Complexity and Public Health Informatics in Low and Middle-Income Countries

This chapter enriches the Expanded PHI perspective through the lens of complexity. Current technical health systems and institutional developments, including the increasing inter-connections between them, and the uncertainities associated with both context and goals are enhancing complexity exponentially. Simple linear approaches to design and develop systems can no longer work, as they imply trying to bring order into processes which by definition defy them. Cloud computing and big data are offered as examples to depict this rising complexity, providing rich opportunities to materialize them. Many organizations are adopting outsourcing models as a means to manage this complexity. However, outsourcing comes in multiple hues and shades, from a simple use of third party hardware to the externalization of the whole value chain of activities, including the analysis and use of data. Public health informatics in LMICs, which are population-based and taking place in largely resource-constrained and unstructured settings, are by definition problematic to outsource and should be approached with caution. An incremental approach where a ‘cultivation strategy’ addresses uncertainities, and ‘attractors’ draw in user-participants are more likely to succeed.