> Molly sent us this data., which is important enough to restate:
>
> To support our focus on developing countries, the biggest challenge is
> equity and the data found in this presentation says it all.
> High-income countries:
> 16% population
> 7% burden of disease
> 89% health spending
> 94% Internet hosts
> Low-income countries:
> 84% population
> 93% burden of disease
> 11% health spending
> 6% Internet hosts
>
>
> To make some other points obvious:
>
> 1) Any solution which involves 'upgrading' the low-income countries to the
> state of resource consumption which the high-income countries use to support
> these numbers will only have limited success!
>
> 2) If you didn't understand point #1, the US has roughly 5% of the worlds
> population and consumes roughly 25% of the worlds oil production. Most of this
> consumption is split between the transportation sector, electrical generation
> and food production. Electrical generation is crucial in the IT industry.
>
> 2a) I am 'embedded' in the US health care delivery system, managing computer
> servers. Our current trend is to obsolete computers every 3 to 5 years,
> replacing them with ever more powerful and power consuming models. I have been
> on the 'bleeding' edge of trying to conserve power, but in less than three years
> of growth, we have exhausted the capacity of our power feeds coming in ~ 30KW
> and our cooling capacity for that power load.
Yes. I had cause to visit one of the data centres for the govt health
organisation for which I work a few weeks ago, to inspect our population
health servers (which occupy just one rack). I was surprised to notice
several new racks of servers, each absolutely full of "blade" servers
each with 20 or 30 CPUs in each unit i.e. hundreds of CPUs per rack, and
there were several such racks. Drooling at all that computational power,
I asked what they were for. The answer: "They are Citrix servers for the
XYZ application." For those unfamiliar with it, Citrix is a (closed
source) technology which allows Windows desktop sessions running on
central servers (the huge bank of blade servers) to be remotely
controlled from Windows desktops via a thin client. Rather like VNC for
Windows, but a bit more sophisticated. The XYZ application was a Windows
GUI app which needed to be accessed from wards in hundreds of public
sector hospitals, and the use of Citrix and the centralised virtual
Windows desktops very appropriately avoided the hassle and expense and
difficulties of installing the application in so many locations.
However, knowing that the GUI application in question did not have a
terribly complex interface, I could not help but reflect that had the
software been implemented as a Web application, then only a handful of
central servers would have been needed to service it. The (valid)
arguments were that redeveloping the application in question as a Web
app would have cost more than the banks of Citrix servers etc needed to
deploy it as a Windows GUI application, and that the Citrix servers
could be used for other Windows apps in the future. All true. But there
is a lesson there for software developers who wish their code to be
deployed in places where there are not the funds available to purchase
large banks of Citrix servers...
In the more local clinic settings, there is a great deal to be said for
the use of robust, low-power discless workstations (eg IBM NetVista - no
longer sold but available second-hand - or NeoWare Capio - see for
example http://www.itreviews.co.uk/hardware/h611.htm ) served from a
Linux (or even Windows) server. Alternatively, a multi-headed Linux
server is worth considering if all the screens and keyboards can be
positioned close to the server.
And then there is power supply technology. Solar and wind power are
increasingly affordable for remote locations, but they demand very low
power hardware eg machines based on the VIA chipsets - which are slower
but use only a fraction of the power of desktop Intel or AMD CPUs and
chipsets. The use of cheaper laptops as servers is also worth
considering. Modern laptops can be fairly reliable as long as they are
left in one physical place and are not moved around while running eg
treat the laptop like a server and leave it in a (ventilated) cupboard.
Also uninterruptable powers supply technology is important, possibly
with generators (yuck!) to fill in for longer outages of mains power.
During the power failures ("brown outs") in Manila in 2000 I saw all
sorts of ingenious (and sometimes hair-raising) battery-backed power
supplies for computers cobbled together from car batteries and inverters
(or in some cases the batteries were supplying 12V and 5V DC current
direct to the computers, which is more efficient).
Then there are issues of dust, moisture and humidity protection -
computers designed for nice, clean environments common in rich countries
often don't last well in poorer country settings.
And that's just the hardware....
> Therefore, I have to conclude, given all these facts, that software developed
> with assumptions about infrastructure in the 'high-income' countries could have
> issues in not finding the same infrastructure in the 'low-income' countries.
> And this is not to mention the differences in staffing, expertise and thus work
> organization patterns that are completely different for a deep or complex
> technological infra-structure.
I once asked a representative for one of the large vendors of hospital
clinical software how many database tables there were in a minimal
installation of their product. The answer, given proudly, was "About
1750". 1750 tables! With each table having many tens of columns. All
that for a minimalist installation. No wonder the cost of customisation
and software maintenance was so great. The argument was that a modern
hospital (in a rich country) is a massively complex organisational
edifice, and the the software needed to run it also ends up being
massively complex. Possibly true (although I have my doubts), but that
doesn't mean that the same software is appropriate for a far less
complex healthcare institution in a poorer country.
> Thus an ideal opportunity for OSHCA to fuse the concepts around open source
> with the concepts of 'appropriately' scaled technology and sustainable
> technology, which will find an immediate application among the majority of
> worlds population and within the next decade or two will be essential in the
> 'high-income' countries as well.
Yes indeed.
Tim C
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