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ICT Support for Knowledge Management in Primary Healthcare: a Case Study of Partnership for Reviving Routine Immunization in Northern Nigeria (PRRINN)
Date of this Version
From observation, very few organizations in Nigeria have Knowledge Management (KM) portfolios and one of such is KPMG that recruits staff regularly to fill knowledge management positions and have primary responsibilities to manage, develop, coordinate, maintain and disseminate KPMG's knowledge management processes and resources amongst several other responsibilities played by personnel employed in the KM section
However, outside Nigeria, there have been plenty of knowledge management (KM) projects that come and go. Many of which have had success stories and organizations including those in primary health care are still leveraging benefits from their KM systems. However, from review of extant literature, it is fair to say that a considerable proportion of KM projects/initiatives have not been so successful. In retrospect, many of the KM projects that commenced in the past were primarily driven by the adoption of technologies. Technologies include tools such as search engines, retrieval and classification tools, e-collaboration tools, portals and content management systems. One of the lessons learnt from these failures is that technology alone should not be the primary driver for any KM projects/initiatives and that an appropriate balance of technology, process, people and content is instrumental to the continued success of any KM deployment. Technology, however, can act as a catalyst for the introduction and initial buy-in of a KM programme but, in order to be successful, this accelerated adoption has to be aligned with a defined KM strategy and supported by a change programme. On the technologies for supporting KM, as mentioned above, during the 1990s, these technologies tend to be discrete, distinct from each other and not aligned with defined business processes. When implemented, a user may have to operate separate systems in order to accomplish his/her task (e.g. location of a firm's procedures/methodologies, discussion with colleagues and sharing material with them).
Although efforts at managing knowledge certainly preceded the computer, it has been computer-based technology that has ushered in the modern era of knowledge management. In the last few decades, and especially in the last decade, there has been as much progress in understanding knowledge management and advancing its practice as occurred in the many preceding centuries that dealt with traditional, conventional, non-technologically-supported knowledge management. Much of this progress has been either stimulated by or enabled by advances in computing technology.
The role of technologies in KM has always been a debatable topic whether in health care, education, academia or industry. Holsapple (2005) finds that the general perception is that technology was a driver in many of the KM projects in the late 1990s but nowadays organizations are treating the process and people aspects as critical success factors in any KM initiatives. Holsapple argued that both the inclusive and exclusive perspectives of separating knowledge from information completely ignored or under-estimated the contributions of CBT to KM. He further proposed a third perspective that is to subdivide the representation and processing of various types of knowledge by a computer system. Through this new perspective, which is further substantiated by observations with several renowned e-business/commerce systems, one can gain a stronger appreciation of how CBT can add value to KM. Information technology can accomplish a lot more than mere storing and retrieving data (Holsapple, 2005).
From observation KM as a field of study and practice is here to stay (Ajiferuke, 2003). Yet, it is still in a formative stage, marked by differences in terminologies, emphases, and boundaries. This paper focuses on one of those boundaries: the relationship between knowledge management (KM) and computer-based technology. It advocates a perspective of the boundary that neither excludes technology, nor identifies with it. This is an inclusive perspective based on a conception of knowledge that recognizes multiple knowledge types (descriptive, procedural, reasoning), multiple gradations of knowledge, and diverse processors of diverse knowledge representations. Views on the relationship between KM and computer-based technology are wide-ranging. Some say that there is little or no relationship. Some contend that any such relationship is largely incidental (Alavi and Leidner, 2001). In contrast, others tend to use the terms information and knowledge interchangeably, seeing information technologies and systems as being at the core of knowledge management.
This study considers the role of technology in knowledge management. In so doing, it takes a position that there is neither a barrier that differentiates information from knowledge, nor can the terms knowledge and information be used interchangeably. Building on this, it finds that technology is essential to an understanding and application of modern knowledge management. Furthermore, it concludes that knowledge management forms the rationale and intellectual basis for studying computer-based technology and systems. Exploration of how technology can complement and mesh with human knowledge handling is where researchers have added and can continue to add value to the knowledge management movement. This paper considers several examples of ICT tools that have been integrated to knowledge handing. It also identifies and discusses several areas where ICT research has a potential to make further contributions to the KM field. The purpose of this study is to contribute to literature on KM from a perspective from Nigeria and growth of this concept in a developing country. From observation there is nothing in literature on use of ICT to support KM or even KM in Nigeria.
Outside Nigeria, over the last ten years or so, there have been two significant changes in landscape of KM technologies. First, due to advancements in open standards, these technologies have become far more interoperable and less platform dependent. As a consequence, many of these technologies are now componentized and can be embedded seamlessly into other enterprise applications. For example, a search engine can be incorporated as part of an e-collaboration suite and a portal usually provides a document management component. The second change is the bundling of the market offerings by the vendors of commercial KM technologies. KM solutions in the marketplace today are likely to be a collection of complementary technologies that aim at execution of a specific process (e.g. collaborative product development), a solution (e.g. problem resolution and service support by a contact center) or a particular industry (e.g. wealth management portal in financial services).
Study Background at PRRINN
In Nigeria, a vast country of over 120 million people, PRRINN is working as part of a consortium of international organizations to improve immunization in four of the poorest states of the country namely - Jigawa, Yobe, Katsina and Zamfara – all of which have very little immunization coverage. The UK Department for International Development (DFID) in Nigeria is supporting the Programme for Reviving Routine Immunization in Northern Nigeria (PRRINN) Consortium to implement a £20m project in four States of Northern Nigeria. It is anticipated that by the end of the project state and local government authorities would have significantly improved the coverage of child immunization. This will be achieved through building the state's capacity to plan, implement and monitor routine immunization activities, and by increasing access and uptake of immunization at community level. In this way ownership of immunization activities will be transferred from external agencies to the local communities. (http://www.transaid.org)
PRRINN has some international partners of which this paper has to make mention of, such as Health Partners International, Save the Children, Grid Consulting and PATH and Transaid and the latter was asked to become involved in the Partnership for Reviving Routine Immunization in Northern Nigeria (PRRINN). In this project, the cold chain and related transportation is absolutely vital for making vaccines more readily available and improving immunization coverage in the target areas. Transaid was therefore tasked to undertake an assessment on the supply side to analyze the current transport situation and existing resources in each state, and how they can be best utilized to help achieve the aims of the project. The initial assessment which was carried out in 2007 revealed that the four state ministries of health are very poorly resourced, and much of facilities non-functional (http://www.transaid.org). The PRRINN programme will increase the vaccination rates through emphasizing the need for capacity building among stakeholders at different levels, with work being undertaken with Ministry of Health employees at all levels, and work with the communities. PRRINN is presently working with the federal government of Nigeria to promote the development of appropriate policies that will harmonize the intervention of different agencies supporting immunization and clarify the resources available for the programme.