Standardization of health information systems in South Africa: The challenge of local sustainability<FNR></FNR><FN>Shirin Madon was the accepting Special Issue Editor for this paper </FN>.

The implementation and development of routine health information systems continue to provide a number of challenges for managers—the more so in developing countries where resources are scarce and human resource and technical skills limited. This article conceptualizes the interdependence between the local adaptation and appropriation of global standards, and the value that this adds to the global standard through improved quality of data. These processes reinforce one another in the creation of sustainable information systems. The article draws upon a case study of a rural hospital in South Africa. A successful change process is documented, wherein the organization, through innovative management and leadership, actively and successfully appropriated the national standard. The case study is used to highlight three main messages, namely, that standards should be able to be locally appropriated, that the creation of networks helps to support the local adaptation of standards, and that the layering of information systems is important to encourage the use of information and helps to improve data quality. &#169; 2006 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]