Implementation of Information Systems in Public Healthcare in India has been a very complex undertaking. Participation of the end-users during design and implementation is important. Participation within bureaucratic settings poses unique challenges, due to hierarchical, centralized, authoritarian and formalistic practices. Even where State agencies have experimented to bring in imaginative changes, participation have not been voluntary, but have been enforced. This short paper attempts to analyse less know and less understood aspect of participatory approach entangled within bureaucratic systems. This paper attempts to analyse the issues around participation in order to identify two key areas: [1] How to encourage public sector employees to participate during design, development and implementation of IS? [2] How can public sector institutions encourage effective participation? Discourses on Participatory Approach is drawn upon to analyse the case of Health Information Systems Programme.