Resumen
Scaling health information system from small scale pilots to national systems in developing countries poses a key challenge to system designers and health managers. As a consequence, many projects dissolve and die before they reach the scale where they are useful for information management. The concept of bootstrapping from the Information Infrastructure literature has proven useful to discuss and understand how to initiate and grow large-scale, complex and networked information systems from scratch. We use this concept to analyze and discuss an empirical case of building a large scale medical licensing system in a Southeast Asian country. Beyond describing the process leading up to the success of the licensing system, we contribute by identifying a range of factors influencing the bootstrapping process and we suggest extensions to make the bootstrapping strategy relevant in this context.