Countering the “dam effect”: the case for architecture and governance in developing country health information systems

This paper presents a case for enterprise architecture (EA) and IT governance for driving techno-organizational change and coordination of health information systems (HISs) in developing countries. We support our claim with analyses of a large-scale electronic HIS in Ethiopia by tracing the logic of actors’ decisions and conduct within and beyond the organizational boundaries of the Ethiopian Federal Ministry of Health to understand how the information system innovation process is designed, legitimized and imposed by internal and external organizational forces. In the absence of formalized institutional arrangements throughout the HIS development and implementation, an international development agency fills a key gap forming an obligatory passage point which we conceptualize as “the dam effect.” Drawing on actor-network theory, we identify three important implications of EA and IT governance: (1) to help achieve an alignment of interests within the enterprise; (2) to serve as a tool for protecting the interests of the enterprise in external negotiations; and (3) to serve as a pragmatic approach to carrying out techno-organizational change.