Scaling of Health Information Systems in Education: A Case of Cross-Sectoral Collaboration

Scaling health information systems (HIS) across sectors faces unique challenges rooted in organizational practice, including varying priorities and interests between and within a multiplicity of stakeholders and user groups. These challenges shape how HIS solutions are built, implemented, and evolve. In this paper, we discuss how the scaling of HIS solutions within an education setting was shaped by cross-sector collaboration. We examine a case where two public sector organizations in Uganda, the Ministry of Health and the Ministry of Education and Sports, leveraged each other's capacities to build and scale a school-based disease surveillance system country-wide. The system was built following the onset of COVID-19 as a response to address a situation where 15 million children were out of school for 2 years. To analyze and discuss our empirical case, we use bootstrapping, a strategy from information infrastructure literature that is useful for understanding how to start and grow large-scale and networked information systems from scratch. We contribute by extending contextual factors of the bootstrapping strategy with two additions: mitigating change processes and institutionalizing organizational practice aspects that we believe constituted scaling of the school-based disease surveillance system and strengthening cross-sectoral collaboration.