Usability is widely acknowledged as a desirable trait of software, referring to how usable it is to a specific set of users. However, when software is developed as generic packages, aimed at supporting variety, designing user interfaces with sufficient sensitivity to use-contexts is a challenge. Extant literature has documented this challenge and established that solving usability-related problems are difficult, both during software development and implementation. Adding to this discussion, this paper contributes by developing a framework to analyze what characterizes usability-related design of generic software. This includes two levels of design; generic-level and implementation-level, and two types of design; design for use and design for design. We apply this conceptual framework on an empirical case based on an ongoing action research project where a global generic health software is implemented in a large state in India. From the analysis we argue that attempts to strengthen usability of generic software require a holistic intervention, considering design on both ‘global’ and ‘local’ level. Of particular importance is how usable the generic software and other design-resources are when implementers are customizing the software. We coin this aspect of design as meta-usability, which represent what we see as an avenue for further research.