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HELINA 2003, Johannesburg, 13-15 October
2003 Preconditions for sustainable information
systems development for African healthcare
institutions The MINPHIS experience and a
software industry survey in Nigeria
Mikko Korpela, DTech (Information Systems),
www.uku.fi/korpela Research Director, Healthcare
Information Systems RD Unit, University of
Kuopio, Finland Co-Organizer, 1st Health
Informatics in Africa conference HELINA93,
Ile-Ife, Nigeria Founding Secretary, IFIP WG 9.4
Social Implications of Computers in Developing
Countries Ex-Chair, Finnish Social and Health
Informatics Association FinnSHIA H. Abimbola
Soriyan, Obafemi Awolowo University, Nigeria Anja
Mursu, University of Kuopio, Finland
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• Contents of the presentation
• Background
• Information activities and software systems
  within the healthcare delivery system, in general
  and in Africa
• Appropriateness and sustainability
• (Objectives see abstract)
• (Methods see abstract)
• Results and conclusions
• The supply chain of software and information
  systems for healthcare
• Who will develop appropriate software for
  African healthcare?
• Who will sustain software development for e.g.
  African healthcare?
• Recommendations

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• Concepts Information system vs. software system
• Information system The processes, people and
  technologies (manual and computer-based) of
  information management within an organization or
  an activity i.e., a social system
• Software system (software application) is a key
  component of computer-supported information
  system hardware is the same anywhere, software
  determines the functionality
• Work activity A number of people working on a
  shared object (e.g., a patients health problem),
  not necessarily in the same time and place, to
  produce a joint outcome (e.g., health
  improvement) a process, its actors, their means
  and instruments, coordination of the process

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Generic model of the healthcare delivery
system What is your countrys specific system?
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Information activities for healthcare delivery
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Information systems for healthcare delivery
Information system for inter-organizational
networking in healthcare IOHIS
Information system for citizen-to-healthcare
linkages eHealth
Information system for clinical healthcare
delivery CIS
Information system for regional integration of
healthcare and social services RHSIS
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Generic healthcare management system
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Information systems for healthcare management
Information system for district health management
DHMIS
Information system for national healthcare
management NHMIS
Information system for healthcare facility
management HFMIS
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Need for appropriate software for healthcare
priorities in Africa?
DHMIS software
NHMIS software
eHealth software
HFMIS software
CIS software for hospitals and PHC
Inter-organizational software
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What is appropriate technology
Technology should be considered appropriate
when its introduction into a community creates a
self-reinforcing process internal to the same
community, which supports the growth of the local
activities and the development of indigenous
capabilities as decided by the community
itself (Pellegrini, Appropriate Technology Conf.
1980, p. 1, emphasis added) Thus
appropriateness is determined by process,
context and moment more than static
characteristics of a given technology Endogeneous
appropriation of technology-as-knowledge by
local actors vs. Exogeneous transfer of
technology-as-hardware by foreign
actors Introduction of ICT into a community
information system development
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Generic framework for sustainability analysis of
IS

• Implications to the development of HFMIS / CIS /
  IOHIS / eHealth?
• ITs impact determined by improved service by
  the IT-supported activity
• Users must be involved in developing software
  and IS that fits their task
• Long-term sustainability determined by impact
  and supporting network
• Appropriate introduction (IS development) is
  the critical phase
• Cannot be accomplished without local actors and
  appropriate methods!

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Generic healthcare software service chain

• Roles of the stakeholders in the healthcare
  software cluster
• Service providers identify needs, set
  requirements, test, utilize
• Software companies develop products to improve
  the healthcare services
• Academia produce preconditions actors,
  know-how, methods
• Public administration guides, standardizes,
  allocates resources

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The core network of activities around healthcare
IS development in Africa
Without appropriate software there is no
IT-supported healthcare where can an African
healthcare org. get it from?
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Four alternative routes for acquiring software
for ISD in healthcare

• Foreign package installed as such or locally
  configured or modified
• Locally developed package installed to several
  sites, like no. 1
• Tailor-made software (not package) to each site
  by sw. organization
• In-house developed tailored software
• Affordability, appropriateness potential,
  sustainability in each case?

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Alternatives for economic viability of software
development for ISD in healthcare

• Only wealthy people can afford voluntary work
  hackers will not develop appropriate software for
  African healthcare organizations
• Foreign aid and government support needed for
  seed funding
• In the long run healthcare organizations must
  fund their software developers like they fund
  their drug suppliers or nurses

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Recommendations

• Local software development capacity is the key to
  appropriate healthcare software in Africa find
  your software professionals, trust them, educate
  them, fund them!
• Foreign aid and government support are needed for
  seed funding to local developers, until they can
  fund themselves.
• International organizations should organize and
  fund a clearing house of useful open source bits
  and pieces (applications, components, platforms,
  interfaces, information models) that African
  software developers can build upon and add to.
• Open platforms (e.g. Linux), open standards (e.g.
  HL7) and open source applications (e.g.
  WorldVistA) are needed, but they are only
  materials for local adjustment and development.
• Healthcare professionals and software
  professionals must apply collaborative design
  methodologies, and be educated in such
  methodologies.

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Acknowledgements This presentation is based on
joint research in the projects INDEHELA-Methods
(1998-2001) and INDEHELA-Context (2003), funded
by the Academy of Finland grants no. 39187 and
201397, in partnership with the Obafemi Awolowo
University, Department of Computer Science and
Engineering. http//www.uku.fi/atkk/indehela Par
ts of the presentation are based on earlier
presentations in Information Technology in
Health Care Social and Organizational Aspects,
Rotterdam, 2001 World IT Forum / Health
Commission, Vilnius, 2003, http//www.witfor.lt