{"id":"https://openalex.org/W4415250143","doi":"https://doi.org/10.1145/3757400","title":"Becoming Infrastructure: A Critical Realist Account of the Evolution of DHIS2 as Digital Public Health Infrastructure in Sierra Leone","display_name":"Becoming Infrastructure: A Critical Realist Account of the Evolution of DHIS2 as Digital Public Health Infrastructure in Sierra Leone","publication_year":2025,"publication_date":"2025-10-16","ids":{"openalex":"https://openalex.org/W4415250143","doi":"https://doi.org/10.1145/3757400"},"language":"en","primary_location":{"id":"doi:10.1145/3757400","is_oa":true,"landing_page_url":"https://doi.org/10.1145/3757400","pdf_url":null,"source":{"id":"https://openalex.org/S4210183893","display_name":"Proceedings of the ACM on Human-Computer Interaction","issn_l":"2573-0142","issn":["2573-0142"],"is_oa":false,"is_in_doaj":false,"is_core":true,"host_organization":"https://openalex.org/P4310319798","host_organization_name":"Association for Computing Machinery","host_organization_lineage":["https://openalex.org/P4310319798"],"host_organization_lineage_names":["Association for Computing Machinery"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Proceedings of the ACM on Human-Computer Interaction","raw_type":"journal-article"},"type":"article","indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"hybrid","oa_url":"https://doi.org/10.1145/3757400","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5015922215","display_name":"Innocent Ndubuisi-Obi","orcid":"https://orcid.org/0000-0003-1827-5400"},"institutions":[{"id":"https://openalex.org/I63966007","display_name":"Massachusetts Institute of Technology","ror":"https://ror.org/042nb2s44","country_code":"US","type":"education","lineage":["https://openalex.org/I63966007"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Innocent C. Ndubuisi-Obi","raw_affiliation_strings":["University of Washington, Seattle, WA, USA and Massachusetts Institute of Technology, Cambridge, MA, USA"],"affiliations":[{"raw_affiliation_string":"University of Washington, Seattle, WA, USA and Massachusetts Institute of Technology, Cambridge, MA, USA","institution_ids":["https://openalex.org/I63966007"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5038284204","display_name":"Nuole Chen","orcid":"https://orcid.org/0000-0003-0700-3784"},"institutions":[{"id":"https://openalex.org/I63966007","display_name":"Massachusetts Institute of Technology","ror":"https://ror.org/042nb2s44","country_code":"US","type":"education","lineage":["https://openalex.org/I63966007"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Nuole Chen","raw_affiliation_strings":["Massachusetts Institute of Technology, Cambridge, MA, USA"],"affiliations":[{"raw_affiliation_string":"Massachusetts Institute of Technology, Cambridge, MA, USA","institution_ids":["https://openalex.org/I63966007"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5041585435","display_name":"Lily L. Tsai","orcid":"https://orcid.org/0000-0002-5264-4655"},"institutions":[{"id":"https://openalex.org/I63966007","display_name":"Massachusetts Institute of Technology","ror":"https://ror.org/042nb2s44","country_code":"US","type":"education","lineage":["https://openalex.org/I63966007"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Lily L. Tsai","raw_affiliation_strings":["Massachusetts Institute of Technology, Cambridge, MA, USA"],"affiliations":[{"raw_affiliation_string":"Massachusetts Institute of Technology, Cambridge, MA, USA","institution_ids":["https://openalex.org/I63966007"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":3,"corresponding_author_ids":["https://openalex.org/A5015922215"],"corresponding_institution_ids":["https://openalex.org/I63966007"],"apc_list":null,"apc_paid":null,"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.38514297,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"9","issue":"7","first_page":"1","last_page":"46"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11024","display_name":"Information Systems Theories and Implementation","score":0.9797999858856201,"subfield":{"id":"https://openalex.org/subfields/3312","display_name":"Sociology and Political Science"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},"topics":[{"id":"https://openalex.org/T11024","display_name":"Information Systems Theories and Implementation","score":0.9797999858856201,"subfield":{"id":"https://openalex.org/subfields/3312","display_name":"Sociology and Political Science"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T10953","display_name":"E-Government and Public Services","score":0.9617999792098999,"subfield":{"id":"https://openalex.org/subfields/3320","display_name":"Political Science and International Relations"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T14147","display_name":"Innovative Approaches in Technology and Social Development","score":0.95660001039505,"subfield":{"id":"https://openalex.org/subfields/1405","display_name":"Management of Technology and Innovation"},"field":{"id":"https://openalex.org/fields/14","display_name":"Business, Management and Accounting"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/sierra-leone","display_name":"Sierra leone","score":0.7688000202178955},{"id":"https://openalex.org/keywords/public-health","display_name":"Public health","score":0.6044999957084656},{"id":"https://openalex.org/keywords/bureaucracy","display_name":"Bureaucracy","score":0.5320000052452087},{"id":"https://openalex.org/keywords/information-system","display_name":"Information system","score":0.4945000112056732},{"id":"https://openalex.org/keywords/health-informatics","display_name":"Health informatics","score":0.41589999198913574},{"id":"https://openalex.org/keywords/work","display_name":"Work (physics)","score":0.4032999873161316},{"id":"https://openalex.org/keywords/participant-observation","display_name":"Participant observation","score":0.3684000074863434},{"id":"https://openalex.org/keywords/corporate-governance","display_name":"Corporate governance","score":0.3529999852180481}],"concepts":[{"id":"https://openalex.org/C3018567284","wikidata":"https://www.wikidata.org/wiki/Q1044","display_name":"Sierra leone","level":2,"score":0.7688000202178955},{"id":"https://openalex.org/C138816342","wikidata":"https://www.wikidata.org/wiki/Q189603","display_name":"Public health","level":2,"score":0.6044999957084656},{"id":"https://openalex.org/C51575053","wikidata":"https://www.wikidata.org/wiki/Q72468","display_name":"Bureaucracy","level":3,"score":0.5320000052452087},{"id":"https://openalex.org/C180198813","wikidata":"https://www.wikidata.org/wiki/Q121182","display_name":"Information system","level":2,"score":0.4945000112056732},{"id":"https://openalex.org/C144024400","wikidata":"https://www.wikidata.org/wiki/Q21201","display_name":"Sociology","level":0,"score":0.42250001430511475},{"id":"https://openalex.org/C3116431","wikidata":"https://www.wikidata.org/wiki/Q31728","display_name":"Public administration","level":1,"score":0.4169999957084656},{"id":"https://openalex.org/C145642194","wikidata":"https://www.wikidata.org/wiki/Q870895","display_name":"Health informatics","level":3,"score":0.41589999198913574},{"id":"https://openalex.org/C18762648","wikidata":"https://www.wikidata.org/wiki/Q42213","display_name":"Work (physics)","level":2,"score":0.4032999873161316},{"id":"https://openalex.org/C17744445","wikidata":"https://www.wikidata.org/wiki/Q36442","display_name":"Political science","level":0,"score":0.373199999332428},{"id":"https://openalex.org/C50522688","wikidata":"https://www.wikidata.org/wiki/Q189833","display_name":"Economic growth","level":1,"score":0.36899998784065247},{"id":"https://openalex.org/C194943564","wikidata":"https://www.wikidata.org/wiki/Q1129049","display_name":"Participant observation","level":2,"score":0.3684000074863434},{"id":"https://openalex.org/C39549134","wikidata":"https://www.wikidata.org/wiki/Q133080","display_name":"Public relations","level":1,"score":0.36059999465942383},{"id":"https://openalex.org/C39389867","wikidata":"https://www.wikidata.org/wiki/Q380767","display_name":"Corporate governance","level":2,"score":0.3529999852180481},{"id":"https://openalex.org/C2777616114","wikidata":"https://www.wikidata.org/wiki/Q47469956","display_name":"Polycentricity","level":3,"score":0.35040000081062317},{"id":"https://openalex.org/C98045186","wikidata":"https://www.wikidata.org/wiki/Q205663","display_name":"Process (computing)","level":2,"score":0.325300008058548},{"id":"https://openalex.org/C65986115","wikidata":"https://www.wikidata.org/wiki/Q1135904","display_name":"Strategic information system","level":4,"score":0.3089999854564667},{"id":"https://openalex.org/C178300618","wikidata":"https://www.wikidata.org/wiki/Q1898509","display_name":"Extant taxon","level":2,"score":0.305400013923645},{"id":"https://openalex.org/C152541439","wikidata":"https://www.wikidata.org/wiki/Q5186693","display_name":"Critical appraisal","level":3,"score":0.2976999878883362},{"id":"https://openalex.org/C41856607","wikidata":"https://www.wikidata.org/wiki/Q483130","display_name":"Geographic information system","level":2,"score":0.2928999960422516},{"id":"https://openalex.org/C148383697","wikidata":"https://www.wikidata.org/wiki/Q1781695","display_name":"Regional science","level":1,"score":0.2799000144004822},{"id":"https://openalex.org/C2778137410","wikidata":"https://www.wikidata.org/wiki/Q2732820","display_name":"Government (linguistics)","level":2,"score":0.2793999910354614},{"id":"https://openalex.org/C164429055","wikidata":"https://www.wikidata.org/wiki/Q2070165","display_name":"Institutionalisation","level":2,"score":0.27649998664855957},{"id":"https://openalex.org/C47344431","wikidata":"https://www.wikidata.org/wiki/Q1519812","display_name":"Health policy","level":3,"score":0.2732999920845032}],"mesh":[],"locations_count":2,"locations":[{"id":"doi:10.1145/3757400","is_oa":true,"landing_page_url":"https://doi.org/10.1145/3757400","pdf_url":null,"source":{"id":"https://openalex.org/S4210183893","display_name":"Proceedings of the ACM on Human-Computer Interaction","issn_l":"2573-0142","issn":["2573-0142"],"is_oa":false,"is_in_doaj":false,"is_core":true,"host_organization":"https://openalex.org/P4310319798","host_organization_name":"Association for Computing Machinery","host_organization_lineage":["https://openalex.org/P4310319798"],"host_organization_lineage_names":["Association for Computing Machinery"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Proceedings of the ACM on Human-Computer Interaction","raw_type":"journal-article"},{"id":"pmh:oai:dspace.mit.edu:1721.1/164180","is_oa":true,"landing_page_url":"https://hdl.handle.net/1721.1/164180","pdf_url":null,"source":{"id":"https://openalex.org/S4306400425","display_name":"DSpace@MIT (Massachusetts Institute of Technology)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"host_organization":"https://openalex.org/I63966007","host_organization_name":"Massachusetts Institute of Technology","host_organization_lineage":["https://openalex.org/I63966007"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Association for Computing Machinery","raw_type":"http://purl.org/eprint/type/ConferencePaper"}],"best_oa_location":{"id":"doi:10.1145/3757400","is_oa":true,"landing_page_url":"https://doi.org/10.1145/3757400","pdf_url":null,"source":{"id":"https://openalex.org/S4210183893","display_name":"Proceedings of the ACM on Human-Computer Interaction","issn_l":"2573-0142","issn":["2573-0142"],"is_oa":false,"is_in_doaj":false,"is_core":true,"host_organization":"https://openalex.org/P4310319798","host_organization_name":"Association for Computing Machinery","host_organization_lineage":["https://openalex.org/P4310319798"],"host_organization_lineage_names":["Association for Computing Machinery"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Proceedings of the ACM on Human-Computer Interaction","raw_type":"journal-article"},"sustainable_development_goals":[],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":90,"referenced_works":["https://openalex.org/W192485904","https://openalex.org/W1171508543","https://openalex.org/W1573877699","https://openalex.org/W1602366767","https://openalex.org/W1964450454","https://openalex.org/W1968761612","https://openalex.org/W1976415944","https://openalex.org/W1982411913","https://openalex.org/W1984997401","https://openalex.org/W1988981622","https://openalex.org/W1989980410","https://openalex.org/W2001083513","https://openalex.org/W2012116935","https://openalex.org/W2039193452","https://openalex.org/W2041785967","https://openalex.org/W2043413253","https://openalex.org/W2044217257","https://openalex.org/W2056514185","https://openalex.org/W2065266118","https://openalex.org/W2073568224","https://openalex.org/W2077199520","https://openalex.org/W2081633174","https://openalex.org/W2083823098","https://openalex.org/W2100391600","https://openalex.org/W2107465084","https://openalex.org/W2118956317","https://openalex.org/W2120182466","https://openalex.org/W2143107436","https://openalex.org/W2160569903","https://openalex.org/W2170578595","https://openalex.org/W2171970463","https://openalex.org/W2185704876","https://openalex.org/W2289030476","https://openalex.org/W2289185109","https://openalex.org/W2290835535","https://openalex.org/W2292270202","https://openalex.org/W2340503623","https://openalex.org/W2346319829","https://openalex.org/W2463896803","https://openalex.org/W2476831699","https://openalex.org/W2477235955","https://openalex.org/W2492839685","https://openalex.org/W2560892765","https://openalex.org/W2564513428","https://openalex.org/W2588765774","https://openalex.org/W2612721506","https://openalex.org/W2740239618","https://openalex.org/W2741609014","https://openalex.org/W2765696547","https://openalex.org/W2767258799","https://openalex.org/W2767632000","https://openalex.org/W2768332621","https://openalex.org/W2781669397","https://openalex.org/W2786578403","https://openalex.org/W2804841627","https://openalex.org/W2804990926","https://openalex.org/W2890714573","https://openalex.org/W2894173933","https://openalex.org/W2896519275","https://openalex.org/W2898964548","https://openalex.org/W2905274880","https://openalex.org/W2940530504","https://openalex.org/W2940979098","https://openalex.org/W2941109697","https://openalex.org/W2942399136","https://openalex.org/W2944142598","https://openalex.org/W2949376760","https://openalex.org/W2950178552","https://openalex.org/W2959720119","https://openalex.org/W2967455432","https://openalex.org/W2982986029","https://openalex.org/W2984775611","https://openalex.org/W2984969990","https://openalex.org/W3003217018","https://openalex.org/W3007934595","https://openalex.org/W3017863658","https://openalex.org/W3095415574","https://openalex.org/W3148461778","https://openalex.org/W3205941072","https://openalex.org/W3207819680","https://openalex.org/W4214810323","https://openalex.org/W4225001646","https://openalex.org/W4229914699","https://openalex.org/W4233546686","https://openalex.org/W4239328475","https://openalex.org/W4250026844","https://openalex.org/W4252685953","https://openalex.org/W4292764312","https://openalex.org/W4309617712","https://openalex.org/W4309618057"],"related_works":[],"abstract_inverted_index":{"Today,":[0],"the":[1,10,24,43,108,120,151,155],"District":[2],"Health":[3],"Information":[4],"System":[5],"2":[6],"(DHIS2)":[7],"has":[8],"become":[9],"de-facto":[11],"standard":[12],"for":[13,38,214],"open-source":[14],"health":[15,115,166],"management":[16],"information":[17],"systems":[18,124,159],"and":[19,61,90,92,122,129,157,162,195],"Sierra":[20,64,149,163],"Leone's":[21,164],"status":[22],"as":[23,112],"first":[25],"country":[26],"in":[27,41,48,63,148,154,183,205],"sub-Saharan":[28],"Africa":[29],"to":[30,75,106],"implement":[31],"DHIS2":[32,111],"makes":[33,211],"it":[34],"a":[35,49,67,101,169,212],"productive":[36],"place":[37],"researchers":[39],"interested":[40],"understanding":[42,185],"end-to-end":[44],"process":[45],"of":[46,69,97,110,125,137,160,186,202,218],"infrastructuring":[47],"low-resource":[50],"bureaucratic":[51],"setting.":[52],"In":[53],"this":[54],"article,":[55],"we":[56,177,189],"examine":[57],"its":[58,145],"design,":[59],"implementation,":[60],"maintenance":[62],"Leone":[65],"over":[66,134],"period":[68],"14":[70],"years":[71],"-":[72],"from":[73],"2008":[74],"2022.":[76],"We":[77],"present":[78],"an":[79],"intensive":[80],"case":[81,207,213],"study":[82,141],"discretized":[83],"by":[84],"three":[85],"morphogenetic":[86],"cycles":[87],"(decentralization,":[88],"centralization,":[89],"fragmentation)":[91],"furnished":[93],"with":[94,132],"explanatory":[95],"account's":[96],"DHIS2's":[98,138,187],"evolution":[99],"using":[100],"critical":[102],"realist":[103],"research":[104],"methodology":[105],"describe":[107],"emergence":[109],"digital":[113],"public":[114,165],"infrastructure.":[116],"These":[117],"accounts":[118],"highlight":[119],"structural":[121,156],"cultural":[123,158],"DHIS2,":[126],"their":[127,130],"elaborations,":[128],"interaction":[131],"agents":[133],"successive":[135],"periods":[136],"evolution.":[139],"Our":[140,209],"finds":[142],"that,":[143],"despite":[144],"continued":[146],"use":[147],"Leone,":[150],"increasing":[152],"generativity":[153],"DHSI2":[161],"system":[167],"engenders":[168],"persistent":[170],"instability":[171],"that":[172,179],"requires":[173],"continuous":[174],"resolution.":[175],"Though":[176],"find":[178],"extant":[180],"literature":[181],"aids":[182],"our":[184,200,206],"evolution,":[188],"proffer":[190],"two":[191],"mechanisms,":[192],"infrastructural":[193],"capture":[194],"socio-technical":[196],"debt,":[197],"which":[198],"aid":[199],"explanation":[201],"events":[203],"observed":[204],"study.":[208],"work":[210],"more":[215],"ontologically-diverse":[216],"theorizing":[217],"bureaucracy-aware":[219],"computing":[220],"systems.":[221]},"counts_by_year":[],"updated_date":"2026-04-04T16:13:02.066488","created_date":"2025-10-16T00:00:00"}
