Is Open Source Good for Global Health?
Dykki Settle
Everywhere you turn these days, it seems that global health is going digital. New terms like eHealth, mHealth, and telehealth have sprung into common usage in meetings, email lists, communities of practice and journals alike. A concept frequently used, misused and generally debated in all of these forums is Open Source.
What exactly is Open Source? You'll hear it's Linux vs. Windows, OpenOffice vs. Microsoft Office, Firefox vs. Internet Explorer, but what makes it different? What makes it useful? What makes it valuable for global health?
Open Source is most clearly defined as a kind of license governing how software, once created, can be shared, adapted and reused. The Open Source Initiative maintains the (largely) community-recognized definition of Open Source. According to the initiative, software is Open Source if it can be legally and freely:
- Shared: Distributed without cost or restriction
- Adapted: Easily and legally modified by other developers (usually from the software's source code: the form of the software that is written and changed during development)
- Reused: new works may be built from it, in whole or in part.
There are fine hairs to be split here, but that's the spirit.
It doesn't take long to see that this concept can also apply to other kinds of creative work. Open Source software, along with written works, music, art and other media licensed ‘openly' are frequently referred to as Open Content. Education using Open Content and equally open course materials is known as Open Education, and so on. More information on how to legally open or restrict these kinds of creations and innovations can be found at the Creative Commons.
The ability to freely and easily share, adapt and reuse Open Content and Open Source technology is a powerful opportunity for the developing world. Not having to incur debt and dependence on the innovations of the global north means that countries can focus on building their own capacity to learn from, build on and adapt software and information to meet their specific needs.
This opportunity is not acknowledged by everyone. A lively debate continues around the advantages and disadvantages of Open Source and proprietary models. Champions of proprietary technology argue that real innovation only occurs with investment, and investment takes place only when there is a clear opportunity for financial return on that investment. Proprietary licensing and copyright protection are designed to ensure that return.
Global health activities, for the most part, are using different measures for their return on investment. Many projects around the world are using the power of open licensing to ensure a return measured by the utility and sustainability of their global health solutions. Here are just a few:
- The Open Source Medical Records System, OpenMRS, is pioneering a unique multi-institutional and multi-country community of developers and implementers building and adapting a tool for managing and tracking clinical encounters. OpenMRS is being implemented by a diverse team in more than 14 sites in 10 countries. Other Open Source clinical encounter systems include WorldVistA and openEHR.
- The District Health Information System developed by the Health Information Systems Programme is an early and growing effort to help countries develop a disease surveillance and service statistic monitoring system built on Open Source technology.
- The OpenROSA Consortium is working to reduce duplication of effort in mHealth (mobile health applications), fostering Open Source, standards-based tools for mobile data collection, aggregation, analysis and reporting. Their JavaROSA Open Source platform is being developed for a wide range of uses ranging from disease surveillance to supporting community health workers.
- The USAID-funded Capacity Project has developed the iHRIS suite of Open Source tools to strengthen the availability, quality and use of information on health workers. The project's human resources information system (HRIS) strengthening program based on this software is supporting health workers, their supervisors and qualifying authorities in 10 countries throughout sub-Saharan Africa.
In the spirit of Open Source, each of these software packages, and everything needed to use and build on them, is freely available to everyone in the world. More importantly than cost, however, these applications are adaptable in a way that more restrictive software can't be. These packages have the ability to be transformed, improved, and even combined as needed to meet country needs, both now and into the future.
It's no longer just about deploying a software package to meet an eHealth need. Outdated and unsupported software programs and computers can be found in Ministry of Health closets around the world. It is now about building the capacity of a health system to identify, adapt and create solutions from an entire library of technology options and opportunities.
Until now this capacity has been built in a siloed and haphazard way by individual Open Source projects. With the emergence of convening groups such as RHINO and the Health Metrics Network in the last few years, these projects have begun to find each other and explore ways to join efforts.
Community is essential to the adaptability and sustainable capacity building critical to Open endeavors. Since these efforts are not proprietary or closed, they can be highly collaborative without fear or restriction. Each of the activities listed above works because it involves a community effort. In-country developers and implementers work hand-in-hand with others from around the world. If the OpenMRS implementation in Eldoret, Kenya, is having trouble with their software they can join online forums and collaborate with other OpenMRS projects. If they develop something new (for example, integration with the iHRIS software) this development can be shared so that Haiti, Sierra Leone, or any of the other OpenMRS projects can use it. The effort isn't about protecting what you have done, but sharing it so that all may benefit, with the knowledge your work will also benefit from what is shared in return.
Ultimately, what can result from such an emphasis on collaboration, local capacity building and system strengthening is a new kind of national health system. A strong, dynamic and adaptable health system that has the power to discover and know its own problems, to prioritize its own needs for development and strengthening, and to build the tools needed to stay on top of emerging health issues. A health system able to provide better and more equitable health care for everyone it serves.
If this sounds good to you, go online and read about the Creative Commons and the Open Source Initiative. Think of how you can make your own work more ‘Open', and jump right in. The opportunities for global health, and for all of us committed to it, are tremendous.
Artists for OPEN Source
Youssou N'Dour and Toubab Krewe are musicians who support the use of Open Source technology in health.
IntraHealth OPEN is a new initiative that engages African technology leaders and health workers to develop and sustain Open Source software applications tailored to meet urgent health care needs.
As IntraHealth CEO Pape Gaye explains, "The OPEN Initiative will foster a new generation of technology professionals, eHealth workers and national leaders who understand, use and support Open technologies to build capacity and improve health."
To raise funds and visibility for the initiative, IntraHealth recently launched a campaign in partnership with Grammy Award-winning artist Youssou N'Dour and musicians from around the world who are donating remixes of N'Dour's song "Wake Up." IntraHealth has also created an OPEN Council made up of leaders in the fields of public health, technology and entertainment to guide and support the project.
"Open Source technologies let us address health challenges collaboratively with African developers in the lead," says N'Dour. "If we invest in Open Source development training in Africa we will be supporting self-sufficient health professionals able to use technology and customize programs to address their critical health challenges."
The OPEN Remix campaign involved donations of services pro-bono from artists, engineers, studios, mastering companies, producers, labels, distributors, advertisers and graphic and website designers.
"It's a noble cause and something that not only interests me on a technological level but also an effort I can totally get behind on a humanitarian level," notes Michael Donaldson, better known as Q-Burns Abstract Message, who contributed a remix.
"Youssou is one of Africa's greatest artists," adds Toubab Krewe percussionist Luke Quaranta, "and it's a privilege to be part of this project. We love to work with other musicians, and here collaboration can help save African lives."
Free downloads of the songs are available with a suggested donation through distribution partners including Rhapsody, iLike, Amazon MP3, and at IntraHealth.
Dykki Settle is director of health informatics for the Capacity Project at IntraHealth International, where he supports open source health worker informatics. Settle began his career as the first webmaster for the SunSITE project now www.ibiblio.org, one of the earliest, largest and longest-running online libraries of open resources.
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