Global standards and Local Applications: Case of Implementing ICD-10 Standard in HMIS Tajikistan
This paper contributes to the ongoing debate on the interplay of global and local standardization processes and how can these be effectively managed. Based on the longitudinal case study of the Health Management Information System (HMIS) implementation in Tajikistan, the paper analyses how the adoption and usage of global standards of International Classification of Diseases (ICD) contributes to the improved quality of health data for clinical and statistical purposes and the related implications it has for the health service delivery. The analysis focus onto negotiation processes among various stakeholders of HMIS in interplay between the global standards and local implementation of these standards through the lens of proposed conceptual framework of ‘global and local interplay of HMIS standards’. Three distinct approaches developed by stakeholders in redesign of HMIS standards were identified, each having advantages and limitations. Further varying level of ICD use in these approaches is discussed along with future prospects from gradual use and institutionalization of ICD.
ICD; HMIS; Healthcare; Standard; Developing country; Tajikistan.