OpenCHS — how it came to be
Today another implementation on OpenCHS platform went live. In Madhya Pradesh’s tribal districts, Jan Swasthya Sahyog is working with the state government to screen people for sickle cell. If they are screened positive, they will then be taken through clinical management including blood transfusion. The field workers will use OpenCHS app for data, case and work schedule management.
Given that we have been working on OpenCHS now for almost 3 years, I thought it may a good time to share what this journey has been like.
Beginning
While working and deploying Bahmni in rural hospitals, I got exposed to a world outside the hospitals — the community health ecosystem. This encompasses numerous activities that happen in — village centres, outpost clinics, primary health centres and at people’s home and doorsteps. Honestly, I found it more interesting even then, than Bahmni — since it promised immense possibilities of doing some creative and useful work. When I moved on from Bahmni, making community health software was a choice already made. In fact, I remember getting excited soon and started within 10 days with Mihir.
There was also a potential opportunity to work with Dr Anagha’s team from Lokbiradari Prakalp (LBP) for their new village program — essentially to assist village health workers to arrive at the right medication dosage for a dozen common complains in tribal areas. Two trips, long story, but we quickly (3–4 months) put together the first version of OpenCHS, which did this without Internet and did the basic job needed. Graciously, LBP asked us to make something more sophisticated for Ante Natal Care. Though it was for the project, I remember this as “angel funding” because by this time we had started Samanvay with very little work other than this :-).
Funding
The NGOs whom we knew from Bahmni days either connected us or they trusted us to do the implementation of OpenCHS for their programs when the product will be ready (by this time we were 5–6 people, most in part-time and in moral support capacity). Luckily around the same time, Social Alpha had started in Bangalore (long after putting up their board :-)) and Chai made a generous introduction. It worked out. Social Alpha has been supporting us for the last 20 months now. I consider Social Alpha to be a significant development, there are not too many places one can go if one is tech, non-profit and wants to make open source software. I believe we have a long journey to make together.
Economic model
Since Samanvay is a non-profit and OpenCHS is open source, the business model was just doing the obvious.
- The software of OpenCHS platform is a public good, hence makes sense to be funded via philanthropic money. There is no market option of finding investment for open source software designed for the development sector.
- Once the platform software is funded, it reduces the work of implementation significantly — making it affordable for most organisations that want to use it.
- We designed OpenCHS to be DB-row-level-multi-tenant so that a shared infrastructure can be maximally utilised, reducing the cost of hosting for everyone.
We learnt new things
- Community health is not limited to rural, but many organisations are also finding it relevant in urban setup — where physical access to hospitals/doctors is not an issue (unlike rural) but awareness and complexity of health issues makes home/community-based health services an option. Some of our implementations are completely urban and some are mixed.
- Each implementation is a long multi-year journey and going Live is just the beginning since many a time it is a completely new way of working for customers — no paper entry, data-based evaluation and decision making, depending on technology. But this is the most satisfying aspect — an opportunity to watch a client organisation grow, derive value/learnings, and demand more from us.
OpenCHS for all type of field work, not just health
In the last six months, it dawned on us that the organisation structure of many social/development/public work is similar to health. There are four distinct units — leadership/executive, program management, field-based supervisors and field workers. The field workers are similarly expected to provide service and do data collection and their program management team supports them based on data they see. For example — social workers who provide social security services to people like getting them AADHAAR card, pensions, ration card, scholarship for their child, etc need a similar system.
The question we grappled with when we got the first few requests/opportunities — will someone now need to develop another OpenCHS like system per sector? That sounded quite wasteful of public money and difficult given limited tech capacity of public space. After deliberation, we decided to use OpenCHS for other domains too, as you can see in the implementations list. But, this significantly expands our job which gives me nervous excitement.
As a consequence, we are now stuck with the name. OpenCHS expands to Open Community Health System but if we are using it for other sectors then the name is wrong.
