3. Methodology
Although the basic structure of district health systems is very similar in many developing countries, the detailed instances of the respective elements are necessarily as different as the involved cultures, economies, administrative settings and the mixtures of involved parties from outside the district. Accordingly it is neither possible nor adequate to propose a common methodology for a systems engineering approach for health information systems as a detailed step-by-step instruction. The broad phases in systems engineering as introduced in section 2.1. "Systems Engineering" remain basically the same in every setting. But the respective considerations for each phase which are described in this methodology might not be appropriate for other situations. The integration of the systems engineer into the district health system and the amount of available resources such as time, equipment, man power and transport influence these considerations as much as the setup of the district health system and the degree of its dependency on national structures and external organizations. Therefore the following methodology has to be seen in the context of the given framework, which is described in section 1.3. "Background and Motivation of this Thesis". This methodology describes the considerations which were made before the actual systems engineering project took place in the Kabarole District. A description of the resulting realization is given in chapter 4 "Realization".
3.1. Planning of the Systems Engineering Project
Since the planning of a systems engineering project has to be done in agreement with the client, it largely depends on the quality of communication with the client prior to the actual systems engineering project. In the context of this thesis, communication proves to be a very limiting factor. The geographical distance brings along high travelling costs, therefore almost excluding the chance of an initial meeting. Telecommunication either by fax or telephone is also limited due to high costs and the difficult, sometimes impossible task of catching a free line in the overcrowded international telephone system. On the other hand, conventional mail is neither reliable nor timely. Another communicative restriction has to be seen in the different educational and professional backgrounds of the client and the systems engineer.
Resulting from this, a delineation of the contents of the systems engineering project also has to rely on assumptions, which base on information from external sources. These sources include experts, reports on similar systems engineering projects and documented background information about the concerned district health system. Therefore the aspects of a project plan, which are listed in section 2.1.1. "Project Planning", have to be formulated broad based. A revision must be expected later on.
A clear definition of the time schedule is also limited due to the geographical distance and the high costs of intercontinental transport. Central part of a time schedule is necessarily the deployment in the district health system. The deployment itself is limited by the available funds, which are to be spent on the systems engineering project. Also, it has to be integrated into the time scheduling of the district health system. However, detailed planning of the time schedule of the systems engineering project is not possible, until the contents are fixed in detail. Therefore the time schedule is also subjected to on site refinement.
Section 4.1. "Planning" describes the realization of the planning phase and the resulting project plan of the systems engineering project, which is content of this thesis. However, the considerations in sections 3.2. "Analysis of the Health Information System" to 3.6. "Reporting on the Systems Engineering Project" are oriented at the objectives of this thesis. Therefore a reference to section 1.4. "Aim and Objectives of this Thesis" has to be anticipated already in this section. The definition of the objectives in section 1.4. has to be seen as part of the results from the planning phase, though. In the same sense, this methodology is a product of the planning phase, too.