This article is organized around a number of sections. The introduction outlines the rationale of the article and deals with some aspects of open source software (OSS) that make it attractive for software development in the health domain for low-income countries. The methodology section then introduces the framework of assessment that is being used. The majority of this article describes a case study of a project run by the authors in Bhutan in the obstetric domain. Critical success factors for such a project are then analyzed and some conclusions are drawn. The discussion covers some of the issues that have arisen from this experience, and articulates some lessons learned.