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Objective In India, a Health Management Information System (HMIS) is used to capture and aggregate data from health facilities across the country to inform decision making by healthcare managers and policymakers. In a country with the unparalleled sociocultural diversity of India, the dynamics of sociotechnical systems produce unique challenges. The study attempts to understand the sociotechnical factors that influence HMIS at the district level. Methods The study is conducted among the healthcare workers who were involved in managing the district HMIS for over a year. We employed quota sampling and conducted face-to-face interviews with eight healthcare workers. The interviews were transcribed and coded using an analytical framework derived from the Performance of Routine Information System Management (PRISM) framework for HMIS evaluation. Results We identified 61 codes sorted into 11 categories and grouped into 3 deductive themes (derived from the PRISM framework, ie, technical processes, challenges and data quality) and 2 inductive themes (ie, the role of private enterprise and human resource management). Conclusion The study reveals areas to improve and lays emphasis on change management. Future evaluations should involve a complete evaluation of the district HMIS using the four PRISM tools and will inform a collaboratively developed plan to address HMIS issues for health system strengthening. [ABSTRACT FROM AUTHOR]