{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T17:07:25Z","timestamp":1790701645784,"version":"4.1.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":260,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Dodoma through the Higher Education for Economic Transformation (HEET) Project","id":[{"id":"https:\/\/ror.org\/009n8zh45","id-type":"ROR","asserted-by":"crossref"}]},{"name":"District of Excellence"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Routine Health Information System data are widely promoted as a foundation for evidence-informed planning, supervision, and service improvement in low- and middle-income countries. Yet their use in decentralized health systems is often shaped by contradictory institutional logics. In this study, contradictory institutional logics refer to conflicting expectations about what actors should prioritize, how data should be used, and which resources are made available to do so. We examined how these contradictions shape routine data use at subnational levels of the Tanzanian health system and how local actors respond to them. We conducted a qualitative study in the Dodoma City Council and the Bahi District Council, Tanzania, between 2024 and 2025. Data were generated through 31 key informant interviews and nonparticipant observations across 12 purposively selected health facilities and two council health management teams. Participants included facility in-charges, health management information system focal persons, facility programme coordinators, and council program coordinators. Data were analyzed thematically using institutional theory as an interpretive lens. The findings from the two councils reveal that routine data use was not absent; rather, it was improvised within a contradictory institutional environment. Strengthening data use, therefore, requires more than technical deployment. It requires institutionalized procedures for review and supervision, broader analytic capacity at the facility level, better alignment between DHIS2 and GoT-HOMIS, and target-setting and feedback practices that are meaningful to local service realities. These findings are analytically relevant to similar decentralized settings, although they are not statistically generalizable beyond the study context.<\/jats:p>","DOI":"10.1093\/oodh\/oqag036","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T19:25:21Z","timestamp":1789673121000},"source":"Crossref","is-referenced-by-count":0,"title":["Surviving institutional contradictions: routine data use practices at the subnational levels"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3849-7158","authenticated-orcid":false,"given":"Bigten","family":"Kikoba","sequence":"first","affiliation":[{"name":"Department of Computer Science and Engineering, University of Dar es Salaam , Bagamoyo Road, Kijitonyama (Science), P.O. Box 33335, 14113, Dar es Salaam ,","place":["Tanzania"]},{"name":"Department of Information Systems and Technology, University of Dodoma , Benjamin Mkapa Road, P.O. Box 490, 41218, Dodoma ,","place":["Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merina","family":"Luambano","sequence":"additional","affiliation":[{"name":"Department of Computer Science and Engineering, University of Dar es Salaam , Bagamoyo Road, Kijitonyama (Science), P.O. Box 33335, 14113, Dar es Salaam ,","place":["Tanzania"]},{"name":"Department of Informatics, University of Oslo , Ole-Johan Dahl's Building, Gaustadall\u00e9en 23B, P.O. Box 1080, Blindern 0316, Oslo ,","place":["Norway"]},{"name":"Health Information Systems Programme (HISP) , number 22, Mazinde Street, Mikocheni B, code 14113, Dar es Salaam ,","place":["Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0138-0928","authenticated-orcid":false,"given":"Masoud","family":"Mahundi","sequence":"additional","affiliation":[{"name":"Department of Computer Science and Engineering, University of Dar es Salaam , Bagamoyo Road, Kijitonyama (Science), P.O. Box 33335, 14113, Dar es Salaam ,","place":["Tanzania"]},{"name":"Health Information Systems Programme (HISP) , number 22, Mazinde Street, Mikocheni B, code 14113, Dar es Salaam ,","place":["Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6030-6050","authenticated-orcid":false,"given":"Wilfred","family":"Senyoni","sequence":"additional","affiliation":[{"name":"Department of Computer Science and Engineering, University of Dar es Salaam , Bagamoyo Road, Kijitonyama (Science), P.O. Box 33335, 14113, Dar es Salaam ,","place":["Tanzania"]},{"name":"Health Information Systems Programme (HISP) , number 22, Mazinde Street, Mikocheni B, code 14113, Dar es Salaam ,","place":["Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"2026092912321431800_ref1","first-page":"578","article-title":"Health information systems: the foundations of public health","volume":"83","author":"AbouZahr","year":"2005","journal-title":"Bull World Health Organ"},{"key":"2026092912321431800_ref2","doi-asserted-by":"publisher","first-page":"618","DOI":"10.1186\/s12913-021-06648-1","article-title":"Strengthening routine health information systems for analysis and data use: a tipping point","volume":"21","author":"Amouzou","year":"2021","journal-title":"BMC Health Serv Res"},{"key":"2026092912321431800_ref3","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1093\/heapol\/czp010","article-title":"PRISM framework: a paradigm shift for designing, strengthening and evaluating routine health information systems","volume":"24","author":"Aqil","year":"2009","journal-title":"Health Policy Plan"},{"key":"2026092912321431800_ref4","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1186\/s12913-024-10834-2","article-title":"Utilization of routine health data and its determinants among healthcare workers in public health facilities of Harari region, eastern Ethiopia","volume":"24","author":"Ayele","year":"2024","journal-title":"BMC Health Serv Res"},{"key":"2026092912321431800_ref5","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1287\/isre.1110.0373","article-title":"Institutional contradictions and loose coupling: postimplementation of NASA\u2019s Enterprise information system","volume":"23","author":"Berente","year":"2012","journal-title":"Inf Syst Res"},{"key":"2026092912321431800_ref6","doi-asserted-by":"publisher","first-page":"105348","DOI":"10.1016\/j.ijmedinf.2024.105348","article-title":"Data work and practices in healthcare: a scoping review","volume":"184","author":"Bertelsen","year":"2024","journal-title":"Int J Med Inform"},{"key":"2026092912321431800_ref7","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1177\/1460458219864730","article-title":"Data work in healthcare: an introduction","volume":"25","author":"Bossen","year":"2019","journal-title":"Health Informatics J"},{"key":"2026092912321431800_ref8","doi-asserted-by":"publisher","volume-title":"Supporting Research in Counselling and Psychotherapy: Qualitative, Quantitative, and Mixed Methods Research","author":"Braun","DOI":"10.1007\/978-3-031-13942-0_2"},{"key":"2026092912321431800_ref9","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1186\/s12913-023-09914-6","article-title":"Use of routine health information systems data in developing and monitoring district and facility health plans: a scoping review","volume":"23","author":"Byrne","year":"2023","journal-title":"BMC Health Serv Res"},{"key":"2026092912321431800_ref10","doi-asserted-by":"publisher","first-page":"583","DOI":"10.3917\/mana.155.0583","article-title":"The institutional logics perspective: a new approach to culture, structure, and process","volume":"15","author":"Friedland","year":"2012","journal-title":"M@n@gement"},{"key":"2026092912321431800_ref11","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1177\/1525822X05279903","article-title":"How many interviews are enough? 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