Governance lessons from an interorganizational health information system implementation in Ethiopia

The paper investigates interorganizational health information system implementation in a developing country health sector and the influence of the sociopolitical context that constitutes the institutions of the global health system. It argues that a comprehensive understanding of interorganizational system (IOS) implementation should include the study of the institutional context and its stakeholders who exhibit complex social and political attributes that influences its implementation and trajectory. This paper charts this course by examining the key governance dimensions of coordination and alignment. Building on this, the study challenges the viability of the unstructured institutional arrangements and the ensuing development modalities for health information system implementation, which are largely facilitated by international nongovernmental organizations and leverage on information and communication technology. The paper concludes by discussing the implications of the study. These include (1) the influence of unstructured interorganizational relations, at both the organizational and sector levels, on IOS adoption, (2) how the social and political behaviors of opportunistic interorganizational participants are implicated in the IOS adoption process, and (3) the role of strategic alignment, largely driven by the informal interorganizational relationship and social dimensions, on the prioritization and fit between IOS technological and organizational components.