Serving African healthcare – OpenLMIS story
Health care systems in Africa still struggle with a variety of challenges that prevent people from getting necessary help and also from increasing chances for wellness in general. Africa is diverse, and so are the medical problems faced by particular regions. A WHO report from 2018 (The state of health in the WHO African Region: an analysis of the status of health, health services and health systems in the context of the Sustainable Development Goals), however, states some common difficulties that occur across the whole continent and that significantly affect the efficiency of healthcare in Africa.
Health challenges for Africa
Among the most harmful ones, there is trouble with accessing the medical service, including clinics and drugs that are often unreachable for citizens from rural areas. One of the causes surely is spending too little on health work-force or infrastructure which contribute to the generally poor quality of African healthcare. With not enough number of medical professionals and an inadequate amount of equipment, there come yet other dangers. Counterfeit drugs, as well as Africa’s unreadiness for treating chronic diseases that start to propagate in the growing middle class (diabetes, cardiovascular diseases, cancer for instance), also add to the image of Africa’s contemporary healthcare.
How can technology help?
There are many ways to fight for the improvement of medical service in Africa, one of them being the adoption of modern digital technology. At SolDevelo, we have the chance to engage actively in this mission and to participate in increasing the accessibility of medical supplies in clinics within the number of African countries. We do so by collaborating on the development of OpenLMIS – open source logistics management information system. OpenLMIS is a cutting edge platform, already used in 11 000 health facilities, across 8 African geographies. The app helps to manage supply chains of medical products, including making orders and monitoring the individual stocks of clinics.
A system that knows who needs what
Having the supplies distributed correctly, so that the particular clinic receives exactly the medicines they require in the amount they need within the reasonable timeframe, is not a trivial undertaking. The problem with the availability of a drug is not always due to its lacking. Frequently it is just not delivered to the hospital with the demand while being stocked in the facility that doesn’t need it. Before the OpenLMIS, the overstocking was difficult to know about, so the prevention also couldn’t be efficient. As a result, some of the supplies were going to waste, when at the same time patients weren’t able to get them for necessary treatment. With OpenLMIS medical professionals can avoid both stockouts and overstock more often. It is a significant step, to improving African’s health systems thus we are glad to participate in such a mission. Our contribution to OpenLMIS started a few years ago when we were helping with its two first implementations in Benin and Mozambique. Soon our engagement grew and we were to face some more compound challenges.
SolDevelo is on it!
Writing a whole system practically from scratch can’t be an easy task, and it was, in fact, our goal back in 2016. We were to develop the 3rd version of OLMIS which was supposed to be a game changer in terms of architecture and overall approach to this solution. OLMIS consists of its core, unalterable part and the second one that is adjusted and modified according to the individual need of a country willing to implement the system. Even though the 1st and 2nd versions of OLMIS were up and running in some African locations, they were failing at keeping the core separate from the alterations made for a particular implementation. As a result, it was difficult to maintain. Also, reusing custom changes already existing in one implementation turned out to be troublesome.
It is not easy to play a hero
3rd version was supposed to address all those issues. By applying microservices architecture, OLMIS was to become an easily adjustable tool, that could fit into any specific needs of a local health system. With our impressive team of 15 developers, we were ready to take on the task of developing the core of OpenLMIS 3.0. It started in a bit of chaos which we luckily tamed. First months were particularly challenging, with the requirements clearing out along the way, after weeks of working on something not quite as expected. It took us a while to obtain a comprehensive insight into the context of the use of OLMIS, and the process was full of uncertainty, doubts and lots of hard work. Initial lack of graphic user interface was only doubling this ambiguity, for it kept us a bit in the dark in terms of the proper functioning of created solutions or at least verifying the results of our work wasn’t very comfortable.
Open source in developing countries
OLMIS is a dedicated system for a very narrow and specific user group and thanks to the project being an open source, all those users can cooperate closely with the developers, request new features, or reports errors. They constitute a community consisting of everyone that somehow affects the project, not necessarily of just contributors with a technical background. It is, therefore, a vital thing to go carefully through such suggestions, identify the actual needs, confront them with the possibility to address them in the software and then come up with the solution satisfying to all parties. Such facilitation wouldn’t make OLMIS a successful solution if it didn’t come along with a friendly, intuitive interface, adjusted to the users’ needs. In this particular situation, we knew that most of the future end users were not working with digital systems frequently. It meant that we had to come up with the layout reminding already known, paper-written forms used for creating orders, and other operations that OLMIS was supposed to handle. This way we were able to avoid disturbing the users’ existing mental models so that they could adopt the new software easier.
Success, here we come
Having all these elements of design and development fit into the final solution, we could eventually present the finished OpenLMIS version 3.0. It was an achievement we were proud of, yet not the end of SolDevelo’s adventure with OLMIS nor with enhancing healthcare in Africa. As mentioned before, initially we were building the core of the third version of OLMIS. When a country decides to implement the system though, it needs customization. Only then it can fully adapt to the unique healthcare of a particular land. Conducting implementation of OLMIS in Malawi turned out a very educational way to verify if our work can withstand the real-life conditions and truly help people to get better treatment fast.
Malawi implementation – not so easy
There were plenty of things that could have gone wrong while working on this first implementation of new OLMIS. The deadlines were tight – all features and custom changes had to be up and running in around 3 months, not a very long period for a system scaling to the whole country. The scale turned out to be a bit challenging in fact. When we uploaded all the data regarding medical orders dating back to 2012 along with information concerning around 6000 drugs used in Malawi, it overwhelmed OLMIS quite severely and required some vital changes in the approach. Our team had to introduce some other modifications as well to ensure that the system in Malawi runs as expected. To achieve this, we were working closely with VillageReach foundation and the implementer of OLMIS in Malawi. Difficulties appearing along the way almost made Malawi withdraw from the project, but thanks to persistence, hard work, and effective cooperation, we managed to avoid such a disappointing outcome. OLMIS started to run in local health facilities. Today, it is an appreciated solution, that significantly affects the efficiency of work.
Social Impact for real
The data proves it. It shows that the number of stockouts dropped from 32% to 23% after introducing OLMIS instead of the manual logistics management information system. The stockouts taking longer than 7 days reduced from 24% to only 15% (http://openlmis.org/impact/). It is evidence that OLMIS enables to manage orders and supplies easier. When it comes to health-workers, they also feel a positive change in their routine. The time needed to perform all the calculations necessary for making orders reduced from 3 hours (when there are only manual tools available) to just 1 minute with OLMIS (http://openlmis.org/impact/). The system saves the precious time of medical professionals which is of extreme value, especially in the conditions of understaffing.
It isn’t over!
We are happy to be a part of OpenLMIS and to participate in their new plans for development. At the beginning of 2019, we were celebrating the release of a 3.5 version of OLMIS that is an ambitious response for constantly evolving users’ needs. We hope that soon we will be able to see an even greater change in the functioning of African health systems originated by constant improvement by OLMIS. It is amazing to be a part of such an important story and to devote time, share experience to the cause that matters.