Adaptability is one of the key benefits of open source software, but it requires investment in capacity building
Cost is not the win it first appears to be to the newcomer to open source. Thankfully, countries appear to be recognizing this. In one country’s recent public sector eHealth workshop, the attendees recommended to the health system leadership that they ‘encourage, coordinate and support’ more use of open source for several reasons. Affordability was the least of them. The real value that countries are seeing in open source is adaptability.
The needs for information change rapidly, especially at an early stage of technology adoption and use. Once a routine system can communicate what is happening, new questions emerge as to why. For example, our HRIS in Uganda recently revealed that there is a much higher percentage of men entering health worker training in the north of Uganda than in the south. (This is an important issue for gender and rural/urban deployment reasons). This fact was never known (or perhaps even knowable) before the country had a health worker information system. Now that the country policy and decision-makers know what is happening, they can go back to the system to ask better questions as to why.
With proprietary technologies, health systems feel that the adaptation needed to quickly respond to changing information needs is both difficult and expensive. Sometimes proprietary systems die entirely. In Botswana, the current proprietary public service HRIS lost all its future viability with the death of its developer and the closure of his company. These stories are not uncommon. With open source technologies, country decision-makers feel the needed responsiveness and adaptability is something they can accomplish more easily.
The ability to realize this perception of easier and cheaper adaptability is dependent on relatively expensive open-source capacity-building. Independence also comes through strong open source capacity. To build that capacity is more than training one, or even a few, developers. It requires the development of a capacity-building engine that will continue to generate skilled analysts and developers. Thanks to the efforts to build ‘capacity-building capacity’ in open source at the University of Dar’s Health Informatics program, for example, we found an excellent local partner for Tanzania’s HRIS strengthening work.
This work is not cheap. Nor is it quick. However, I prefer seeing countries and donors investing time and resources in this than in software licenses. One large, relatively developed country’s national Oracle-based HRIS efforts are stymied in part because they require nearly four million US dollars in licensing fees on top of anything else. I can’t help but think an equivalent investment in capacity-building would have much more lasting and valuable effects.