As part of health sector reform, most developing countries are in the process of restructuring the Health Information Systems (HIS) by way of standardizing and integrating various vertical reporting systems. Nevertheless, the pressure resulting from the vertical systems supported by donors renders the integration goal challenging and unachievable. While many studies have argued for the heterogeneity of interests and multiple data needs of the donors as the major cause of the problem, this paper argue for more detailed and critical analysis of the problem. To contribute to this, the paper emphasize the need to understand the main actors involved in the process in terms of the resources and rules available to them; and their implication in the HIS integration venture. By drawing on an empirical case study and Structuration Theory concepts, the paper identified the dialectic power relations between the actors resulting from the asymmetric ownership and control of resources and rules. To alleviate the power tensions, the paper proposed i) the need to build shared meaning of the integration process through communication approaches ii) and the need to distribute the control of the integrated HIS using modularization approach facilitating ‘the tapping on’ of the resources available to each group of actors.