Global Health Delivery 2.0

Open-Sourcing Global Development Aid workers have just gained a whole new approach to their important work in developing countries. In a recent article in the widely regarded biomedical journal PLoS Medicine, physicians and epidemiologists from Harvard, Yale, and UCSF, affiliated with the non-profit organization Nyaya Health, have detailed several web-based tools for improving data sharing, performance monitoring, and collaboration. Some might call it “open-source development”; the authors call it “Global Health Delivery 2.0”.

The development industry, long plagued by lack of standards and accountability, should pay heed. Nyaya Health itself is part of a recent trend among new technology-savvy, transparency-aware non-profit organizations. Run by US- and Nepal-based health professionals, they operate a hospital in the district of Achham, Nepal, one of the most remote and impoverished communities in South Asia. The district, just emerging from a decade-long civil war, has minimal health infrastructure; there were no physicians for a population of 250,000 people prior to the start of Nyaya’s clinical operations. Owing to the telecommunications challenges in Achham, Nyaya Health has developed strategies that require minimal bandwidth and computing infrastructure. The thrust of the work described in their piece has been driven by their experiences caring for the sick in Nepal and “has been powered by simple, free, easy-to-learn systems that are powered by the open and collaborative nature of the Web 2.0 strategy.” Just as clinical trial and genomic data have been “open sourced” , leading to new advances in biomedicine, the researchers argue that data made public by networks of medical providers and public health practitioners can be useful for establishing standards and methods for care delivery and public health practice.

Nyaya Health utilizes five main web 2.0 strategies to share its operations protocols, outcomes data, costs, and organizational processes: quantitative outcomes data and logistics protocols on a wiki (a website that allows multiple users to quickly edit pages); an open access, online de-identified patient database; geospatial data analysis through real-time maps (electronic geographical information systems); qualitative information in the form of prose reports describing patients, logistics, management, and community politics on a blog (a website that displays email postings by date); and a public line-by-line online budget. In each of these endeavors, transparency and operations research go hand-in-hand. By maintaining all of their operational research data in a public online forum, they argue that they “are able to effectively communicate our continued process of programmatic revision and improvement, achieving institutional memory and acquiring critical feedback from our colleagues and supporters.”

In this new era of so-called “people-powered politics” and governmental transparency, the tools utilized by Nyaya Health in rural Nepal should be closely watched. Those who are passionate about the health and prosperity of individuals living in developing countries should all consider how to adopt Nyaya Health’s approach into their development work. In the words of the authors, “Developing common standards will improve clinical effectiveness and resource allocation to build a truly rigorous and innovative science of global health delivery.”