IT Enactment of new Public Management: the Case Study of Health Information Systems in Kenya

Abstract

In the last twenty years most African Governments have embarked on health sector reforms sponsored by international partners. Conceived under New Public Management, the majority of these reforms leverage information technology to decentralise hierarchical structures into more information efficient organizations. The paper illustrates the case study of health management information systems in Kenya in order to better understand how the enactment of information technology has influenced the organisational outcome of New Public Management reforms within the health sector in Kenya. The case study provides a longitudinal account of how the adoption and usage of information technology within two health management information systems of Kenya Ministry of Health has affected the implementation of NPM reforms. Data collection and analysis have been framed within an institutionalist perspective viewing different agents acting under the pressure of competing logics (New Public Management and Old Public Administration) at three main levels of action: the macro or policy level (e.g., formal policies), the meso or organisational level (e.g., professional norms and management), and the user or agency level (e.g., IS users' routines). The case study has shown that NPM institutions were not supported by coherent actions unifying all actors involved in the restructuration of health information systems in Kenya so that IT enactment was not consistent across the health information system giving way to structural changes that were not aligned with what was envisaged in the reforms. Findings point to the rhetoric behind certain reform discourses by main actors involved, particularly, at the macro‑policy level. The paper calls for a stronger source of political legitimacy to support discourses around public sector reforms so that through the right competences and systems of values at the meso level information technology can be used as a catalyst for a more consistent implementation of the reforms. New discourses around the potential of IT should be more aligned with certain institutions underpinning the practices of policy makers at the macro level inducing Government echelons to legitimize IT at the macro‑policy level.