This week I start working on a project to help gather medical information in villages throughout Rwanda, so the project I’ve been working on for the past couple of months is officially over. I’ve written my postmortem and had a chance to recuperate from the travel (including the airline losing my baggage in London and a screaming three year old on an eight hour flight — horror stories best only hinted at).
But this last project looks as if it was about as successful as I could hope for, so indulge me a few moments while I tell you what we did.
While medical information is gathered throughout Uganda, reports are regularly written, and analysis is frequently done, sharing information between health care workers and officials is problematic. Until now, there was only one small central library at the Ministry of Health which held only a single stand-alone PC for accessing and reading electronic documents.
To make matters worse, the proprietary software for storing and accessing the electronic documents only accepted PDFs, so anything a doctor wrote in, say, Microsoft Word had to be converted before it could be used in the system.
With the help of the Knowledge Management (KM) team at IntraHealth, a few of us on the Informatics team put together a Joomla+KnowledgeTree combination that would allow health care workers and officials to upload any Office document, collaborate around them, and easily access them from any networked computer.
My work centered on the integration and initial set up of the software — putting it all together in a way that made the KM people happy. And, frankly, much of that work isn’t any different than what I could be doing in almost any Tech Shop or corporate environment. And for a while, it was like any software project, full of frustrations and delays. While KnowledgeTree was an obviously mature piece of software, I found some of its idiosyncrasies irritating and some of its capabilities anemic.
The real difference — the real satisfaction — came when I was finally able to sit down with the librarian at the Ministry of Health in Uganda and I heard him say “This is great, it is so much better and easier to than our current system! And we don’t have convert all our files to PDF first!”
It was a relief to hear those words. Until then, doubt still lingered. But after that meeting, while there was still a lot of work to be done and a lot of work that I wouldn’t be able to complete, now I knew that we had a successful, even worthwhile, product.
Even better, the technical people I worked with and trained as well as the Ministry workers all understood the usefulness and had the same goal in mind: fostering adoption of the new “electronic library” throughout Uganda.
Now, back to the work. Hopefully I’ll have another success story in a few months.
Posted by
Mark Hershberger on 8/14/2008 • Tags: Africa, Capacity Building, FOSS, Information Systems, Tools
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I wanted to share some resources I’ve recently discovered that promote the use of free and open source software (FOSS) in Africa. Some of these applications are for health, some are for other purposes. But the more open source software becomes familiar to users in the developing world, and the more they use and trust free software, the more likely they will be to adopt an open source information system like iHRIS. We are all working toward the same goals: providing low-cost, sustainable software that helps these countries improve their systems.
- The Free Software and Open Source Foundation for Africa is promoting the use of FOSS and the FOSS model in African development, and the organization supports the integration of FOSS in national policies.
- Open Source Africa provides a migration guide and a connection to the FOSS community in southern Africa.
- The Google Africa Blog is sharing news, stories and thoughts about using Google tools in sub-Saharan Africa.
- OpenMRS is an exciting project to develop an open source electronic medical record system framework specifically for the developing world.
Posted by
Shannon Turlington on 7/30/2008 • Tags: Africa, FOSS, Free Software Community, Open Source, Software
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Next week in Washington, D.C. some of us here in the Informatics group will be attending the 35th Annual International Conference on Global Health.
We’re excited that Pape Gaye, our CEO, will be moderating and presenting a panel on “The Impact of Weak Health Systems on the Health Care Worker Crisis” and hope everyone will take the time to attend. In addition I will be hosting a round table discussion on Global Health Open Source Development and Online Community .Please drop in, join in on the discussion, and say hello. After the roundtable I will make sure to share some of the discussion here so check back in if you aren’t attending.
Posted by
David Mason on 5/23/2008 • Tags: Events, FOSS, Open Source, Public Health
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With the start of the new year, it is traditional to predict trends for the coming months. So I thought I’d take a look at our ICT work and identify what I see as trends for our work moving forward and for ICT for development in general. I don’t think any of these predictions are earth-shattering, but they should be helpful as guides for our work and areas for further discussion.
Generally, I see two strong trends and then one I’m not so confident about:
- Greater focus on using cell phones and text messaging to connect systems to users
- Broader acceptance of Open Source technologies in nonprofits and in the developing world
- Increased use of social networking tools to improve communications among people doing this work and people using our systems (this trend is “iffy” because I don’t know if this is something that will really take off in 2008, at least in our organization)
Cell phones and text messaging
It is clear that cell phones are the fastest growing and probably most accessible technology for two-way communication in the developing world. Text messaging, in particular, has become an efficient way to send and receive necessary information, more ubiquitous than email. People in the developing world are more likely to have access to a cell phone than to an Internet-connected computer, they are familiar with the technology, and it is generally cheaper for them. Some unique uses of the technology I’ve seen recently are texting locations of mobile HIV clinics in South Africa and tracking epidemics in Rwanda.
We will need to take advantage of this trend to make our Web-based systems, such as iHRIS, easier for our clients to use, particularly in areas where there is no Internet access. The cell phone may even be a solution for accessing just-in-time information from online repositories, such as the HRH Global Resource Center.
Open Source technologies
I see a promising trend for Open Source technologies becoming more widespread in both the sectors that we work in–nonprofit and public health–and the countries where we work. As Open Source becomes more familiar and thus more trustworthy, the advantages will become too clear to deny. The costs are significantly lower, and the potential for turning over systems to local developers to maintain and grow is much higher.
For our part, we’ll be using such technologies as the Asterisk telephony system and possibly Open Source software on cell phones in addition to the standard LAMP (Linux-Apache-MySQL-PHP) set of development technologies, as well as releasing all of our software developed in-house under Open Source licenses and actively encouraging outside developers to improve them. I expect we will expect our partners to also leverage Open Source technologies. Most importantly, though, I am hearing from the country level that strategic technology plans are being made based on adopting Open Source software for everything from servers to desktops. .
What about social networking?
I think the surge of social networking tools, such as blogs, wikis, podcasts and more, is a very exciting development for those of us who live with always-on, high-speed Internet connectivity. But how does that translate to our work in low-resource settings? I’m not sure, but many nonprofits are exploring that question now and sharing their ideas.
Social networking tools are so powerful and so popular because they tap into our very basic human desire to connect and share with one another. Last year we dipped our toe in the water through this blog and virtual learning environments, which were essentially online communities for sharing information. Perhaps this year we can use them more thoughtfully as a way to better connect with dispersed employees, volunteers and even our clients who are using the technologies we develop. We can exchange ideas, get feedback and work collaboratively faster and more effeciently than we have before.
But for that to happen, the tools have to be accessible, easy to use and compelling. We should start with a few small, targeted projects and see what happens. Instead of trying to reinvent the wheel, we should harness those free tools that have already been developed for us, tools like Twitter and YouTube. Tapping into the power of these tools will require creative thinking and a willingness to experiment, as well as time to see what works best for us and our community.
Does anyone have any ideas or predictions for 2008? Please share them in the comments.
Posted by
Shannon Turlington on 1/21/2008 • Tags: Cellphones, FOSS, ICT4d, Mobile Technology, NPtech, Open Source, Public Health, Social Networking
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I’ve been thinking a lot lately about Virtue. One thing that has been lost over time with the word “virtue”, which we can rediscover with the etymology of the word, is that it is supposed to be habitual. The original Greek context of the word is habitual excellence. I must admit preferring that interpretation of the word over what it has come to mean since.
When thinking about virtues in the sense of trying to achieve habitual excellence I remember an article written by Yochai Benkler and Helen Nissenbaum: “Commons-based Peer Production and Virtue (PDF).” In it, Benkler and Nissenbaum suggest that commons-based “peer production offers an opportunity for more people to engage in practices that permit them to exhibit and experience virtuous behavior.” In other words, releasing your code or content in an open fashion, or joining in on an open source project is a good practice that provides a chance at “habitual excellence.” More simply, there is virtue in open source. It’s not clear to me that the majority of people involved in open source projects are doing so simply to be good citizens or to blatantly achieve habitual excellence. In Some Simple Economics of Open Source (PDF) Lerner and Tirole wrote “Any explanation [of the many contributions made to open source projects] based on altruism only goes so far.”
I find that most people working in open source do not consider their contributions the same as charitable works. Perhaps it is more simply a part of their computing environment. To many contributors, it is as natural to log in to IRC and answer a question or submit a small patch to share a fix to a problem as it is to configure the desktop background. Nonetheless, there is at the heart of this openness a belief that the proprietary system of development and distribution of software is inherently wrong. It’s not just a matter of wanting to, as Bill and Ted said, “be excellent to each other“, more it’s an understanding of, and desire to work within, the correct system (a common trait with the better engineers). When it comes to code, the system of transparency is the correct way, it is the excellence.
It is true that transparency is not always a virtue. Transparency can be a virtue by enabling feedback. But transparency, if it is one sided, can also be dangerous. People are threatened by transparency because we all have secrets, and usually don’t want to share them. That said, institutional transparency can help all of us because it improves trust and creates a system which steers us towards honesty. If we assume that the system is transparent then that guides our behavior. Just as Benkler and Nissenbaum note about Wikipedia and its “self-conscious use of open discourse”. The participants of Wikipedia know the realm in which they work, they understand the goal and their work fits into that goal without over-reaching protections and restrictions. If we are used to systems that hide our actions then transparency is a threat. However, if we understand a system’s goals, processes, and implementation, and are allowed to work within it (or even experiment in it), we will respect the framework while doing so.
Institutional, or system-based transparency is easier to explain, and more easily understood in the realm of code and by technical people. This is because it is already organic to their ethos. They get it immediately because, despite making us hole up in dark rooms with our screens shining their warm, familiar glow on our faces, our computers have become social tools. Despite our redefinition of the term, we do interact with each other through our technology. This is important because the act of sharing is built into this grander social network. I use the word ethos to define this because sharing is the distinct spirit of what is going on in the technical world. The more interesting part of this is that that spirit has now moved into other areas that the technology has forced itself into. Media being the prime examples: photos, music, movies. Transparency is not a natural tendency to those who have been creating such media before now. This has slowly changed with the introduction of licenses such as the Creative Commons, and with successful experiments such as Radiohead’s latest release, In Rainbows. Sharing works, especially when all parties understand the system and the intent behind the sharing, has become most apparently beneficial to distribution and dissimination.
This should be no different for health. Health is one of our foremost human concerns. To successfully treat health problems around the globe there must be sharing. There must be transparency. This is important for all aspects of health systems, from the information that guides our understanding and diagnosis of problems, to the tools we use to facilitate the vast amount of work that needs to be done. Without transparency where is our health? Locked in trade secrets? Protected from our understanding for what gain?
The good news is that we are on the right track. We’ve been working hard on our code, which is all being developed in a fully transparent manner, but we are also doing a great deal to make sure our information is available too. The last couple weeks I’ve been learning more about the great work the folks in the Global Resource Center are doing and find their freely available information truly inspiring. I think there are probably areas within our work in which we can be even more transparent, not just so that others may benefit from our knowledge, but so that we can then benefit from theirs as they join in on the habitual excellence we are working with in being transparent. And join they will. Not just to be altuistic, but because the system of transparency we are engaging in is the correct system for health.
Posted by
David Mason on 12/6/2007 • Tags: Activism, Community, FOSS, Open Source, Public Health, Sustainability
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The DDDM workshop in Uganda this summer provided the first opportunity for many of the participants to review and discuss reports from the iHRIS Qualify system in the Nurses and Midwives Council. Dr. Pamela McQuide, HRIS leader, said she was extremely excited about participants’ reactions to seeing the reports. “When participants had actual Ugandan data, they erupted in discussion,” she said. She explained that the reports spurred lots of questions and they talked for three or more hours, showing that “they are very hungry for their own data and supporting it.”
One participant said the workshop gave meaning to the data they had been generating and built up credibility and interest in the HR information systems being established in Uganda. “It was the first attempt we had at integrating information from the various sub-systems in HRH and seeing how all these sort of fit together in order to have meaningful information.” He went on to say that the most surprising thing he realized was the amount of data already available. “It was just amazing to know there was so much data already available from different subsystems. I found that overwhelming, it was just phenomenal.” As he stated, a strong HRIS is a phenomenal tool for integrating data, where the sum becomes much more important than the parts.
Another participant said that after viewing the data he realized they already had routine information that they should start taking advantage of. He described how different the situation in Uganda was before HRIS strengthening was initiated, “We were looking at a format that was inaccessible, it was paper-based and in containers, but now that it’s in a database it’s easy to analyze.” He went on to say that the reports presented at the workshop were “able to tell us what was really happening on the ground.”
The HRIS team is in the process of implementing similar systems at the other three Uganda medical licensing bodies (the Pharmacy Council, Medical and Dental Council, and Allied Health Professional Councils). As an outcome of the workshop this summer, bi-annual HR data reports will be produced. The reports will incorporate data from all four councils and other sources, such as data from the EU and will influence annual reporting, budgeting, and strategic planning.
Once data can be integrated from various sources and reports can be generated, it is important that the information is presented in a variety of ways so that decision makers can understand and use it. Dykki Settle, HRIS leader, led a session on data quality and presentation that covered useful techniques to enable decision makers to use data. He emphasized that reports should be timely, tied to policy questions and available to the right people. Colorful reports will not be effective unless, as Ummuro Adano has stated, they are “combined with active leadership, change management, and effective professional development for key decision makers.”
Posted by
Carol Bales on 11/30/2007 • Tags: Africa, Capacity Building, Decision-Making, FOSS, FOSS4G, HRIS, ICT4d, Information Systems, Open Source, Public Health, Sustainability
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