摘要：This article addresses the issue of strategies for developing decentralised bottom-up health information systems (HIS) in developing countries in general, and for the development of community based HISs aiming at empowering local communities and their structures in particular. Following an integrated data warehouse strategy, the HISs in question are including information of different types, such as data on health services, health status and demographic surveys, and they are addressing equity in health services provision and health status and thereby the needs of disadvantaged communities. Important in this context is that striving for equity between poor and rich geographical areas and population groups will require a HIS that, for core components, is shared across a country, state or region to measure and monitor the extent to which equity is being achieved and to pinpoint areas where more resources and efforts are needed. Thus, for a HIS to best address the needs of local communities, it will need to be an integrated part of a larger area HIS framework. This paradox, that locally based HISs that are addressing the needs of communities need to be part of something bigger in order to be useful, will be described and discussed in this paper using case studies from Sierra Leone, Kenya and India. While in Sierra Leone the traditional Chiefdom structure is using the HIS to address equity and document their demands for improved health services, in Kenya and India the significant issue is that improved Internet and mobile telephone infrastructure is enabling the community level to get access to their own information and to analyse and to disseminate it within a larger framework, and thereby to be better able to address their demands.
关键词：Community informatics; health;Community; health information systems; equity
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