PurposeThe purpose of this research is to identify ways in which medical record keeping systems and health information systems might be integrated effectively and sustainably. The aims include minimising the workload of busy frontline health professionals and radically improving data quality.Design/methodology/approachThis is a qualitative research project, grounded in the theoretical stance that information systems are sociotechnical systems. The primary focus of this research is on real-life custom and practice. The study population consisted of participants in information systems. As is common in qualitative research, sampling was purposive rather than statistically representative.FindingsThis research suggests one unconventional conclusion. New approaches that use intermediate and hybrid technologies may have a better prospect of delivering satisfactory, realistic and affordable medium- to long-term solutions than strategies predicated on the assumption that only systems that are wholly electronic are worth considering.Originality/valueThis research is original in the sense that it investigated records rather than information technology systems. The findings are likely to be of applicability in other developing countries, especially those that share legacy systems with Malawi, such as Botswana, Tanzania, Zambia and Zimbabwe.