The increasing adoption of digital healthcare solutions has accelerated the implementation of electronic prescribing (e-prescribing) systems to enhance patient safety, reduce prescription errors, and improve workflow efficiency. This study presents the design, development, and pilot implementation of an e-prescribing system in Chipata, Zambia, involving two healthcare facilities and two pharmacies. A baseline study identified persistent issues with handwritten prescriptions, including illegibility, delays in medication access, and low patient adherence. Using the Waterfall System Development Life Cycle (SDLC), the developed system integrated real-time drug interaction alerts, role-based access control, and compatibility with existing Electronic Health Records (EHRs). Pilot results demonstrated a 40% reduction in prescription errors, a 50% decrease in prescription fulfillment time, and a 20% improvement in medication adherence. Challenges such as limited technical infrastructure and user resistance were noted. Key recommendations include infrastructure enhancements, offline functionality, expanded training, and national scalability. This study highlights the transformative potential of e-prescribing systems in resource-limited healthcare settings.