Adopting OpenMRS: A kick start to Kenya's software industry?

Let me first apologies to the faithful readers who have advised to limit the length of posts. I am still learning the art of summary, so please allow the bad old ways for now.

Donor interest

Kenya's response to HIV and AIDS has over the last decade become a thriving industry in itself. The sustained donor interest and flow of funds to the sector has remained an area of curiosity to many onlookers. A growing school of thought exists; curious why the not-so-meagre funding should not go to fighting Malaria and other diseases with higher mortality rates than AIDS. The donor politics aside, there is a real interest among the so called development partners to finance implementation of Electronic Medical Records (EMR) Systems. Their intention, ostensibly so, is to assist in managing administration of Anti-Retroviral Therapy (ART) among people living with HIV in Kenyan health facilities. The more observant ICT strategist or development minded entrepreneur will hear of a distinct and rare opportunity amidst the noise – a launching pad for a vibrant software industry in Kenya.

Competitive Advantage for ICT in Kenya

ICT and software industry in particular is one of the remaining escape routes that Kenya has, to liberate its people from their economic and social quagmire. Perhaps one only needs to invoke the stereotypical example of the MPESA success to dare the common pessimistic to shrug off the defeatist 'that is too ambitious' attitude. A strategic adoption of the OpenMRS health information system currently implemented by AMPATH at the Moi University Referral and Training Hospital and at the Millenium Villages Project seems a realistic launching pad for a vibrant software industry in Kenya.

Kenya has in the recent past built vast human resource base around ICT ranging from the deeply engaged software developers, systems administrators, trainers and ICT managers. You only need to look around your immediate circle to find a relative or a friend who has undergone some IT related diploma or degree level training. We need not arrange an economic management seminar with Michael Porter to learn that a nation can develop competitive advantages around the skills of its people. Besides in our knowledge economy, traditional factors of production such as land and capital are belittled by the very knowledge-base of a people.

An unencumbered software industry

A vibrant software industry will exist only where there is a relevant skilled and motivated human resource base. The challenge however remains that the most highly talented and committed ICT practitioners become increasingly frustrated by an ever nagging glass ceiling – the licensing and intellectual property demands of the foreign software giants. Any efforts to turn Kenya into a net producer of software will be frustrated as long as the software developer's successes must be attributed financially to some global software monopoly – call it Microsoft, Oracle, SAP, IBM or Google - whichever.

Apart from a financial 'embargoes' and 'dependencies' on Kenyans derived from ownership of proprietary software, the Software industry continues to suffer from a suppression of creativity. If globalization pays for creative economic value, then globalization tells you that you are too poor to be creative, then globalization has condemned you to poverty. A skilled and talented software developer in Kenya cannot be creative enough for really significant economic value if they cannot tinker with their software application's database back-end (eg. Microsoft SQL server, Microsoft Access and Oracle databases).

Currently, in most cases the talented developer may not necessarily need to tinker with the database or operating system back-end. They may only need a reassurance that the software product they are banking their livelihood on will not break helplessly due to a bug or hidden deficiency in the back-end controlled by Microsoft or any other monopolistic manufacturer. The reassurance only, that in a bad case scenario they can tweak the underlying platform themselves is liberating to the would be Kenyan software millionaire. Indeed many back end environments in computers and servers are bulky with unnecessary features for a vast majority of consumers in the developing world. The software implementer will wish to have the ability to cut down on unnecessary functionalities offered in the standard back end or operating system environment. Such reassurance and empowerment in the IT world only comes in the from adherence to the OpenSource software philosophy.

Why OpenSource and OpenMRS?

OpenSource software philosophy encourages ICT specialists to acquire install and use software with licences that do not demand payment for normal use. The licensing structures are such that the software is essentially owned and supported by a global community of self driven ICT specialists and users. Indeed the manufacturer or licensing company may generate revenue from more specialised adaptation of the software where 'more insider' support, maintenance and tweaking are required. For software development entities who feel a need to access and tweak the software themselves, the source code for such software is publicly accessible through on-line download or other low cost distribution channels.

Indeed the larger proportion of implementation cost for open source software is largely human capacity building. A structured and elaborate capacity building for software developers and implementers is about all that is required for a large scale adoption of EMR systems based on OpenMRS in Kenya. Of course that should go with a little investment in the not-yet-common foundations of good governance and management practices. Such support could be rendered through some form of facilitating agency; a public or private sector entity or even the donor agency themselves. A well managed facilitating agency should in the long run facilitate export of OpenMRS implementation and support services to the rest of the countries

With development partners wishing to mitigate their risks of project failure, they will rarely go wrong with a larger portion of their investment going into human capacity building. Donor support for adoption of OpenMRS and other OpenSource software projects should offer them a significantly less risk of failure since it is rare to go wrong on human capacity building; the single largest cost component of implementing an OpenSource system. The apparent cost of such capacity building of ICT specialists and health facility staff may be rendered insignificant compared to the opportunity cost of developing or adopting systems based on proprietary technologies; perpetually paying licences and support fees to foreign companies and experts.

Apart from the OpenSource nature of OpenMRS, it has other useful strengths, among them the following:-

1. OpenMRS participated in Google Summer of Code of 2007 and 2008 hence benefits globally from inputs of highly talented and skilled programmers and their mentors
   
2. OpenMRS has support from a global community with implementations cutting accross continents hence has easily addressing global standards such as HL7
3. OpenMRS has been embraced by the software development community for extended functionalities eg. a)teaming up with Pentaho the data mining and busines intelligence specialist and b) the development of a Google Android application for medical diagnostices using phones based on OpenMRS - to name a few
   
4. OpenMRS functionality is not limited to HIV related health conditions see abstract on OpenMRS as a key Malaria intervention
   
5. In early 2009, OpenMRS was ranked by Kenya's NASCOP as one of the top three EMR systems being used in Kenya among IQCare and Fuchia which are locked in to Microsoft proprietary technologies and imply payment of expensive Microsoft Licence fees for every extra user or installation. (Note that the reliability of the ranking criteria aside, large scale adoption of such alternative systems as IQcare does not guarantee meaningful opportunities to Kenya job seekers as demonstrated where software development jobs are fashioned for Indian counterparts to 'develop solutions for the developing world').
   

In conclusion, it seems impossible to over-do capacity building among software developers, implementers and entrepreneurs to adapt OpenMRS for public, private and mission hospitals in Kenya that do not have EMR systems. That may be the little investment that development partners in the HIV and AIDS sector need to make in Kenya to address their core interests and whose secondary effects to a fledgling software industry might just be phenomenal.