Paraphrased:

Recent years have seen a steady expansion of information and communication technology (ICT) in frontier economies, including least developed countries in sub-Saharan Africa. A significant proportion of such developments have been initiated by international donor agencies, which, unlike private investors, concentrate less on achieving appropriate financial outcomes, but rather pay attention to partner involvement, sustainability and capacity building.

Even under ideal circumstances, over 80% of ICT-related projects fail, and do so for valid reasons, ranging from half-hearted management support, cursory accommodation of end users' requirements, failure to bridge the gap between geeks and ordinary users, and poor project management leading to premature resource exhaustion.

ICT projects in the developing context face additional formidable challenges that are not always appropriately anticipated by donors and implementing partners: Given the relative isolation of many developing countries, they tend to pay a premium for out-dated equipment and sub-standard service, even though prevailing customs and excise regulation might well exempt ICT from payable duties.

The reasons for this are many-fold, and include unwillingness of some manufacturers to provide adequate service to frontier economies, given the logistics and secondary costs involved. As a consequence, equipment procured from abroad through established donor channels is commonly the only feasible way to gain access to up-to-date ICT technology.

Further troubles lie ahead when the planners of e-health interventions fail to tend carefully to the rigorous demands of partner country environments: vibration, dust, heat, rough handling, poor connectivity and aberrant electricity supplies pose challenges to any ICT infrastructure and are unbeknownst to planners and engineers in the developed world. Privacy issues, such as data containment ensuring the strict separation of national identity databases and health-related electronic records, may be an issue that is conveniently overlooked.

The procurement costs of upgrades of proprietary systems incur significant licensing and support fees. On the other hand, Free and open-source software (FLOSS) allows unlimited local modifications by the end user, and access to a huge pool expertise via the internet community. FLOSS is likely to leverage significantly more capacity building and ownership for the end user.

There are a few important lessons to be learned from the above:

Small is beautiful. Software solutions should be smart, highly resource-conscious and scalable. With decreasing, instead of increasing memory and space requirements, yet enhanced scalability and flexibility, fanless and diskless servers become a sorely needed reality. Undoubtedly this demands excellence in software and systems design, and the right choice of programming language.

Freely available, highly secure, robust and resource-efficient operating systems, such as Linux and BSD, provide a sound platform for sensitive data and allow for the free and effortless integration of FLOSS applications with auxiliary applications, such as email to SMS or fax gateways.

FLOSS systems, such as for laboratory information management (LIMS), electronic medical records (EMR), hospital information management (HMIS) and enterprise resource planning (ERP), transfer total control to the client. While initial implementation and training are likely to be required, and therefore to be costed, the capacity to completely manage a FLOSS ICT infrastructure is rooted locally, and much more sustainable than closed solutions.

Given these challenges and requirements, we openly advocate for FLOSS software that is suitable, not only in the resource-limited health environment in sub-Saharan Africa, but anywhere else, providing robust, yet open, peer-reviewed technology.

Bika Health, the product of the Bika Health Foundation, a non-profit entity based in South Africa, was born out of the need to develop a sturdy, secure, scalable and HL7-compliant LIMS accessible to health care providers working under rough conditions, and is based on the equally free and open-source ISO-ready Bika LIMS products tailored to the agricultural, water quality management, environmental monitoring, inter-laboratory proficiency testing and general chemistry industries.

As a member of the Bika Foundation, we are aware that there is only a handful of truly royalty-free and open-source LIMS products available, and we fully endorse their philosophy to empower the client and end-user alike.

Integration with EMR and HMIS is essential, as well as supply chain, human resources, inventory and accounts management. We recommend GNU Health, developed and backed by GNU Solidario, a global, all-inclusive and sustainable community of enthusiasts, professionals, academics and revenue generating clients.

Health care providers in resource-limited settings are encouraged to choose carefully and opt for flexible, user-friendly and scalable hospital management systems that are at the same time royalty-free and open-source, with guaranteed open upgrade paths.

Larsen CH, synaLinQ (Vietnam, Kenya)
Mobile: +254-753-632481