Hi Folks,
a Friendly reminder about Littlefish (its only been up for 18 months:-)))
Project Vision?
"To create a user friendly patient information and recall
system on an open source basis with the focus on use
by community based primary health care health
organisations in the developing world or remote and
rural areas or areas of need."
> I think we should be more active in getting members from developing
> countries into the list. Any ideas?
Well I have been doing this among the littlefish group and mailing lists and
contacts for the last 4 months because the discussions here have been so
important.
(NB the nature of these discussions to date have been very first world high
tech discussions around the American/Eurpean style health care systems-which
is not the reality of most health care systems in developing countries- i
mean lets forget insurance company involvement in Botswana :-))
I am going over to South Africa in late May to meet with the WG9.4
group-"social implications of computers" in developing countries to discuss
the use of Littlefish and open source development in health care.
Regarding the WHO ,UNESCO etc
Our approach has been to contact the grass roots "workers" rather than waste
too much time trying to attract the attention of the beaurocrats on high.
To date I am in contact with health organisations groups individuals,
universities and the Tropical medicine schools in Liverpool & London.
I have been talking with various groups in developing countries to develop
end user groups for feed back.
One note of caution: there have been too many incidents of trying to
transpose the systems of one country to another that has produced great and
costly failures eg from the US to the UK.
I have included here a post from Calle Hedburg From HISP in South Africa
It raises some inportant concerns and realities
(Quote:)
The quality of current hardware in the health sector in sub-Saharan Africa
varies a lot: A recent survey done by the Ministry of Health in Zimbabwe
showed for instance that 65% of their PCs were pre-Pentium (source: Paper
presented at HELINA'99). South Africa is considerably better - I would
estimate that at least 70% of PCs in active use in the health sector are
Pentium 133 or better. Uganda - where I worked from 1992-96 - hardly have
computers in the health sector at all.
The important issue to understand, though, is that very few of these PCs are
allocated to health FACILITIES - nearly all of them are found in the
administration and in the large central/academic hospitals. Littlefish is
aiming for one or more applications running at facilities, and nearly all of
these facilities would need NEW computers for this purpose. South Africa, as
the richest and most developed country in South Africa, has only partially
computerised 5-10% of its around 4,000 health facilities. Most of these are
either large hospitals OR community health centres ("day hospitals") and
clinics in the larger urban centres. (and not even all of these - City of
Cape Town is for instance right now considering various options for
computerised patient registers at clinics).
Another key issue in SA is that a lot of PCs were replaced with Pentium 300s
last year due to not being Y2K compatible, and the majority of "old" PCs
remaining are predominantly used as terminals to various "mainframe-like"
systems or used for word processing etc.
Bottom line: any significant expansion of computerised patient-based health
care systems will rely on new hardware. I strongly believe that will be the
case in most other sub-Saharan countries too, even if many of are so poor,
corrupt, and/or mismanaged that equipment is used far beyond its expiry
date. (You save USD 1,000 on equipment and instead waste 10 times that in
lost productivity, constant hassles and breakdowns, poorly performing
Information Systems etc - most people don't understand that
hardware/software is only a fraction of the total Health Care information
system cost). Many of the poorest countries will probably not get money for
any significant investments in computerised patient information systems in
the near future, so the use of Open Source software might only speed up
computerisation to a limited extent.
I'm currently recommending a typical standalone "small business PC system"
for capturing, analysing, and outputting data/information at Health District
level:
- 500-600 MHz PIII or equivalent,
- 128MB+ RAM,
- 10-20GB HDD,
- CD-ROM or DVD drive,
- CD-(re)writer (for data transfer and backup)
- 56K Modem and/or network card
- A4 laser
- A3 or A2 inkjet (for wall graphs).
Total cost around USD 2,500.
I believe the most common FACILITY computer, though, will be whatever is
considered "entry-level" (or home) PC at any time (cost around USD 1,500
including one inkjet printer). Medium or larger hospitals might go further
and rely on client/server applications with thin clients, but even these
will normally never be less than the current "entry-level" PCs.
PC-collecting do-gooders and PC recyclers might argue that old PCs still
have a life (and they do in certain circumstances - like using them as mail
servers under Linux), but that's never gonna catch on to any significant
extent - especially not with regard to patient-based information system
where reliability and dependability obviously is of primary concern.
My recommendation would be to use e.g. a Pentium 300 or better with at least
64MB of RAM and 4GB HDD as a baseline for Littlefish software.
Finally, I would also like to point out that trying to develop software that
will run on any 386/486 PC in this case might result in health bureaucracies
finding "good arguments" for dumping their old PCs onto clinics and grabbing
new PCs for themselves. I have worked in a number of developing countries,
and the dominant trend is regrettably that new equipment (cars, PCs,
whatever) is grabbed by the top brass. Older models are cascaded down
through the ranks, leaving the staff doing the work at the coalface with
ramshackle stuff. A manager is regarded as stupid if he/she don't assert
his/her position that way. This culture of greed is not very different in
developed countries (ref stock options etc US bosses give themselves), but
the low salaries and extended family needs found in developing countries
results in even relatively "cheap" items like a PC being seen as desirable
and status-yielding (exacerbated by low level of computerisation).
This is not only the case in the public sector: A good friend of mine
supplying computer hardware to the private sector in SA told me at least 50%
of his profits on a PC sale usually comes from handling this cascading
process: The software/data from the boss' old PC is transferred to the new
machine, the deputy's software/data is transferred to the old boss PC, and
so forth. (These guys don't use their PCs that much). The oldest PCs, with
crappy 14" monitors etc, end up with the secretaries and data entry clerks
that use them 8 hours a day...)
(Finish quote)
It seems to me that perhaps the most fruitful area that we could initially
tackle would be to develop a business case
for open source health care for developing countries. - We must not assume
that everyone has heard of open source (half the planet have never made a
phone call) and many of the Medico's and Nurses in the hospitals I work in
have never heard of Linux.
We should also bear in mind that we WILL run into some serious static from
the Pharmaceutical industry when it comes down to implementing prescribing
modules and databases as open source can be seen as threatening their
revenue stream.
Also many drugs are simply too expensive -note South Africa refusal to pay
the price demanded for anti HIV medications.
It seems to me that OSHA neds to develop links with trusted third parties
who can advise Health Depts in developng countries
on the best and most appropriate use of cheap medications that will have
the most impact.
It will be vitally important to stress the standards we are utilising
GEHR,CORBAmed, HL7 ,PIDS, COAS, LQS ,UML,etc etc
So on the littlefish front
I have just uploaded a first draft prototype of Littlefish which we will be
extending across the breadth of the requirements.
(It is in Delphi so the prototype coding will not "pollute" the final
application which will be in Java & UML.)
So if you want to bring to bear the ideas that have been talked about the
last few months I for one ain't going to stop you:-)
Rant over:-))
Best Wishes
Chris Fraser
