Several themes emerged from our analysis of the data that did not easily fit into the framework originally proposed, which included components for content, users, governance, and technology.
It seems to us that the intersections of users, governance, content, and technology give rise to the four new themes, which all describe elements of translation among the original components.
We crafted our questions and foci for observations around the four components of users, governance, technology, and content, so it was not surprising when the themes of workflow, governance, usability, measures and metrics, data as a foundation for CDS, and knowledge management were identified as themes.
Based on a World Bank (2004) framework of accountability relationships in service delivery, Brinkerhoff and Bossert (2008) frame the relations among three categories of health system actors (governments, providers and service users) as governance relationships which ultimately affect health service delivery.
Ostrom (1990) challenged the traditional belief that commons management inevitably requires state ownership or privatization and instead established the notion of user self-governance.
Government ownership or privatization is usually understood to undermine user self-governing institutional arrangements, while user self-governance has proved to be a very powerful policy alternative in managing the commons in many cases.
A few major factors are important — around signaling, governance, user engagement, and general risk — and are worth considering before making the decision.
There are huge challenges around signaling, governance, user engagement, and risk that are worth debating and getting feedback on from trusted professionals.
