When digital systems stop working: a qualitative study of misalignment between the implementation of a human resources information system and health zone realities in the Democratic Republic of the Congo.

Abstract

Digitalized human resources information system (HRIS) is promoted to strengthen health workforce governance, yet its implementation often breaks down in many low-resource settings. We explored barriers and facilitators to HRIS implementation at provincial and health zone levels in the Democratic Republic of the Congo (DRC) and identified intervention points. This qualitative study involved interviews with 46 staff from provincial health divisions and health zones in three provinces of the DRC: Kongo Central, Haut-Katanga, and Kwango, representing different stages of HRIS rollout. Interviews were conducted between August and September 2023. Data were analyzed inductively, and findings were mapped onto the updated Consolidated Framework for Implementation Research (CFIR). Two overarching themes emerged: experiences of HRIS implementation and current situation with workforce management information and information needs. Dissatisfaction with paper- and Excel-based data management and the need for accurate human resource data shaped motivation to use HRIS. The main barrier to continued HRIS use was unresolved login failures, driven by the lack of locally accessible technical personnel. CFIR mapping showed that barriers spanned multiple CFIR domains, including misalignment between HRIS implementation and operational realities and reliance on external rather than domestic financing. Sustainable HRIS implementation requires alignment between system design, local operational realities, and financing structures rather than system introduction alone. In the DRC, seemingly minor technical problems can halt system use, revealing the fragility of HRIS when local technical support and institutionalized funding are absent. Without decentralized support and contextual adaptation, HRIS implementation risks exacerbating such digital divides rather than strengthening governance.