This article 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, as well as in planning for the scaling up of the system. One of the recommendations was to support local decision-making through a flexible, decentralized system to collect, process, and analyze essential primary healthcare data. The institutional logics underlying the current HMIS in Tajikistan were heavily influenced by the tenets of central planning from a deeply embedded Soviet system that was alien to the ideas proposed. This article explores the different institutional logics arising from what already existed and from our proposals, as well as the interplay among them over the course of the project. Clearly, a complete deinstitutionalization–amounting to a paradigm shift–is necessary to overcome the differences in institutional logics. However, this is a remarkable challenge, given a centralized control context. This study makes interesting contributions to the domain of IS/HMIS research in two ways: (a) by reporting from a country that until now has been almost invisible to the IS community, and (b) by adding to the debate around IS and organizational change through the lens of institutional logics and deinstitutionalization.
Health Management Information System; Tajikistan; decentralization; deinstitutionalization; IS/HMIS