A Complexity-Informed Framework for Health Information System Interoperability in the Nigerian Federal Health Architecture

Health information system interoperability in the Nigerian federal health architecture is frustrated by multiple competing standards, vendor lock-in, fragmented governance, and the complexity of coordinating interoperability investment across federal, state, and local government health management levels. Existing interoperability frameworks developed for simpler national health information architectures do not adequately address the complexity dimensions that make interoperability governance in Nigeria a wicked problem. This dissertation develops an original complexity-informed framework for health information system interoperability governance in the Nigerian federal health architecture, making theoretical contributions to both health informatics and complexity science applied to health systems. The theoretical framework draws on complex adaptive systems theory, institutional economic theory, and network governance theory to construct a model of interoperability emergence in a multi-actor, multi-level, and multi-standard health information ecosystem. Original theoretical contributions include a formal representation of the Nigerian health information system as a complex adaptive network, a node-level interoperability capacity model specifying the conditions under which individual health facilities achieve and maintain interoperability, and a governance intervention theory specifying which complexity leverage points most efficiently drive system-wide interoperability improvement. Empirical validation is conducted through a mixed-methods study of health information system interoperability status and governance across sixty health facilities in Lagos, Kaduna, and Borno states, measuring interoperability achievement against a validated maturity scale. The governance intervention theory is tested through analysis of a natural experiment provided by contrasting state-level interoperability investment strategies in two states. The framework provides an evidence-based guidance resource for the Federal Ministry of Health national health information system strategy. Keywords: health information system interoperability, complex adaptive systems, federal health architecture, governance, Nigeria.