Participatory design is generally regarded as an effective approach in systems evelopment to overcome challenges such as changing contexts, difficulties of capturing users’ needs and problems of achieving systems’ acceptance. However, user participation is associated with certain contextual assumptions or beliefs from its origin in the West that are not always applicable in the context of Low Income Countries (LICs). The initial technical capability of users, motivation and desire to participate, availability of resources and long-term support mechanisms are often taken for granted in the West, but in many cases not present in the context of LICs. In the Western setting, due to favourable socio-economic and political conditions and the presence of skilled users, an approach to design of systems from scratch with user participation tend to give quality systems. However, in a LIC setting where the intended users have limited computer skills, there is a need to put an extra effort into training and to find alternative approaches to achieve participation in system design. In such a setting, we argue that participatory customisation, a process where the users in collaboration with the developers adapt an already developed or partly developed system to meet the needs of their own workplace, can be a better approach. In this paper we approach participatory customisation in LICs by looking in detail at the customisation of the District Health Information Software (DHIS) in two pilot health districts in Tanzania. The Tanzanian project is part of a global research initiative (the HISP), and in order to put forward more general approaches for LICs, we compare our findings from Tanzania with similar customisation processes in Cuba, India, Mozambique and South Africa.