In the recent years most African countries have embarked on a series of reforms involving the

decentralisation and also integration of health information systems in order to allow improved

efficiency and effectiveness in the health care. However, although the discourse around these issues

are reflected in global policy documents of almost twenty years ago, IS are still fragmented and weak

at the lower levels of the health service. The paper takes a multivocal and multilevel institutionalist

perspective to analyse the role of information technology in shaping these shortfalls between

institutional accounts and enactments of reforms. Based on the case study of two divisions of the

ministry of health in Kenya, it aims to better understand the change implications of information

technology for the structures of a health information system in Africa. This is meant to improve the

understanding of the way technology-mediated human interactions produce variance between planned

organisational change envisaged in donor-driven reforms of the health care service and unplanned

HIS structures emerging from the local institutionally-embedded usage of IT tools.