Evaluation of a bottom-up action research approach in a centralised setting: HISP in Cuba

There has been a high rate of failure in the implementation of information systems in developing countries. Participative approaches have received a lot of attention as a way to ensure more appropriate systems with a greater rate of success. The authors of this paper spent 4 months working on designing and implementing a health information system as part of the health information system program (HISP) in the Cuban Ministry of Health using this type of approach. This paper describes the experiences there. The HISP has proven to be a relatively successful information system in India and in several African countries, aiming at empowering local health management and improving information use at the local level. The primary contribution to the current literature on participative approaches is the lessons learned in trying to use this approach in a highly centralized setting. General implications for system development and collaboration in Cuba are also discussed.