How to establish IT governance for social welfare and health care IT is an issue faced by organizations within this sector. Needs to establish inter-organizational IT governance arrangements have increased. They facilitate data sharing, pooling of development efforts and IT purchases, etc. This research investigates the creation of inter-organizational IT governance involving over 100 organizations. They provide specialized medical care, basic health care and/or social welfare services. Attention is placed especially on the role of perceived need to cooperate in the creation of IT governance. Empirical data range from notes, emails and project documents to survey data. Results achieved suggest that the perceived need to cooperate is necessary to the creation of inter-organizational IT governance arrangements. This finding augments the knowledge base of both IT governance research and best practice standards.