The Change Strategy towards an Integrated Health Information Infrastructure: Lessons from Sierra Leone

In this article we describe and reflect on an ongoing project to develop an integrated health information system (HIS) in Sierra Leone. We emphasise the complexity of such an effort and on challenges faced with building a health information infrastructure in the context of a developing country. The main lesson of the paper is in the design of a change strategy towards an integrated HIS in Sierra Leone influenced by information infrastructure literature. The key elements of the strategy are 1) to facilitate a gradual change process building on the existing systems and practices (the installed base), 2) to bootstrap political will through quick wins and pilot projects, and 3) a flexible standardisation approach to integration to smoothen the change experience for users and stakeholders, and minimise resistance.