Capacity Building and ICT Governance – Selected materials and support notes Discussion at Workshop on System Design, Standards, and Interoperability for Health Information Systems 2011, Hoi An, Vietnam Eduardo Jezierski, CTO, InSTEDD –

Discussion Topics 1. What are the types of capacity that you need locally – and how do you build them? 2. What are common issues with technology vendors and suppliers, and how do you assess fit?

Should you have a MOH tech team? Ministries of Health’s mission is not technology- it uses technology MOH needs technology Governance – Strategy, Policy, Architecture, Methodology – Ideally may include one senior program manager, technology architect, and designer Some MOHs in the world are building ‘Tech Department’ – Directly under the Minister – Responsibility of information and technology governance Implementation typically is better done outside MOH – More incentives to build skills and produce a great result – More incentives to learn from tech community – More incentives to share knowledge with local IT community – Opportunity to find additional revenue and sustainability opportunities You don’t have your own MOH petrol distribution & gas station, gas station, car engine tuning…

Capacity Building for HIS Strengthening Governance Implementation Policy Strategy Architecture Methodology Architecture Design Deployment Security Scalability Operations Infrastructure Asset Mgmt Mobile operators Hosters Hardware provs. Data Design Process Design Example Partnershps Change Mgmt. Integration + Interop Etc etc etc etc Need in MOH Need in country, not necessarily in MOH

Common Challenge Users don’t know what they don’t want until they see it Designers have training to discover what you really need, not just write down what you ask for Project estimations tend to fail / miss Assumptions Change Priorities Change People Change You have the right to change your mind! Iterative, agile approach See ‘working systems’ Manage risks proactively Do risky part firsts Reduce time to first pilot Solutions:Reality:

New models for local capacity for HIS We have been using a model called ‘Innovation Labs’ It is a team that supports technology design, development and implementation for Government & NGOs Local staff create a centre of gravity for the best ICT skills in the country, so they work on the country needs in health Technology agnostic – the team can work with any open source, commercial, and service Centre of excellence for technical project management and field design, and other skills the MOH doesn’t have incentives to be the best at

Resources Health Enterprise Architecture Framework Global knowledge base of health information systems architectures and methods, patterns, and practices – with contributions from multiple countries4

Some special situations You have a constraint and you HAVE to work with a particular vendor, or house staff that may not have enough capacity – Make sure there are other qualified providers in the project that build his/her capacity in the context.

Simplified Vendor/Tech Checklist Do you want them to build what you need, or what you ask for? Will you have access to your data? Can you choose who else will? Will you be able to support your system long term – have access to code, or guaranteed tech support 5 years from now, for example? Is your vendor over-reaching its skills? What similarly complex projects have they done? Is your project going to contribute to long-term capacity in the country, ministry, and institutions? Will it work to intended scale? 20 users is not the same as Is the design going to be done far away, or in dialogue with your users? Is your vendor willing to work with you to continuously correct the course?

Technology Architecture Assessement How do you assess if a technology will fit your HIS and is suited for national scale? Phase 1: Design Assesement Method: Establish areas of questioning for functional, nonfunctional, and business requirements. Functional Requirements: Based on the use cases required for the Rwanda HIS within a year (eg supporting registration, referrals, etc.). Nonfunctional Requirements: Based on industry practices Business Requirements: Based on practitioners’ input Facilitate architecture and design review in panel format (physical or virtual), performed with SMEs and following industry practices. Demonstration with Q&A Phase 2: Integration Pilot Method: 1.Establish claims (e.g. TORs, SLAs, etc.) for the assessment driven by MOH with expert review, including measurable qualitative attributes, quantitative metrics, and implementer opinions. 2. Get input from the real-world pilot as it runs 3. Have a facilitated retrospective analysis of the implementation pilot Phase 3: Scale & Security Method: Decide the use cases to be stressed (frequent, critical) Decide the parameters of the use cases and context to use in the stress Run stress test in synthetic environment (data, hardware) – in a staging environment Find the limiting factors of the system and what parameters expose them Document and share with implementers, to see if adjustments can fix the limiting factors Develop a threat and privacy model and perform a security review and penetration testing

Appendix

About InSTEDD iLabs

About InSTEDD Vision We envision a world where communities everywhere design and use technology to continuously improve their health, safety and development. Mission Our mission is to improve global health, safety and sustainable development through: – Building Capacity within communities to foster a local culture of innovation – Creating Collaboration Technologies for social good – Collaborating with End Users through a bottom up design and development process – Ensuring Usefulness and Impact through research and evaluation Values Social Responsibility - Collaboration - Agility

InSTEDD at a Glance Non-profit based in Silicon Valley, USA Programs: – Support of government, NGO and community programs – Bottom up design, scaled deployments, local ownership Innovation Labs: – Southeast Asia, based in Phnom Penh – Latin America, based in BsAs (2011) Technologies: – Collaboration and information flow technologies – Mobiles to back-end analytics, for experts, crowds, and beneficiaries – General use (e.g. mobile chats, reports) and specific (e.g. health informatics) – Open source & hosted Funded by Rockefeller, Google.org, USG and others

iLab Phnom Penh - Example Ongoing Projects HIV/AIDS Patients Appointment Reminder System Rapid Response Team Disease Surveillance Child Immunizations near China/Myanmar Border Community Surveillance System Primary Outbreak Investigation Report National Malaria Elimination All these have been designed and built by local iLab staff

The problem in ICT4D, eHealth, etc Sustainability Gap Who and how will maintain and evolve solutions over time? Design gap: Hard to build appropriate tech remotely Innovation Gap No systematic way to discover & support innovation Collaboration Gap How to break silos and involve the larger local community?

Innovation Labs address critical gaps Local social enterprise with service and product revenues Local Design of Applications and Programs Rapid field iteration accelerates innovation Open network of Government, NGOs, Private Sector, Universities, informal associations

InSTEDD iLab, Phnom Penh

InSTEDD iLab – Southeast Asia

InSTEDD Innovation Lab- Phnom Penh Locally registered InSTEDD branch Local Khmer staff – - Design, Product Management and field support - Engineering - Program Management Women in Leadership Bootstrap by Rockefeller and Google.org

Phnom Penh Innovation Lab Inception Build team Support regional biosurveillance Mobile Operator agreements 100% Local app design First local revenues National scaling of programs Collaboration Side effects Sponsored 1 st Barcamp ShareVision Created Phnom Penh Hackerspace Transition to Social Enterprise (18 months) Formal Evaluation TEDx Phnom Penh KYE Khmer Young Entrepreneurs +Rockefeller+ Google.org+ HI-PPP

Catalyst of Collaboration All these had direct sponsorship from, or were initiated by InSTEDD iLab members: ShareVision Mekong ICT Camp Khmer Young Entrepreneurs Association Barcamp Phnom Penh 2008, 2009, 2010 Hackerspace Phnom Penh Barcamp Vientiane 2010 Barcamp Yangon 2010, % of TEDx Presentations by iLab members

InSTEDD Innovation Labs Regional Assets Collaboration Center Technical capacity building & sharing Incubation and Acceleration Local and international mentorship Public and private sector partnerships

Becoming a Social Enterprise Triple bottom line: - Social Impact - Capacity Building - Economic Sustainability This affects selection of projects and org’s ‘scorecard’ M&E underway in 2011, independent evaluation

Built in iLab: Dynamic Resource Mapping Facility Registry, tracking resources, Web, Smartphone, and SMS access