Health information systems (HIS) in most low- and middle-income countries (LMICs) have been often implemented under the international pressure of accounting for health care investments. The idea behind robust and efficient HIS is that health information can allow for better planning and monitoring of the health service, which may translate into better health outcomes. Yet, the use of HIS as accountability tools has often been criticized as being counterproductive by making health information more meaningful to national governments and international agencies rather than those in charge of local health services. The objective of this paper is to analyse how HIS influence the emergence of local accountability practices and their consequences for the provision of health care. A theoretical perspective from structuration theory is built and integrated with the technology domain of HIS. This perspective is used in the analysis of a case study of HIS in Kenya. This study raises implications for the use of structuration theory in understanding accountability and the role of IT materiality in processes of structuration. It contributes to a better understanding of how HIS can foster improved health care and human development. It also contributes to the understanding of IS not just as means for governing people’s behaviour but also as means of socialization through which users can negotiate multiple accountability goals.