Architectural frameworks for developing national health information systems in low and middle income countries

Consolidating currently fragmented health information systems in low and middle-income countries (LMIC) into a coherent national information system will increase operational efficiencies, improve decision-making and will lead to better health outcomes. However, engineering an enterprise information system of the scale and complexity of a national health information system (NHIS) pose unique and complex challenges in LMICs. In this paper, we review current approaches to NHIS development and discuss challenges faced by LMICs to develop their NHIS. Based on current LMIC systems we identify three stages of system evolution and propose that LMICs should follow an evolutionary, middle-out approach to NHIS development supported by appropriate architectural frameworks.