Drawing on ethnographic work with Ghana’s health information system, my talk details experts’ attunements and critical adaptations to global health practices. I take the well documented roll-out of the digital health information system DHIS2 in Ghana as case to portray the invisible “backstage” labor (Star and Strauss 1999) of mid-level health data managers who both standardize health data at the local and district levels of the Ghanaian public health system, while also managing and attuning to competing valuations, specifically, regional variations in patients’ clinical presentation of WHO standard case definitions, the integration of habitual knowledge and care practices with standard epidemiological projections, and the meticulous and decidedly analog monitoring public health concerns in the face of critical resource constraints.