Information and Communication Technology for Development (ICT4D) projects are implemented with the goodwill intentions to address a wide range of societal issues specific to developing countries. However, due to various constraints, the outcomes of these projects are mixed. Therefore, how to effectively implement ICT4D projects remains an important question in the ICT4D research. This research-in-progress explores this question through a case study of ICT implementation in Papua New Guinean hospitals, using affordance theory as the theoretical lens. Within our ICT4D context, we unpack the affordance-actualisation process by identifying two affordances and their realisation actions and outcomes. Moreover, we theorise two types of improvisation critical during the affordance-actualisation process: adaptive implementation and flexible application. Our preliminary findings extend the theoretical understanding of affordance-actualisation in the ICT4D context and emphasise the importance of improvisation for successfully implementing ICT4D projects.