move from paper-based to electronic systems. Conclusions Four themes emerged: the importance of multiple sectors and data sources, the need for interoperability, the ability to incorporate system flexibility, and the desirability of open group models, data standards, and software. Themes mapped to EA frameworks and operational components and to health system building blocks and goals. Most articles focused on processes rather than outcomes, as countries are engaged in implementation.

As part of health sector reform, most developing countries are in the process of restructuring the Health Information Systems (HIS) by way of standardizing and integrating various vertical reporting systems. Nevertheless, the pressure resulting from the vertical systems supported by donors renders the integration goal challenging and unachievable. While many studies have argued for the heterogeneity of interests and multiple data needs of the donors as the major cause of the problem, this paper argue for more detailed and critical analysis of the problem. To contribute to this, the paper emphasize the need to understand the main actors involved in the process in terms of the resources and rules available to them; and their implication in the HIS integration venture. By drawing on an empirical case study and Structuration Theory concepts, the paper identified the dialectic power relations between the actors resulting from the asymmetric ownership and control of resources and rules. To alleviate the power tensions, the paper proposed i) the need to build shared meaning of the integration process through communication approaches ii) and the need to distribute the control of the integrated HIS using modularization approach facilitating ‘the tapping on’ of the resources available to each group of actors.