Information and communication technologies that strengthen knowledge-based governance in low and middle-income countries (LMIC) will affect work processes and organizations on a massive scale. This paper draws attention to demands on public sector organizations in resource-constrained contexts that face different challenges than in high-income societies. This paper from the Indian public healthcare sector reports on design, development, implementation, and scaling of a free and open-source software-based hospital information system for district hospitals. The paper focuses on the implications for work, competencies, and organization, building on and extending the concepts of “automate” and “informate.” The paper focuses on the emerging and recursive interplay between information infrastructure and work within the context of organizational realities of a district hospital in an LMIC context, captured by the concepts of “infrastructuring of work” and “work of infrastructuring.”