Scaling information infrastructures: The case of the medical licensing system in a Southeast Asian Country

Abstract

Scaling health information systems from small-scale pilots to national systems in developing countries poses a key challenge to systems designers and health managers. Consequently, many projects dissolve and die before they reach the scale where they are useful for information management. The concept of bootstrapping, from the information infrastructure literature, has proven useful for discussing and understanding how to initiate and grow large-scale, complex and networked information systems from scratch. We use the concept of bootstrapping to analyze and discuss an empirical case of building a large-scale medical licensing system in a Southeast Asian country. Beyond describing the process leading up to the success of the licensing system, we contribute to the literature by identifying a range of factors influencing the bootstrapping process, and we suggest methods of making the bootstrapping strategy relevant in this context.