This paper examines the concept of commons-based peer production (CBPP) in the context of public health information systems in the South. Based on an analysis of the findings from a global network of software development and implementation, an approach to preserve the importance of local user participation in distributed development is presented. Through practical examples, we discuss the applicability of the CBPP model for software production aimed at improving the public health sector in the South, and propose the concept of a “snowflake topology”.