Another difficulty for the design of a SAPHMIS is caused by structural changes, which affect the health system and its reporting system after the installation of the SAPHMIS. These changes can occur for practically all entities which play a role in the HMIS:

• Health units can be newly created, shut down, merged or split.
• New health services can be introduced to the health system, bringing along new reporting forms.
• Reporting forms can be changed in content in order to follow changing information needs.
• The reporting frequency of a form can change e.g. from monthly to trimestrial.
• The composition of indicators which have to be calculated for routine analysis can change.

There is practically no such thing as an eternal reporting system, which calls for a maximum adaptability of the SAPHMIS. These changes have to be introduced to the SAPHMIS by non-skilled staff. These changes have to be managed by the SAPHMIS, calling for a relatively sophisticated design of the program code and the underlying database structure.