Potential methodological and contextual limitations

Role as a researcher

The intention when I went to Mozambique was to rather soon go to one of the provinces to support implementation of the HISP approach there. However, as it turned out I could never do as planned, and for that reason my actions and research became somehow a bit more arbitrary. The original plan was abandoned, and may have resulted too scarce data on areas of specific interest.

I had never done work as a “researcher” before I arrived to Mozambique, so initially I had very limited knowledge of how it might be conducted. This probably hindered me from searching for and finding relevant issues in the beginning. However, the learning curve was steep, meaning that adaptation to the context as a researcher soon improved. As a researcher in the qualitative and interpretative field, I can objectively not know if my methods for data collection were the most appropriate ones. Though, I still believe they were sufficient as I mean the problem areas in this thesis have been shed light on in an appropriate manner.

Role as a researcher in the research context

Arriving as a researcher and in addition from another country, may have given restrictions to what information was shared with me from the interview subjects.

Especially, this seemed to be the case when interrupting the staff from their daily routines, and at the same time asking critical questions about their quality of work. In a couple of occasions I was met with some scepticism, and some took a defensive position, probably obstructing a good conversation. It is in general not possible to know if the interview subjects were telling what they really meant or giving the whole truth. Maybe I was told what they assumed I wanted to hear. An example: Almost all health management staffs who were asked about their use of DHIS during our two weeks field trip in March 2004 said that they really wanted to use it. However, the software was installed at more or less every location. Still no one had taken it into use. It may seem strange that everybody is so eager to use something they have access to, but no one is actually using it.

As the HIS development project in Mozambique has evolved, there is no doubt (for me) that many of the involved people are not completely objective to what is happening. Everybody seems biased regarding what has happened and is happening, and why, in one way or the other. Since I was not heavily involved with the project before my arrival, I soon noticed this. I therefore tried to maintain my objectiveness during my stay and work. If I succeeded, is up to someone else to evaluate. However, because of this early observation, it has been in my mind all the time when reading papers produced from findings in the context of investigation as well. Another aspect is how the human mind works. During conversations and interviews I got hold of a lot of historical information. However, people have a tendency to remember what is important for them and their interests, meaning that biased memory recalls might have materialized (Shermer, 2002).

METHODOLOGY

In connection with the previous subsection I will comment shortly about the use of second hand sources of information. I have drawn on knowledge and understanding from other research papers and resumes as source of data. This means that what I read is already interpreted at least once. My re-interpretation then might loose some of it weight as all reflections behind the first interpretation (done by others) may be unknown to me. In addition, when doing comparison of different contexts, there may be a miss-match between outcome and cause between the contexts. Example:

Mavimbe (2005) found several causes behind inflated immunization coverage rates in the Province of Niassa, Mozambique. In Inhambane and Gaza I found similar values.

However, without investigating the specific reasons for those numbers in the respective provinces, I can not know if the outcome (which has similar character) has the same reasons. Nevertheless, already found causes may be used as something to look for, and in addition the methods used to investigate for causes may be replicated.

Language challenges

In Mozambique, especially on the countryside, English language is in general not known. This means that several conversations and interviews had to be in Portuguese.

Even in the ministry of health I had various conversations and did interviews in Portuguese. Though, my Portuguese was improving all the time, and eventually reached an acceptable level, there was room for misinterpretations both ways.

Regarding reading documents in Portuguese I don’t see language problems as a source for errors, as I always made sure to read thoroughly enough, or I got assistance, to make sure I understood everything the way it was meant.

3.3

Summary

My research was informed and conducted by taking an Action Research approach.

Action research is seen upon a rather democratic method where researchers do their actions and research in the context studied at the same time as aiming at improving problematic conditions. It includes three elements: 1) Research. In my case this was about how to better understand legacy systems challenges. 2) Participation. Mutual learning between researchers and problem owners for understanding and enhanced possibilities for better solutions. I worked with Mozambican health staff and management and stakeholders at several levels in the Mozambican health sector. 3) Action. In my case we tried to develop better HIS solutions for the Mozambican health sector than was already there.

Action research is not a quantitative method, and was so for a long time seen as inappropriate in the IS field. However, lately it has gained broader acceptance. A typical challenge for action research projects is to maintain the action after the researchers leave. In developing countries action research projects are often donor funded, and having a limited scale and time span of efforts. Regarding sustainability of action, scale of the project seems to be of crucial factor. Small scale action research initiatives are much less likely to be sustainable than larger networks of action.

METHODOLOGY

Interpretative studies give room for misinterpretations. Regarding my specific study, the scope of it might have had an impact of the outcome of the study. Relatively few systems and only parts of the Mozambican health care organization are investigated.

However, by following processes over more time, it might still be possible to generalize findings. Furthermore, Greenwood and Levin (1996) state that as general laws must apply to particular cases, particular cases test the validity of general laws.