I spent a year from 2012 to 2013 volunteering with SIM in Kenya, working on the beginnings of OpenHMIS, a project to provide high-quality, low-cost hospital software to hospitals and clinics in developing countries.
The initial challenge of the project was to develop good enough business tools to replace existing paper, Excel, or Access solutions in place at our pilot sites. The critical components to enable a pilot installation at a small clinic near Nairobi were basic registration and cashier systems.
Because the clinic we would be installing the software at was an hour drive from our work location, frequent user testing was difficult. However, we made several trips to the AIC Marira Clinic to install the system, to do user training, to first run our system alongside the existing one, and to eventually replace the old system, solving software and usability problems along the way.