Data value and care value in the practice of health systems: A case study in Uganda

In anthropology, interest in how values are created, maintained and changed has been reinvigorated. We interrogate concerns about relationships between data collection and patient care by following a pilot study in Kayunga, Uganda aimed at improving the collection of health systems data. Through ethnographic research (July 2015 to September 2016), we observed that measurement, calculation and narrative practices could be assigned care-value or data-value and that attempts to improve data collection transferred ‘data-value’ into health centres with little consideration for its impact on care. We document acts of acquiescence and resistance to data-value by health workers and describe rare moments when senior health workers reconciled these two forms of value, and care-value and data-value were enacted simultaneously. Our analysis suggests data-value and care-value are not necessarily conflicting. Actors seeking to make changes must, however, consider local forms of value and devise interventions that reinforce and enrich existing ethical practice.