MobileActive.org

As fair warning, this post is part rant, part confession, part promotion (see links below!), and part call to action for increased investment in local innovation in low- and middle-income countries.

I spend a good deal of my time raising money, working on budgets, and generally championing open source software designed to be used by health workers in low-income countries.   Most of this ‘eHealth’ software ends up being developed by extremely talented and dedicated software developers from the United States and other wealthy countries. I spend a relatively small portion of my time trying support and strengthen local software development capacity. 

For example, we’re working with a small, all Tanzanian innovation company called ITIDO.  While equally talented and motivated, ITIDO’s staff has less training and, consequently, less expertise than those of the organizations I’m affiliated with. However, it’s hard to shake the feeling that in the long run, Tanzania needs successful ITIDOs more than it needs organizations I’ve helped create.  It seems that a well-functioning ITIDO is more likely to build lasting, relevant, solutions that will actually be used in Tanzania.  

A key challenge is time. We often feel the need to deliver results in a few months.  And, indeed, there is no time to waste in developing and deploying technologies that have the potential to improve desperately needed healthcare.  Given limited funds and the need to deliver quickly, the most efficient approach is almost always to go with highly experienced software developers.  And this becomes more and more true once you start building software with one group of experts.  The people who know the current software best are the ones who can most quickly extend it.  Capacity building takes time.

One approach we advocate is establishing a “Coded in Country” (CIC) label for software, akin to a Fair Trade label for projects. There is ongoing discussion about the best definition of CIC, and if there should be an official certification process, but the original idea was that a software application or module is CIC if at least half of the money goes into local development. CIC nodes will provide capacity strengthening and opportunities for international exposure to talented local developers. The idea has generated a good deal of enthusiasm from many groups, especially those deploying eHealth software for use in Sub-Saharan countries in Africa. 

CIC and other related topics will be discussed during an online panel hosted by GHDonline on the topic of local development of global eHealth software from July 19-30 (sign up now!)

Of course, these ideas are not new and there are many organizations doing a pretty good job of local capacity development already.  And, of course, there are many individuals and businesses from low-income countries that are innovating without any help from abroad. 

However, I see a missed opportunity here. The last five years or so have seen a dramatic rise of funding for global health corresponding with a rise in funding for software systems to support healthcare.  The ultimate success of these efforts depends on more than the quality of the software.  That is often the easiest part of the solution.  Success depends on how well this software is integrated into health systems, on how well it can be maintained, how it can be adapted as needs change, and how well feedback from the field is reaches those who can act on it. We should use the resources we have to do more than build software, but to strengthen local capacity and expertise to make these other critical factors more likely to happen.

One might take this as an argument for countries only using software that is locally developed, leading to an absurd scenario in which every country is encouraged to make its own web browsers, word processers, and email clients.  This is not what I advocate for, of course.

I think health software is different—at least currently.  There is a great deal of innovation, configuration, and integration yet to come.   Particularly in the mobile space, the technology landscape is changing so fast that the software we’re using a few years from now may be quite different than what we are working on now.  This all points to a need to unleash the creativity that exists in every low-income country on these problems rather than just try to deliver the software we think they will need.

My argument touches on a larger and more complex issue of the role of experts and who should be leading development projects.  I’m very proud to be part of a new micro-granting initiative that is based on the idea that people often have the best ideas of how to solve the problems they face.  We are experimenting with different models around a simple idea:  put resources in the hands of community members to solve their problems.   We work with a local facilitator to identify a problem with a clear, quantifiable metric and then help refine ideas from local community members to address it, eventually funding one or more.  

Even though we have just started, I’ve found this to be some of the most rewarding and by far the best impact-for-the-money efforts I’ve been part of.   One of our primary motivations is the common observation that any solution must be embraced by its users and beneficiaries in order to be successful, and our belief that this is vastly more likely to happen when the ideas come from the community as well. 

I don't know where we going from here exactly. However, it sure seems that technology is continually becoming less of the problem, and that innovative energy needs to be focused on the organizational models and ecosystems that deploy the technology to be sustained and improved.  The best way to address this is to start leveling the playing field. Groups such as the Open Mobile Consortium have a key role to play, and a responsibility to be an eager partner in this necessary change.

Creative Commons Photo Courtesy Frerieke.