Hospitals in Zanzibar have experienced problems in collecting and managing its health care data. The main problem was lack of standards in data collection and reporting from the wards and clinics. The decisions to improve the information system within the hospitals embarked on a project known as the Health Information Systems Programme (HISP). This paper analyses HISP’s on-going action research and participatory design efforts in the development of an integrated HIS for hospitals in Zanzibar. Key lessons learned are the need for a long term strategy to HIS development, identifying the most important data sets and gather them early on, providing feedback to health workers from an early system implementation stage, the focus should include the source of information and HIS is a developmental activity. At the time of writing this paper there are standardized paper forms for data collection, established reporting routines and a working version of computer software for data storage, analysis and reporting.