Introduction Health information management system data is collected for national planning and evaluation but rarely used for health care improvements at the sub-national or facility-level in low-and-middle-income countries. Research suggests that perceived data quality and lack of feedback are contributing factors. We aimed to understand maternity care providers′ perceptions of data and how they use them, with a view to co-design interventions to improve data quality and use. Methods We based

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... r research on constructivist grounded theory. We conducted 14 in-depth interviews, two focus group discussions with maternity care providers and 48 hours of observations in maternity wards of two rural hospitals in Southern Tanzania. Constant comparative data analysis was applied to develop initial and focused codes, sub-categories and categories continuously validated through peer and member checks. Results Maternity care providers appropriated numeric data on service provision to reconcile their professional values and demands from managers and the community with effects of a challenging working environment. They felt controlled by their managers′ data requirements and alienated from service provision data. Providers added informal documentation ways for their own narrative data needs to reflect on and improve service quality. These also assisted them to recreate social relationships with managers, clients and the community. The resulting documentation system led to duplication and increased systemic complexity. Conclusions Data from health information systems does not represent an independent and neutral entity but is embedded into the social realities of different users. Appropriation and use of data reflect these realities and users′ working environment. Interventions to improve data quality and use may need to incorporate the multitude of clinical and administrative documentation and data needs to avoid duplication and inefficiencies.