¹Department of Informatics, University of Oslo, Oslo, Norway

Correspondence: Selamawit Molla Mekonnen, Department of Informatics, University of Oslo, P.O. Box 1080 Blindern, Oslo N-0316, Norway. Tel: +47 22840682

Received 28 February 2007; Revised 10 August 2007; Re-revised 4 May 2008; Re-revised 12 June 2008; Accepted 13 June 2008.

Abstract

This paper presents an institutional theory-inspired analysis of the dynamics of interaction between processes of standardizing and scaling, in the context of Health Information Systems implementation in the Ethiopian public health care system. Standardizing and scaling have, in existing research, been treated primarily as independent technical processes that are isolated from the institutional context in which they take place. This paper tries to redress this balance in this research in two ways. Firstly, it argues for these processes to be taken as inter-related which can both support and undermine each other. Secondly, this mutual interaction is argued to be mediated by the institutional context. Specifically, we draw upon concepts from institutional theory inspired by Douglas North, focusing on the degree of overlap between formal institutions (attempts to establish formal policy on activities such as the definition of indicators and uniform reporting formats) and informal constraints in practice reflected in inadequate capacity – both technological and human, and existing work practices.