Complex systems and public health information systems: insights from India's national health information architecture

Many low- and middle-income countries (LMICs) are actively strengthening their National Health Information Architectures (NHIAs) to keep pace with ever-evolving health data and integration needs. Because these systems are large and complex, embedded in diverse socio-technical and political contexts, their evolution often comes with emergent properties and unintended consequences. Through a complex-systems lens, we examine the Indian NHIA as it evolved over the past 15 years. We find that while the information infrastructure has expanded explosively, persistent and growing fragmentation has hindered the use of data to generate actionable insights on health outcomes. Our analysis underscores the need for a holistic approach that moves beyond merely growing the NHIA’s technological components.