Routine health information systems in most third world countries are woefully inadequate to provide the information support necessary for planning and management of the health services. According to Neame and Boelen, "The health care environment is bursting with information, but the sector lacks the capacity to find, communicate or use it effectively".¹ One of the main reasons for this situation is that routine health information systems in most countries are centrally planned and managed.² Indicators, data collection instruments, and reporting forms usually have been designed by centrally located epidemiologists, statisticians, and administrators (called data people), with minimal involvement of lower-level line managers and providers of the health services (called action people). The cultural differences between the two groups are often so huge that Dunn speaks of the "two communities metaphor".³ Data processing and analysis are mainly the responsibility of a centrally located office. Complex data transmission and compiling systems slow down the production of feedback in such a way that, by the time a feedback report is received at lower levels, the information is frequently obsolete for decision making. Planners and managers face deadlines and time constraints in their daily decision making. Outdated information, even of high quality, is of low value to them. The main result of this centralization is that information use is weakest at the district level, where the main public health interventions are planned, implemented, and monitored, and at the health unit level, where individual health decisions are made.