Health information systems, decentralisation and democratic accountability

While decentralisation is a much-used term in development discourse, there is lack of clarity about how much autonomy should be granted to local agencies in programme implementation. This is particularly the case in the health sector in developing countries where decentralisation has resulted in the primary health centre (PHC) being identified as the focal point for the delivery of basic health services to rural citizens. An important element of primary healthcare reform has been the implementation of health information systems (HIS). These systems primarily account for monies spent to higher levels of administration and funding bodies rather than account for primary healthcare provision to citizens. In this article, we focus on various emergent processes of change that are occurring under the auspices of the National Rural Health Mission (NRHM) in India to strengthen the interface between the PHC and the community. We present a case study of Gumballi PHC in Karnataka, South India. Our findings reveal ways in which these new processes can be supported by conceptualising the HIS as more than a mere reporting tool.