Scaling of health information systems in India: Challenges and approaches

This article addresses the issue of scaling of information systems (IS) in both theoretical and empirical terms. Scaling is an important issue in IS, especially in the contemporary context of globalization, as attempts are ongoing to expand IS in the same context as well as take it into other contexts. Theoretically, an information-infrastructure (II) perspective is drawn on to analyze the challenge of scaling, viewing it not merely as a technical problem, but as a socio-technical one involving a heterogeneous network constituted of technology, people, processes, and the institutional context. Empirically, scaling is analyzed based on experiences from an ongoing project to implement health information systems within the primary health care sector in India. The theoretically informed empirical analysis leads to some preliminary insights relating to the questions of what is being scaled and how it is being scaled. Some conclusions are drawn on theoretical and practical challenges related to scaling, and on implications for human-resource capacity development. © 2006 Wiley Periodicals, Inc.