Purpose: The purpose of this paper is to examine adoption of the balanced scorecard (BSC) by a large public-sector health organisation in an African country, Ethiopia as part of a programme to implement a unified sector-wide strategic planning and performance monitoring system. The study explains how this trans-organisati onal role of the BSC is constituted, and explores how it operates in practice at the sector-and organisation-levels. Design/methodology/approach: The study employs the case-study method. Semi-structured interview data and documentary evidence are analysed by drawing on the concept of translation from actor-network theory. Findings: The case-study organisation adopted the BSC as a part of broader public-sector reforms driven by political ideology. Through a centralised government decision, the BSC was framed as a sector-wide system aimed at: aligning the health sector’s strategic policy goals with strategic priorities and operational objectives of organisations in the sector; and unifying performance-monitoring of the sector’s organisations by enabling aggregation of performance information to a sector level in a timely manner to facilitate health sector policy implementation. While the political ideology facilitated BSC adoption for trans-organisational use, it provided little organisational discretion to integrate financial administration and human resource management practices to the BSC framework. Further, inadequate piloting of information system use for the anticipated BSC model, originating from the top-down approach followed in the BSC implementation, inhibited implementation of the BSC with a balanced emphasis between the planning and performance monitoring roles of the BSC. As a result, the BSC underwent a pragmatic shift in emphasis and was reconceptualised as a system of enhancing strategic alignment through integrated planning, compared to the balanced emphasis between the planning and performance monitoring roles initially anticipated. Originality/value: The study provides a theory-based explanation of how politico-ideological contexts might facilitate the framing of novel roles for the BSC and how the roles translate into practice.