Health sectors in developing countries are commonly struggling with disarrayed health information architectures, where multiple vertical, disease-specific programmes have implemented their isolated information systems. A consequence is parallel and overlapping systems where information is stored at different locations and in different formats. To address this, multiple global standardization efforts to harmonize health information architectures have been initiated. Still, there is only limited knowledge about the role of these global standardization communities in shaping national health information architectures. This article is based on a case study of the global Open Health Information Exchange (OpenHIE) standardization community. With an Information and Communications Technologies (ICT) ecosystem perspective, we aim to improve our understanding of the relationships between global standardization communities and national ICT ecosystems. Theoretically, we contribute with our conceptualization of national ICT ecosystems.