Benefits of Local Knowledge in Shaping Standards A case study from community health service and information systems in Ethiopia

This study investigates the pivotal role of local knowledge in shaping standards in the health service provision and health information systems implementation in the context of a developing country. To do so, we draw on empirical data from a qualitative case study of health data gathering and service provision during a child survival intervention campaign conducted in Ethiopia. Theoretically, we draw on studies that thematize the tension between the universal nature of standards or protocols and the inevitable need for adaptation and flexibility when they are implemented in a given concrete context. The study conceptualizes the national guidelines, which guide health workers in the data gathering and health service provision process, as standards. We examine the implementation of those guidelines in the actual set up, and show the significance of local knowledge in order to fit the standards to the reality at the ground. The findings indicated that health workers sometimes deviated from the standards and devised alternative ways of doing based on their context-specific knowledge and locally available materials. We emphasize both the need for standards as such, as well as the value of productive deviation from the standards when required depending on the context. The article provides theoretical insights relating to standardization with flexibility, and suggests differentiating between fixed and flexible elements of standards. We argue that the lessons learned on the data handling process observed in the campaign can help to improve the data quality and strengthen the routine health information systems.