1. A Brief History of Strengthening Health Information Systems in Resource Constrained Countries “No matter how dysfunctional some find the existing system, others find it quite suitable to their needs.”

2. A brief history... 2  2004: Key future collaborators for OpenMRS meet at a conference  2006: First OpenMRS deployments in Kenya and Rwanda  2008: Bellagio eHealth series o Enterprise Architecture paper published by Health Metrics Network o Delegates call for move ‘from silos to systems’  2009 RF grant making o RF funds OpenMRS to develop business plan and sustainability model o RF funds PATH to apply requirements methodology to logistics management (with PHII) o RF funds JEMBI to develop Health Enterprise Architecture Framework (HEAF) o Rf funds MoH Rwanda: to form eHealth unit, begin Rwanda Health Enterprise Architecture  2010: o CRDM used in Rwanda to capture primary care requirements o RF funds PATH to apply CRDM to insurance information systems o WHO releases SDMX-HD o v1.0 LMIS requirements released  2011: o ISO working group on enterprise architecture releases ‘house’ maturity model of EA o RF funds VillageReach to expand OpenLMIS collaborative o RF recommends funding to OpenHealthTools to form collaborative repository for architectural artefacts o OpenMRS in clinical deployments in ~40 countries

3. 3 Research indicated many silo’d information systems created a burden on countries Initial engagements with private sector suggested that this market (National Health Information Systems) was not yet ripe for significant commercial product investment Past investments and experience with OpenMRS have proved that open source can work and add value in global health Requirements aren’t enough… Why is RF interested in OpenLMIS?

4. Copy-left FOSS (Free and Open Source Software) is a fundamentally different model for the production of intellectual property; it is a different way to make things jointly At its core is a reversal of traditional property rights These rights are enshrined in the ‘license.’ There are a multitude of different open source licenses…

5. What does ‘open’ mean? In the context of software, ‘open’ usually means at least the following: –All source code is freely available for download, modification and redistribution –All source code is released under a license which is considered ‘open’ by the Open Source Initiative “We’ll let your people look at the source code” is NOT the same as “open”

6. Free Software Foundation Definition “Free software” is a matter of liberty, not price. To understand the concept, you should think of “free” as in “free speech,” not as in “free beer.” Free software is a matter of the users' freedom to run, copy, distribute, study, change and improve the software. More precisely, it means that the program's users have the four essential freedoms: 1.The freedom to run the program, for any purpose (freedom 0). 2.The freedom to study how the program works, and change it so it does your computing as you wish (freedom 1). Access to the source code is a precondition for this. 3.The freedom to redistribute copies so you can help your neighbor (freedom 2). 4.The freedom to distribute copies of your modified versions to others (freedom 3). By doing this you can give the whole community a chance to benefit from your changes. Access to the source code is a precondition for this.

7. A Shared Vision for a National LMIS An effective logistics management information system (LMIS) should ensure that adequate quantity and quality of vaccines, essential medicines, and supplies are always available to meet patient demand. In order to do this, the LMIS must enable: –Capturing accurate routine administration, dispensing, and consumption data. –Real-time, end-to-end logistics management from point of origin to service delivery point. –Demand forecasting, capacity planning, and modeling based on consumption. 7

8. 8 Logistics Management Logistics management. The part of the supply chain that plans, implements, and controls the efficient, effective forward and reverse flow and storage of goods, services, and related information between the point of origin and the point of consumption. Representative Sources: Nelson DP, Adams IC. A Guide to Improving Drug Management in Decentralized Health Systems: The Monitoring-Training-Planning Guide for Program Implementation. Arlington, VA: Management Sciences for Health, Inc.; 2000. Owens Jr. RC, Warner T. Concepts of Logistics System Design. Arlington, VA: John Snow, Inc./DELIVER; 2003. Owens Jr. R C, Islam A, Whitehouse M. Guidelines for Implementing Computerized Logistics Management Information Systems (LMIS), second edition. Arlington: John Snow, Inc./DELIVER; 2006. US Agency for International Development. Cold Chain and Logistics Management: An Essential Part of Safe and Effective Vaccination Programs. Washington DC: US Agency for International Development; 2008.

9. Health Impact is Achieved When Appropriate Solutions are Implemented

10. Collaboratively Determining Common Requirements

11. EPI Store Keeper - Vietnam Pharmacist - Senegal Logistician - Rwanda Stock Picker - Kenya Country Validation with LMIS Users

16. P11 P10P9P7P8P6P5P4P1P2P3 Page 16 201120122013 JFMAMJJASONDJFMAMJJASONDJFMAMJJASOND 3. Project SOW and Kick Off 4. Development 5. Deployment 6. M&E 7. LMIS v1 (Scenario A) Project Closure 2. Landscape – Charter Approved 1. Requirements Zambia Example of Applying Common to Create Specific Requirements “The CRDM process has helped us envision a holistic information system, gather inputs from the right people, and move forward into system development with confidence.” Dr. G. Syakantu, Director-Clinical Care and Diagnostics Services, Zambia Ministry of Health “The CRDM process has helped us envision a holistic information system, gather inputs from the right people, and move forward into system development with confidence.” Dr. G. Syakantu, Director-Clinical Care and Diagnostics Services, Zambia Ministry of Health

17. If you want to go fast, go alone. If you want to go far, go together. African Proverb 17 “What if we go together?”

18. Requirements Are The Beginning 18

19. Now It’s Time to Get to Work 19 “It’s easy to have a complicated idea. It’s hard to have a simple idea” – Carver Mead “There is only one move that really counts: the next one” – Chess master Jose Capablanca

20. 20 ขอบคุณ Asante Merci شكرا لك 謝謝您 Cảm ơn bạn

22. OSI Definition 1. Free Redistribution The license shall not restrict any party from selling or giving away the software as a component of an aggregate software distribution containing programs from several different sources. The license shall not require a royalty or other fee for such sale. 2. Source Code The program must include source code, and must allow distribution in source code as well as compiled form. Where some form of a product is not distributed with source code, there must be a well-publicized means of obtaining the source code for no more than a reasonable reproduction cost preferably, downloading via the Internet without charge. The source code must be the preferred form in which a programmer would modify the program. Deliberately obfuscated source code is not allowed. Intermediate forms such as the output of a preprocessor or translator are not allowed. 3. Derived Works The license must allow modifications and derived works, and must allow them to be distributed under the same terms as the license of the original software. 4. Integrity of The Author's Source Code The license may restrict source-code from being distributed in modified form only if the license allows the distribution of "patch files" with the source code for the purpose of modifying the program at build time. The license must explicitly permit distribution of software built from modified source code. The license may require derived works to carry a different name or version number from the original software. 5. No Discrimination Against Persons or Groups The license must not discriminate against any person or group of persons. 6. No Discrimination Against Fields of Endeavor The license must not restrict anyone from making use of the program in a specific field of endeavor. For example, it may not restrict the program from being used in a business, or from being used for genetic research. 7. Distribution of License The rights attached to the program must apply to all to whom the program is redistributed without the need for execution of an additional license by those parties. 8. License Must Not Be Specific to a Product The rights attached to the program must not depend on the program's being part of a particular software distribution. If the program is extracted from that distribution and used or distributed within the terms of the program's license, all parties to whom the program is redistributed should have the same rights as those that are granted in conjunction with the original software distribution. 9. License Must Not Restrict Other Software The license must not place restrictions on other software that is distributed along with the licensed software. For example, the license must not insist that all other programs distributed on the same medium must be open-source software. 10. License Must Be Technology-Neutral No provision of the license may be predicated on any individual technology or style of interface.