The purpose of this thesis was to investigate the development and implementation of health information systems (HIS) and mobile health (M- Health) for low resource contexts in a globally distributed setting (GSD) where participatory design (PD) is central. This thesis shed light on limitations and solutions in existing theories on distributed participatory design (DPD) and it seeks to answer the research question "How can participatory design be enabled in distributed software development of health information systems for low resource contexts?". Theoretically, the thesis builds on perspectives from literature on HIS and M-Health, strategies for DSD, strategies for PD and theories on DPD. Qualitative research methods have been employed, in a combination of a case study and an action case. The case study was of a global organization that practices distributed software development (DSD) of a HIS. The action case was of a case where a mobile client for reporting in a HIS was implemented in a low resource context. The main findings of this thesis indicate that although many efforts have been made, the degree of participation is low in the development of the system investigated. The main reason for the low participation has been the enormous scaling of deployments and spread of the system to a lot of contexts. The findings also indicate that existing literature and theories on DPD have limitations. Therefore, based on aspects from existing theories on DPD, a new approach is suggested to face an increasing number of contexts and use cases.