Exploratory, inductive analysis has not validated the linking of diffusion of innovation and dynamic equilibrium frameworks by grounding these theories in empirical information systems development. This paper reports on an ethnographic case study that followed the introduction of new health information management strategies in a low-income country. The aim was not to test theory, but to use existing theory to develop an interpretation of the themes and patterns which arose. During the analysis this research empirically validated the idea of organizational fit and concepts from the diffusion of innovation theoretical framework. Some refinements to the models and several contributions to theory have been made. In addition many implications for practice are identified. Furthermore, because theory can have an impact upon the way planners frame problems and identify solutions, this combination of theoretical frameworks could bring benefits to future IS development and organizational change.