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.
Bernardi, Roberta, "Panel: Labor importation as the steroid for nations' ICT success: A debate" (2009). ECIS 2009 Proceedings. 199.