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The health systems in many developing countries lag seriously behind the developed world in the use of health management information systems (HMIS). The World Bank, like other international donor organizations, is increasingly called upon to provide technical and financial assistance in this area, but success stories remain rare. Because HMIS are critical to developing and improving health systems delivery and finance, the bank must find ways to increase effectiveness of the interventions it supports. This paper attempts to contribute to this process by proposing a new conceptual framework for the assessment of HMIS interventions, and then demonstrating the framework by applying it to an existing project to support national health insurance in Latvia. The paper documents the key characteristics of the HMIS project, discusses successes and failures to date, and presents lessons learned that may be applicable to other HMIS projects in developing countries. The case study focuses on a functional classification of the HMIS implementation, and critical success factors that have emerged with regard to systems implementation in developed countries.