I’ve been in Rwanda for a little over a week now. Its my first time here and so far I really do love this country. Its quite beautiful, much more lush and green than I had imagined. The people are quite friendly and always offer up a smile. I am here to start a new project that will involve using hand-helds to collect health data (more on this in a later post). To that end I’ve been working closely with the folks at the Twubakane project. Its great to be here and see some of these bigger projects working outside of the context of my comfortable office at home. There is a lot of great work going on here.
After meeting with the folks I will be working with at Twubakane, I was taken to the Ikigo health center in Kicukiro. Its a small facility that seems to be handling a great number of folks in a densely populated area. We had a surreal experience riding out to the center as we were bumping along the pothole-filled dirt road only to run into a film crew in the middle of a shoot - camera on rails, mic booms, the works. I’m still left confused by it. Nonetheless we met with some of the community health workers who go door to door in their villages to collect data. I learned that they are elected by their peers in the villages to do the job - there is a great deal of trust there. Twubakane should be praised for these kinda of approaches as it brings a sense of honor to these important tasks. We talked at length (with much translation) about what has worked and what has been difficult with the paper-based system we hope to replace or enhance. There are some very important steps in the paper system we’ve got to think on. The current system allows all of the workers and the program supervisors to review the data together as they compile it. This lets them figure out if changes in the numbers are due to a growing health problem, or mistakes in collection. If we have the data in our system doing the compilation for them we might skip this step and that would be bad for the communities. We must keep this in the program itself.
Meeting with the health workers was worth the trip for me on its on, but of course I’ve done more than that while here. We hope to be able to hire a local developer to join the team, but only have a couple days left to get that done. It is possible though. I’m excited about this project and being here in Rwanda has brought home to me the importance of certain aspects of our approach at IntraHealth. The use of open source hit me in the head as I was asked very pointedly about it (unprompted, I promise!) It seems the idea of having to fly someone in to work on a couple of extra proprietary systems has grown old. But more than that, the true ownership of these projects in terms of Stakeholder Leadership Groups, or the elected health workers, or hiring local talent seems to be the right approach for this kind of work.
Posted by
David Mason on 3/3/2008 • Tags: Africa, Cellphones, Data Collection, Digital Divide, Mobile Technology, Open Source, Public Health, Technology, Volunteers
No Comments Yet
Add Yours
As a registered nurse with years of international experience in social policy and human resources management, I find the prospect of using Open Source systems for health care extremely exciting.
Over the years I have seen other types of technology programs in Africa fizzle after projects ended or the funding ran out. An expensive liability is outdated software that cannot be modified or tailored to meet expanding requirements in countries experiencing rapid growth and development.
When I was the principal investigator and project director for the Kenya Nursing Workforce Project researching the possibility of starting a new school of nursing, I went to one of the big Kenyatta University campuses and was told that they already had the necessary equipment for distance learning. I was elated and asked to see the system that was already in place. There was a big room filled with gadgets and an auditorium. It had been set up years before by the World Bank to broadcast training programs from NY to developing countries all over Africa. However I learned that it was only a one-way broadcast from NY. After the World Bank’s training program and funding ended the school had not been able to use the technology, because they did not have the ability to broadcast out. I asked what would it take to use this technology to train nurses in Kenya, and he said we’d have to totally start over and scrap everything. They invested oodles of money to develop a system that is unusable now. What happened with the training program is similar to what often happens when projects depend on proprietary software.
I have become a passionate advocate for Open Source. Open Source technology is a way for Africa in particular to use cutting-edge software in a way that is fiscally responsible. Educational programs in Africa have traditionally used Microsoft software. This has created a big problem because in order for the Ministries of Health and other organizations to sustain the programs after the projects end, they have to pay substantial licensing fees. The advantages of using free Open Source software is clear in countries that are financially restrained like Kenya, Uganda and S. Sudan. These countries cannot afford huge software maintenance costs.
I recognize that there are challenges to switching to Open Source software. Because Microsoft technology is what people are used to, it has been viewed as the only reliable technology. Therefore, people have felt that if the product they were using wasn’t Microsoft, then it was inferior. I’ve been very supportive of using and developing an Open Source method that governments and universities will be able to sustain in the future without these huge licensing fees, but with a network of developers that can keep the system running using advanced technology. I have this very concern about a project that I worked on in Africa, and I’m unsure whether or not the MOH will be able to sustain the licensing fees, as expected, after the project funding ends.
The Ugandan Ministry of Health has been very supportive of the use of Open Source technology and our iHRIS software. We installed iHRIS Qualify at the Nursing and Midwives Council last spring and are now implementing similar systems in the other three councils. The IT expert working there, a consultant for the Capacity project sitting in the Ministry of Health, wants Open Source software to be the standard. He feels Open Source software gets less viruses, and he’s insisted that they use Open Source for all their office programs as well as their HRIS. They have already switched to using Open Office - Linux versions of Word, Excel, and PowerPoint. They have also started on-the-job training for Open Source developers working in the public health system in Uganda.
With Open Source health information systems being created across the country, there is a growing need for local Open Source developers. The Capacity project is planning to start working in nine districts in Northern Uganda in this year of the project. We’re going to need people in different parts of the country who can really implement and facilitate these systems. There is a strong desire in Uganda to partner with Makerere University in Kampala to train developers, and IntraHealth is currently developing programs to help make this happen on a wider scale. IntraHealth already conducts on-the-job training to the growing network of developers working on public health in Uganda.
Open Source technology can protect users from the huge problems created by outdated and prohibitively expensive software. Most importantly, Open Source can be effectively and affordably used by the ministries, councils, universities and professional associations making health service delivery operational in these countries on very limited budgets.
Dr. Pamela McQuide
Posted by
Pamela McQuide on 11/20/2007 • Tags: Africa, Digital Divide, FOSS, HRIS, ICT4d, Information Systems, Open Source, Public Health, Sustainability, Technology
No Comments Yet
Add Yours
Shannon recently wrote about mobile technologies and the possibilities that are open to us with the influx of mobile usage in the countries in which we work. What’s equally exciting is what has happened since in the development of open mobile technologies.
Here in the United States we have the worst situation in the world when it comes to openness in our mobile technologies. Our phones are “locked” to particular carriers so that we cannot use them on another provider. This is mostly an historical problem as the carriers originally thought the money would be in selling the devices. While there is some money to make there, the real money comes in selling the service. Nonetheless, we are left with the old model. In the rest of the world the two are separated. One buys a phone then decides which network to go use it on. While most US phones can be unlocked to work with other networks, its not something easy enough for everyone to be able to take advantage of. The disturbing trend set in place by Apple’s iPhone takes the locking another step further to the point where Apple is trying all they can to keep its users from using anything but AT&T.
Enter Google. Google has launched the Open Handset Alliance which has the weight of many companies behind it with the goal of developing an open platform for mobile devices called Android. While they were not the first to start such a task (beaten to it by the OpenMoko folks, they have the name recognition to make a very big splash.
So what does all this news mean for us and our work? I suppose to answer this I go back to IntraHealth’s mission which is to “mobilize local talent to create sustainable and accessible health care.” With an open platform we can more easily introduce the people we are working with in-country to the technologies in which we have developed applications and processes to deliver health care. In this case, applications that can take advantage of the enormous use of mobile technologies in the countries in which we work.
With proper funding the ideas for these application are endless. Imagine a district health care facility with a system that can send a text-message to a patient to let them know a follow-up appointment is needed. Texting is cheaper and easier for most folks in developing countries. Imagine a member of the Nomadic Somali people in North-Eastern Kenya using a mobile phone to schedule an appointment with the health care facility they happen to be closest to on a given day - and then using that same phone to let the provider access their medical history. Imagine a district health office in a very rural area accessing their Ministry of Health’s system via a mobile device when their power goes out. What once was a break in access to communication is now just a switch to another technology. The possibilities are endless, and with an open source platform, they are cheaper to implement and easier to develop on.
Half the fun of accessing these new technologies is coming up with new ways of applying them to old problems. How would you use it?
Posted by
David Mason on 11/13/2007 • Tags: Cellphones, Development, Digital Divide, FOSS, Mobile Technology, Open Source, Technology
1 Comment
Add Yours
“Am I a geek, or a suit?” I pondered, sitting in a large hall with some thousand others in Victoria, Canada, during the Free and Open Source Software for Geospatial (FOSS4G ) conference. The question was posed to me by keynote speaker Damian Conway, PERL enthusiast, frequent speaker at FOSS conferences, and management consultant. I wondered to what extent my fellow conference-goers were pondering the same question. Looking around me at the number of bearded geography types who followed his speech with open laptops running strange Unix command lines, I concluded probably not that many. As developers, most of them self-identified with the geek label by default. The exception might have been the four obvious suits who decided to check out the conference, and perhaps some boundary cases such as myself.
Still, as a service to all of us–geeks, hybrid geek/suits, or suits–Damian Conway laid out a business case for open-source software. Contrasting the realm of the geeks with that the minds of the neoliberal “suits” (or: the ones making the actual decisions), the question Conway posed is why don’t the suits wholehearthily embrace the free software the geeks make available? Is there something fishy about open-source?
According to Conway, and taking the case of the battle of the giants, closed-source Windows operating system versus free, open-source Linux, the ten questions any open-source enthusiast geek has to come prepared with when speaking to a suit are as follows:
(Suit question 1) But SCO owns UNIX?
(Geek answer) No, that whole thing was a business play by SCO to raise the price before management dumped the stock. Oh, and if they actually did (the court said they didn’t recently) the open source community would code around it.
(Suit question 2) Open Source has a higher total cost of ownership?
(Geek answer) Yes, if you read studies funded by proprietary vendors, otherwise, it does not.
(Suit question 3) Proprietary software is easier to use.
(Geek answer) Yes, but only marginally and most of that is from familiarity.
(Suit question 4) What about compatibility/interoperability?
(Geek answer) Actually typically Open Source supports more standards and are typically better than even previous versions of proprietary software on the same document.
(Suit question 5) What about security?
(Geek answer) Open Source tends to win here because it has genetic diversity. (How many versions of UNIX are there?)
(Suit question 6) What about support?
(Geek answer) Open Source options parallel proprietary, PLUS you can have folks in house!
(Suit question 7) But what if the product goes away?
(Geek answer) There’s no single supplier, so less likely than proprietary vendors. Open Source is not cost driven and proprietary folks end products all the time.
(Suit question 8 ) Who will we sue if something goes wrong?
(Geek answer) Just like proprietary - no one. Proprietaries are too big to sue (unless you have tons of money) and with Open Source, there’s no one to sue!
(Suit question 9) How will Open Source improve customer experience?
(Geek answer) Open Source use will drop company prices, thus customer prices, scale cheaply, etc.
(Suit question 10) How will Open Source improve the company bottom line?
(Geek answer) All sorts of things will be cheaper: licensing, licensing management costs, risk, insurance, hardware, security, etc.
So, what did I learn? Governments and major corporations around the world are now moving swiftly towards wider use of Open Source software. Open Source software development and support is based on a model of collaborative interaction that is entirely different from the competitive world of commercial software. It’s not a business; it’s a culture. As a manager, to get the greatest benefit from Open Source you need to understand and engage that alien culture, to appreciate the motivations, aspirations, mindset, and limitations of its community. As a geek, you need to know how to sell it.
Alien or not, the geeks, hybrids, and four suits around me showed some serious passion to drive down the costs of software. That’s a good thing, particularly for developing nations struggling to fund their health care system. It is hard to argue with that.
Posted by
Danny de Vries on 11/6/2007 • Tags: Community, Decision-Making, Digital Divide, Events, FOSS, GIS, HRIS, Information Systems, Open Source, Software, Sustainability, Technology
No Comments Yet
Add Yours
Having worked in various IT (Information Technology) departments and roles over the years, I’ve become accustomed to the point of view that IT workers are “just” overhead. In many organizations, they are considered a cost of doing business. Often the attitude is summed up in a statement like this: “We’ve got to have email, but I’ll be darned if I know what those people do all day!”
Sometimes, it is even worse and the IT department is just seen as an obstacle to work around. As the Wall Street Journal writes: “often it’s just easier to accomplish certain tasks using consumer technology than using the sometimes clunky office technology our company gives us”.
Then there are the poorly supported in-house applications that the IT department tends to throw together. If the organization is large enough, they’ll have a dedicated support team, but, again, this is seen as a cost of doing business instead of something that adds value.
I think part of this can be understood because much of what a savvy technology worker does is completely behind the scenes. If it is done well, the end-user sees the product of the work, but not the hours put into it. The end-user has no means of understanding the work performed.
I encountered just this sort of thinking in a conversation with my brother the other night. In May, he’ll take his boards and become a certified pharmacist. In the past, he’s worked as a lab tech at the Genome Sequencing Center at Washington University in St Louis, so he is no stranger to the value that a good IT department can add to any organization, but he was still under the impression that IT had a “neutral” economic effect.
In an attempt to illustrate just what kind of difference IT has made in the past and can make in the future, I used an example almost any American our age is familiar with: Pa Ingall’s house.
Enamored with the idea of owning his own land (and being somewhat of a loner), Pa headed west and worked and struggled to build a farm and house for his family. He worked long hours, but, at the end of the day, the best house he could build for his family still lacked some amenities like indoor plumbing and electricity that even the poorest modern day American home-owner would consider necessities today. The technology was simply not available (e.g. electricity) or was completely infeasible (e.g. indoor plumbing for prairie homes). Obviously, the creation and spread of technology has helped create a healthier and more efficient home for the modern American.
The Open Source efforts that IntraHealth’s Informatics team are pursuing could offer the same scale of benefits for health care in developing countries. As you can see from the photo to the right, many of these countries still use nineteenth century methods for organizing information about their health care workers. When there is a regional epidemic, the official in charge will have to rely on his memory or go sort through stacks of paper-based records to find the right people to send to the area.
The paper-based system lacks good reporting tools, as well. Manually compiling a list of areas with worker shortages is going to be a time-consuming, error-prone task. iHRIS puts good reporting tools at your fingertips. Reports can be created in seconds, rather than hours or days.
If iHRIS is successful to any degree, we will have a real chance of dramatically improving the health care in these countries by helping the health care workers get better access to training and by ensuring that they are deployed where they are most needed.
This, from something as mundane as providing better access to personnel records.
For someone who has been involved in IT for a few years, the chance to have this kind of impact can be intoxicating!
Posted by
Mark Hershberger on 10/29/2007 • Tags: Africa, Data Collection, Decision-Making, Digital Divide, HRIS, Information Systems, Open Source
No Comments Yet
Add Yours
