Global software development is a phenomenon that is receiving considerable interest from researchers during past two decades. Several challenges have been identified and approaches to deal with these challenges have been developed. Typically, western companies outsource their projects to countries where costs are lower and skilled professionals are easily available. Majority of these projects are developed for commercial purposes. However, software development projects between India and Pakistan involving open source software for public health information systems have never been explored earlier. Therefore, this is particularly a very relevant and important area of research which I have tried to explore through this thesis. This thesis will address the following research questions. 1. What are the challenges in cross-border software development for open source public health information systems? 2. What are some approaches to address these challenges? These questions are empirically examined in the context of cross-border software development between India and Pakistan. The project involves development of a health information system based on open source software. The results show that the complexities of contextual factors are closely connected to several challenges. A problem in conveying and understanding context specific requirements over distance creates delays in the development process but can be mitigated through face-to-face meetings. Also, differences in cultural values and expectations result in conflicts, but could be mitigated by negotiated culture. Moreover, due to the distributed working environment, communication between stakeholders was also found to be a challenge, but online means of communication and meeting face-to-face helped resolve the problem to a certain degree. To summarize, although linguistic similarities and working within similar time zones are clear benefits of cross-border software development, the importance of face-to-face meetings cannot be done away with.