"... build a sustainable, high quality rural health system for the whole country."
- Bill Clinton, March 2007
The pilot phase of the project, currently being administered by Partners in Health and The Clinton Foundation is set to begin in the villages of Butaro and Kinoni on Monday. The systems infrastructure, comprised of the Sun Ray 2, Sun Fire X2100 server, and Solaris OS, were selected by the project steering committee to serve up the healthcare worker desktop environment. The selection criteria reflected the goals of the project as well as the relatively austere conditions where the healthcare facilities are located:
- Electricity is scarce and not terribly stable in rural Rwanda, so the Sun Ray 2, which consumes about 4 watts and is an entirely stateless device, is a good fit for the workstation. Attached to each Sun Ray is a low power 15" display which brings the total power consumed by each workstation to less than 25 watts. On the server end, the X2100 is the lowest power server available from Sun. The total electricity demand for the primary IT infrastructure in a typical clinic - 7 workstations (Sun Ray and display), 1 server, 1 network switch - is less than 500 watts.
- These facilities do not have extensive protection from the heat and dust that are common in Rwanda's rural villages, so reliable systems that will hold up to extremes is important. The Sun Fire X2100 is a reliable workhorse with good serviceability. Combine that with the Sun Ray's zero moving parts (except keyboard and mouse) and you have about the most reliable setup possible. Every clinic and hospital will inventory one spare Sun Ray, so if one does fail it's a simple replacement to put that workstation back into service - no installation or configuration required. Just attach it to the network and you're back to treating patients. Spare X2100 servers will be inventoried in Kigale, so a server failure will require that the replacement be dispatched to the facility for replacement.
- Rwanda is a fledgling economy. The ICT infrastructure upon which the healthcare system and other critical social services are built must be sustainable and low cost. Any dependence on proprietary commercial products would effectively impose a tax on growth and leave Rwanda's infrastructure at the mercy of foreign commercial enterprises. So, wherever possible, free and open source products were chosen. The Solaris operating system, the Gnome desktop environment, and the Open Office productivity tools fit the bill, and nicely complement the medical records software to be used in these clinics, OpenMRS.
OpenMRS and Africa's Health Workforce
OpenMRS is an open source application, written in Java, that was conceived by Paul Biondich at the Regenstrief Institute. It is designed expressly to address the need for electronic medical record keeping in the developing world, but also to serve as a framework for building generalized medical informatics systems. The Rwandan government selected OpenMRS as a key component of their healthcare scale up effort.A few countries in sub-Saharan Africa, Rwanda among them, have set a long range vision for national economic and social advancement. Vision 2020 is Rwanda's development strategy to achieve or even surpass developed world standards for national government, rule of law, education and human resources, infrastructure, entrepreneurship, and agriculture. OpenMRS and the supporting open source and energy efficient technologies from Sun contribute toward the infrastructure as well as the human resource goals of the plan. These tools will help to expand the pool of workers capable of delivering critical forms of healthcare by providing a standard protocol and reference resources to community members and paraprofessionals employed in health worker roles, thereby alleviating dependence on highly trained medical practitioners for routine diagnosis and procedures. Estimates from the development community and the UN indicate it would take more that 20 years for sub-Saharan countries to reach the 2.5 health workers per 1,000 people ratio to be consistent with UN targets, assuming they even had sufficient training capacity to matriculate that many doctors and nurses. Instead, OpenMRS helps to change the equation and make it possible to expand health care services much faster than would be possible in a traditional public health model.
In essence, the four workstations in the photo represent a new model health system, not only for Rwanda, but potentially for many other countries in the developing world.
Related Reading:
- Can Rwanda's Vision 2020 Succeed? post on WorldChanging.org
- OpenMRS FAQ
- Sun Ray in Health Care (and other Sun Ray success stories)
In the maelstrom of preoccupations that kept me awake last night, self-service in the cloud was a strangely prominent theme. A sad commentary on my slumber time, I know, but it was eerily coincident with news of OpenSolaris freed from a special registration process - when I woke this morning I found this announcement in my Inbox:
