Health Information Systems and Accountability in Kenya: A Structuration Theory Perspective

Health information systems (HIS) in most low- and middle-income countries (LMICs) have been often implemented under the international pressure of accounting for healthcare investments. The idea behind robust and efficient HIS is that health information can allow healthcare managers and providers to better plan and monitor health services, which may translate into better health outcomes. Yet, researchers have often criticized the use of HIS as accountability tools as being counterproductive by making health information more meaningful to national governments and international agencies than those in charge of local health services. In this paper, I analyze how HIS influence the emergence of local accountability practices and their consequences for healthcare provision. I build a theoretical perspective from structuration theory and integrate it with the technology domain of HIS. I use this perspective to analyze a case study of HIS in Kenya. This study raises implications for the use of structuration theory in understanding accountability and the role of IT materiality in processes of structuration. It contributes to a better understanding of how HIS can foster improved healthcare and human development. It also contributes to the understanding of IS as means not just for governing people’s behavior but also of socialization through which users can negotiate multiple accountability goals.