Institutional strategies towards improving health information systems (HIS) in Sub-Saharan Africa

The development of “Health Information Systems” (HIS) in lowincome countries have been on the agenda for the last three decades. Despite significant mobilization, however, little progress has been made in realizing improved systems. One among the popular reasons for such progress concerns the lack or unwillingness of some relevant groups of actors to participate in HIS initiatives. Such explanations often delimit participants to a project or organisation level, and scant attention has been paid to the institutional environment, web of values, norms, rules, beliefs, and taken-for-granted assumptions that has long been recognized to influence the day to day realities of organisational life. This chapter, drawing on an institutional theory of membership, and based on discursive data of more than a decade and half from a low-income county’s HIS development endeavors, reveals institutional processes and pressures that constrain participation of relevant actors.