An article in the June 5, 2008, issue of Business Week addresses some of the challenges faced by the One Laptop Per Child project. Not surprisingly, these are same the challenges that any large-scale technology project in the developing world must overcome.
The article points out that:
- Importing a powerful new tool, like a laptop, into a culture that’s not acclimatized to using it and doesn’t fully understand its capabilities means that many of the tool’s features won’t get used.
- New technology requires ongoing support, and you can’t just delegate support to people in the country, such as teachers, after only 40 hours of training.
- New tools must integrate into communities and support–not contradict–that community’s way of doing things. The community could be the local village, the country, an organization such as a school or hospital, or a governmental system such as the health or educational system.
- You must run a development project like a business; you can’t achieve results when people are spread too thin and you take on too many tasks without a clear plan for executing them.
The article also describes the culture clash that arose within the OLPC project between Open Source advocates and those who wanted to partner with Microsoft. Open Source software is ideal for a project like this, which tries to reduce costs as much as possible, while giving students access to tools, including the software itself. But governments like known entities, and Microsoft is that, especially when it negotiates with governments to reduce software licensing costs.
In summary, executing a massive technology project in the developing world is complicated and has many, many variables, some of them unforeseen. The number of stakeholders involved is enormous. There are many potential points of failure. To succeed, projects must be planned carefully and resourced appropriately, and project implementers must pay attention to more than just the technology. They also have to consider the cultures they’re entering, the systems already in place and the people who will be working with the technology. In other words, it’s not easy executing an ambitious ICT for development project like One Laptop Per Child.
Posted by
Shannon Turlington on 6/20/2008 • Tags: ICT4d, Sustainability, Technology
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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
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Years ago amazing visionary, mentor, colleague, and friend Brian Cantwell Smith (philosopher, computer scientist, and brilliant idea generator) described Philosophy as the hallway from which all other disciplines were doorways. Physics, Art, Literature, and so on — the analogy works — they all open from a foundation of philosophical thought, inquiry, and critical awareness. For Philosophy, especially in the USA, this seminal position as the foundation of everything has waned for a number of reasons within the Academy, but the analogy seems so apt it should live on.
To that end, I’ll carry it further — if philosophy and philosophical thought are the hallway, then technology is the air duct (breathing new ideas and thoughts into all disciplines), and the electrical wiring (connecting heretofore separate “schools” of thought with new, energetic ways of doing things), and it is the lighting system (shedding light on new ways of visualizing, conceptualizing, and sharing information).
Technology is no longer a luxury enjoyed by only the World Wide Web countries (US, Europe, Asia) and technological solutions are far from being just for technologists – it is core to everything we do, to all “disciplines”. In the sciences there is a great amount of work going on in 3D areas — that innovation is moving to the Humanities too. The Arts have a close connection with technology that can be seen in digital media departments at top Universities: NYU UCLA. The work going on in Law schools in intellectual property reflects the new issues created with digital media, its ownership and use. Libraries and Information Schools are tackling new ways to archive and “preserve” digital assets. There are now large bodies of work in digital archives: http://www.whitmanarchive.org/ Biologists are making new discoveries by using new technology. In health there is amazing work going into visualizing data, showing trends and properties of data that may not have been seen before the tools existed. Surgery is being transformed by robotics work – robot-assisted surgery. Every discipline has incorporated innovations in technology into their research, methodologies, and practices.
We are all using new technology and Web 2.0 solutions in our everyday lives to find and form new communities, to collaborate, to communicate, and to share: Instant Messaging, Skype (VoIP), Google Docs, RSS feeds, podcasting. The question is no longer whether or not to make use of technology – the question now is how. At Intrah I’m joining a team that asks this question and works to find innovative ways of using new and existing technologies to make healthcare information accessible where it is needed most.
Posted by
Jess Mitchell on 2/22/2008 • Tags: ICT4d, Social Networking, Technology
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In reading this article from BBC News on “The Invisible Computer Revolution,” a number of points seemed worth taking notice of. The article posits that a computer revolution is taking place in the developing world without attracting much notice from those of us in the development community. In the industrialized world, we are so used to interacting with our desktops and laptops (like the one I am writing this on right now) that we are ignoring the computer that has already penetrated the developing world: the cell phone. Because we don’t typically use the cell phone for computing tasks, we don’t recognize what a powerful and cheap device it is.
I have written about this before, but I wanted to highlight a couple of other points made by this article. First is the point that demand for cell phones in the developing world is driven by the user, not by nonprofits or aid agencies trying to put cell phones into their hands. We already know that for adoption of technology to be sucessful, it must be demand-driven. Rather than trying to sell a government on a cheap laptop, we should take advantage of the technology that is already in the pockets of so many people. It makes sense, doesn’t it?
Of course, even in sub-Saharan Africa, the fastest growing cell phone market in the world, many people still don’t have access to a cell phone. But the article points out that access has grown much more rapidly in certain sub-groups, such as health care workers–exactly the population we are trying to reach. One application the article proposed was continuing education software for health workers, delivered by text message straight to their cell phones. Why isn’t anyone writing this software? Why aren’t we?
I think those of us working in ICT for development need to start using our cell phones the way our target customers use theirs: to retrieve and transmit information (rather than make voice calls). Then we might stand a better chance of coming up with ideas for technology-based solutions that work in their world, not ours.
For further reading, here is a terrific overview from MobileActive on a variety of ways cell phones and text messaging are being used to solve problems in the developing world.
Posted by
Shannon Turlington on 2/13/2008 • Tags: Cellphones, Development, ICT4d, Mobile Technology, Technology
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I’ve had the opportunity to follow the development of OpenID and related technologies from afar for a couple years. Watching the good work of some friends who have developed ClaimID has opened my eyes to what the hurdles are in keeping a unique identity as we move more and more digital.
Here’s the problem: Identity on the web can be nefarious at best. An email address is at its heart temporary and often not the only unique email one person might have. Who hasn’t either contemplated or actually dumped an email address after a particularly bad week of spam? Identities are also defined online by the many services and sites we might have a login for. Yet these are usually different IDs - we can’t be sure of a person’s identity by looking at various accounts.
ClaimID is a great example of a way to combat this by allowing a person to manage their online identity themselves. Further, they are doing so by using the very simple and elegant OpenID protocol. The concept of OpenID being that we have a unique identity which allows us to log in to various services and sites with one single ID by allowing the services to retrieve credentials from a trusted identity provider of the user’s choosing. This last part being key: “of the user’s choosing”.
OpenID is still very much in a phase where, although it is being adopted by some well known services, it is still in roll-out. Although this means we can’t use our OpenIDs in many places yet, the tools for developers to add OpenID support are available and ready for use.
This could be very important for our work here at IntraHealth. This week there have been a couple of different projects plans come up which have made me think about how we could use OpenID. In both cases it comes down to patient records and tracking. The thought of such use in places like Uganda has made me step back and wonder why this type of implementation hasn’t been talked about much in Western medical records and services development. Perhaps it has and I have missed it, nonetheless I do feel like a tool like OpenID could present the beginnings of the type of security which is needed to provide patients and health care givers records online or on handheld devices.
The trick here is creating the trusted identity provider. In the case of the Ugandan projects we could propose that the Ministry of Health become a trusted provider for a Ugandan citizens “Medical ID”. This ID could then be used on the already growing list of servers and applications which have to have unique identifiers for their patients. The same system could also be used to identify health workers as they pass from systems like iHRIS Qualify to a training center’s application - therefore more easily (and automatically) updating either system’s records on what type of training the health worker has completed. The beauty of the OpenID process is that, if implemented correctly, it allows the patient or worker to be in charge of their own identity and who they trust with the creation and storage of that identity. As long as we keep them first in any design, they win.
Posted by
David Mason on 1/14/2008 • Tags: Design, Development, Software, Technology, Tools
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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
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