An institutional analysis on the dynamics of the interaction between standardizing and scaling processes: a case study from Ethiopia

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.