This thesis considers issues surrounding use and development of open source geographical information systems (GIS) as a part of the district health information systems in developing countries. The base for this thesis is field work done by the two authors in three different states in India in cooperation with the Health Information System Program India. The thesis looks into the general concepts of open source and geographical information systems in the Indian context, and present a GIS application created for a district health information system. Issues concerning open source GIS are discussed with observation done by the two authors. Based on the discussion the thesis will conclude that some reflection in the discussion may be of interest for developers of open source GIS.