This research is about health facility managers in Cape Town, South Africa – how they collect and use information for managing their health units and how an information culture is expressed in the facility management and work practices. Through an in-depth case study in 5 health facilities in Cape Town, work practice and management at health facility level is explored and analyzed according to themes related to health information systems, management, organizational change and organizational culture. The research is also about the “Health information systems in developing countries” discourse and how through use of language a certain reality is constructed to picture information use and information culture at facility level, as seen from the researchers’ perspective; a ‘reality’ I found differed from the ‘reality’ as experienced and described by the facility managers. Discourse analysis is a methodology within qualitative research concerned about the constructive effects of language – how talk and text – in a certain context constructs a social reality. I found it useful to explore the HIS discourse from this perspective. To conduct the discourse analysis, a set of texts from the discourse was selected from the abundance of literature concerning health information systems in developing countries in general and the HISP project in particular. Key concepts were identified and analyzed. The results from the case study and discourse analysis are then combined in the discussion – to shed light on the discussion of information culture and use of information for decision making and management, focusing on the facility level in Cape Town.