A rich case study on the process of implementing generic software in the public health sector in India, which seeks to address the following research question: What constitutes the implementation-level design of generic software in a public health project in India? To answer the research question, three areas are explored during this research. First, generic software and the gap between the provided features and the required features in specific contexts known as misfits. Second, design approaches in implementation-level design and how they handle misfits between the generic software and local requirements. Thirdly, the struggles and challenges met through the interactions between the actors in the process of implementation-level design.