Mozambique provides a truly challenging setting for the implementation and introduction of health information systems. With its brutal, colonial history under the Portuguese, followed by a devastating post-colonial civil war, Mozambique is only slowly recovering. The legacy from this relatively recent history has left deep scars in ways that are relevant to the development of health information systems under the current social and political conditions, as this special issue sets out to demonstrate.
With its almost 800,000 square kilometers, Mozambique is a vast country exceeding the size of Texas or France and has a population of approximately 20 million. Material and institutional resources, however, are extremely scarce. According to the Human Development Index developed by the United Nations Development Programme (UNDP) and the World Bank, Mozambique is ranked at number 157, making it among the 22 poorest countries in the world (UNDP, 2004).
This scarcity carries immediately over to the health care sector. Life expectancy is 38.5 years. Endemic malaria accounts for about 50% of all outpatient consultations with an estimated 14% of 15-to 49-year-olds with HIV/AIDS. The country's 435 physicians and 1200 health facilities are hard-pressed to serve the population of about 20 million.
From this crude outline of the socio-historical and political landscape, it should be evident that Mozambique represents an extreme case for developing and using health information systems (Avgerou & Walsham, 2000). In Flyvbjerg's (1998) terms, Mozambique is a critical case in the sense that if you can make a solution work here, against all odds, they should work in other, more favorable, locations as well. Yet, dramatic shortcomings in all kinds of resources, has simultaneously the potential to trigger local improvisation or bricolage, the life-blood of any properly grounded information systems, as pointed out by Ciborra (2000).
The information systems described in this special issue address the health care sector, i.e., they are domain-specific and not generic. This has important repercussions of both an analytical and practical nature. To establish working information systems in this sector, it