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An Introduction to

Global Goods

Carl Fourie

Senior Technical Advisor

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“Governments around the world are embracing this new age of digital health transformation. Expectations are high as more governments look towards these new tools and the connections they create.”

Dr. Mpoki Ulisubisya, Permanent Secretary�Tanzania Ministry of Health, Community Development, Gender, Elderly and Children

OpenHIE Community Meeting, July 2018

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The impact of digital technologies on our lives is indisputable. With increasing global connectivity, advances in technology, and decreasing barriers to entry, digital technologies are shaping our collective future. Governments are looking for more strategic ways to use these tools, and expectations are high that they can help us reach our health goals, such as universal health coverage, Sustainable Development Goal 3, and generally improving health services for individuals.

The quote you see here is from Dr. Mpoki Ulisubisya, Permanent Secretary of Tanzania’s MoHCDGEC, from the first OpenHIE Community Meeting. During his speech, he reiterated the importance and potential of digital tools in the future of health care. He is one of many government officials committed to integrating digital technology into health systems in a more strategic way.

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Digital health promises a future with more responsive, participatory health care—but only for those who can access it.

Governments need quality, affordable digital health technologies that work for all communities.

The future of digital health relies on better alignment among country leaders, investors, and innovators.

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Digital Square was created to address the need for alignment and coordination in the digital health sector.

Digital Square | connecting the world for better health

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“Create funding mechanisms and models that enable co-funding and both build and sustain digital health commons.”�

USAID–Fighting Ebola with Information, 2016

“Transition investments towards global public goods that build national health systems.”

�National Academies of Science, Engineering, and Medicine, May 2017

“Ecosystem collaboration is needed to address current fragmentation and create a holistic digital health model.”�

GSMA–Scaling Digital Health in Developing Markets, June 2017

“Support interoperability of digital technologies for health by...the use of international and open standards as an affordable, effective and easily adaptable solution.”

WHO Resolution 2017–A71/A/CONF./1

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Vision

A world where appropriate use of digitally enabled health services closes the health equity gap.

Mission

Digital Square coordinates investments into smart, scalable health technology solutions and creates an environment in which �they can be sustained.

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Digital Square addresses the need for �a thriving marketplace for digital health.

Digital Square | connecting the world for better health

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Alignment & �Co-investment

Global Goods

Regional & �Country Systems

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Digital Square promotes the development, adoption, and reuse of digital health global goods. We partner with innovators to increase the availability, adaptability, and maturity of high-quality software, service, and content options for countries.

Digital Square | connecting the world for better health

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Global Goods

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Software in Global Health Over Time

A Spengler, U Wahser: How to Build a Global Good

09/05/2019

"We can use computers!"

"We can re-use software!"

"We can free the code!"

"We can co-create!"

~ 1985

~ 1995

Public Domain

~ 2005

Open Source

~ 2015

Global Goods

Pilotitis

APPendicitis

Computer Graveyards

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Health Information System Landscape

iHRIS �health

workforce

DHIS2�public health & �service delivery indicators

Many Pilots

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Global Goods

Digital Square is working to change the health information system ecosystem through stronger collaboration.

The digital health space faces the challenge of 1000 flowers blooming, or a health systems disease that we call “pilotitis.” The proliferation of unsustainable pilots and tools caused some countries, such as Uganda (whose official statement calling for coordination in eHealth is featured as the center image) to call for digital health efforts to be harmonized and coordinated, mandating a stop to one-off pilots that do not support the Ministry of Health’s goals and tools that do not integrate with their established health information systems.

Increasingly, tools supported by a strong, collaborative global community of develop and implementers– like the iHRIS workforce information system now used in 25+ countries or DHIS2 used in 60+ countries – offer a much needed response to the pilotitis problem. These tools have the potential to achieve interoperability at scale as they are often the De-facto authorities for health system metadata; Have existing networks of local and regional informaticians, developers, implementers; and are often part of MOH HIS strategic plans and donor funding requests.

Digital Square supports theses kinds of adaptable, interoperable digital health tools called “global goods” that can be used across different countries and contexts. Mature digital health global good software is software that is (usually) Free and Open Source Software, is supported by a strong community, has a clear governance structure, is funded by multiple sources, has been deployed at significant scale, is used across multiple countries, has demonstrated effectiveness, is designed to be interoperable, and is an emergent standard application.

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Curating the Garden with IHEs

architecture

reference implementation

and standards

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Digital Square supports adaptable, interoperable digital health tools and technologies called global goods that can be used across different countries and contexts.

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Principles for Digital Development

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Design with the User

�

Understand the Existing Ecosystem

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Design for Scale

Build for Sustainability

Be Data Driven

�

Use Open Standards, Open Data, Open Source, and Open Innovation��

Reuse and Improve

�

Address Privacy & Security

Be Collaborative

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Calls to Action: Coordination in Digital Health

Digital Square | connecting the world for better health

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“Transition investments towards global public goods that build national health systems.”

�National Academies of Science, Engineering, and Medicine, May 2017

“Ecosystem collaboration is needed to address current fragmentation and create a holistic digital health model.”�

GSMA–Scaling Digital Health in Developing Markets, �June 2017

“Create funding mechanisms and models that enable co-funding and both build and sustain digital health commons. ”�

USAID–Fighting Ebola with Information, 2016

“Support interoperability of digital technologies for health by... the use of international and open standards as an affordable, effective and

easily adaptable solution.”

WHO Resolution 2017–A71/A/CONF./1

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Digital Square | connecting the world for better health

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Digital Health Global Goods

Global goods are digital health tools that are adaptable to different countries and contexts. There are three types of global goods:

Software

A software tool that is free, open source, and used to manage, analyze, or transmit health-related data, with proven utility in several settings.

Services

A software tool that is used to manage, transmit, or analyze health-related data that can be freely accessed as a software service and adheres to open data principles.

Content

A resource, toolkit, or data standard that is available under an open license and that is used to improve or analyze health data management processes.

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Using Global Goods for Digital Health

Digital Square | connecting the world for better health

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Global Goods Maturity Model

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Software Maturity

Security
Scalability
Software productization
Technical documentation
Interoperability and data accessibility

Global Utility

Country utilization
Country strategy
Digital health interventions
Source code accessibility
Funding and revenue

Community Support

Community engagement
Community governance
Software roadmap
User documentation
Multilingual support

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Digital Square | connecting the world for better health

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Open Proposal Process

Vetted by Peer Review�Committee

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Open Application Process

Digital Square | connecting the world for better health

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Open Proposal Process

Open Submission �of Concept Notes

Vetted by Peer Review�Committee

Funding Decisions by Board

Proposal �Co-creation & Collaborative Feedback

Final Proposal & Budget Submission

Periodically, Digital Square holds a “open call for applications,” whereby organizations can submit concept notes for new global goods investments using an Open Application Process.

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Digital Square Investments:

System Categories & Global Reach

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Client Health Records (9)

2.2

Client identification and registration (6)

2.1

Telemedicine (3)

2.4

Healthcare provider decision support (9)

2.3

Referral coordination (7)

2.6

Healthcare provider communication (3)

2.5

Healthcare provider training (1)

2.8

Health worker activity planning & scheduling (6)

2.7

Laboratory and Imaging Management Diagnostics (6)

2.10

Prescription and medication management (2)

2.9

Untargeted Client Communication

1.2

Targeted Client Communication (1)

1.1

Personal Health Tracking

1.4

Client to Client Communication

1.3

On-demand information services to clients (2)

1.6

Citizen-based Reporting (2)

1.5

Client financial transactions

1.7

Legend

Shaded (#): # global goods supported by Digital Square (approved by Governing Board)
White: Not currently supported by Digital Square

Supply Chain Management (3)

3.2

Human Resource Management (2)

3.1

Civil Registration and Vital Statistics (1)

3.4

Public Health Event Notification (2)

3.3

Equipment and Asset Management (1)

3.6

Health Financing (1)

3.5

Facility Management (4)

3.7

Data Coding (1)

4.2

Data Collection, Management and Use (9)

4.1

Data Exchange and Interoperability (4)

4.4

Location Mapping (6)

4.3

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Public Health Disease Surveillance System

Empty Box*

mHero*

ODK

Reveal

SORMAS

Electronic Medical Records

Laboratory Diagnostics Information System

Telemedicine

Data Interchange, Interoperability and Accessibility

Facility Management Information System

OpenHIE*

OpenELIS*

Child Growth Monitor

Bahmni*

OpenMRS*

OpenSRP

Mobile WACh

OpenDeliver

mSpray

LIS COP*

OpenHIM*

GOFR*

Healthsites*

Health Management Information System

Logistics Management Information System

Civil Registration and Vital Statistics

Clinical Terminology and Classifications

Community-based Information System

Geographic Information System

Health Finance and Insurance Information System

Human Resource Information System

Knowledge Management System

Pharmacy Information System

Shared Health Record and Health Info. Repositories

Census, Population Information & Data Warehouse

DHIS2*

OpenCHS*

OpenLMIS*

Logistimo

OpenCRVS*

Open Concept Lab*

CommCare*

Planwise

OpenIMIS*

iHRIS*

Digital Health Atlas

Pharmadex

HEARTH*

Client Applications

Client Communication Systems

Emergency Response System

Environmental Monitoring System

Identification Registries &Directories

Learning and Training System

Research Information Systems

Digital Square approved global goods aligned with WHO Classifications of digital health interventions

Legend:

31 total global goods (19 funded)

*Aligned with OpenHIE

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Digital Square | connecting the world for better health

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Level 1

Level 2

Level 3

Level 4

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Global Goods Guidebook Version 1.0

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Guide for Novices, Designers, Evaluators, & Integrators

Educates health information system designers, evaluators, and integrators about best practices in implementing global goods
Includes external resources for digital health novices, designers, evaluators and integrators

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Arranged by WHO System Categories

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Extracts from the Guidebook: Frequently Asked Questions

What are the benefits of global goods?

Vendor lock-in can be avoided
Freely available and modifiable source code
Shared cost of new feature development and software

What is the price of a global good?

There is no cost to access the source code.
There are costs associated with deploying a global good.
These costs may include the procurement of services to configure, extend of model the tool within its existing architecture.
There may also be costs associated with aligning the tool to existing and emerging policies and strategies.

Here are two of the most frequently asked questions about global goods that we address in the guidebook.

Wat are the benefits of global goods?

Since global goods are open source tools, there are a wide range of benefits to their use:

Many developers contribute to a global good; therefore, vendor lock-in, a situation in which customers are unable to switch developers without a substantial cost, well that can be avoided. The source code is freely available and modifiable so there are more opportunities for collaboration across organizations and health programs areas.

The cost of new feature development and software maintenance is shared across users and supporters of global goods, so resources can be focused on adaptation and implementation.

Software development best practices in requirements gathering and user acceptance testing, have already been undertaken, and so resources can be focused elsewhere.

What is the price of a global good?

Global goods are open source solutions; therefore, there is no cost to access the code. There is always a cost in deploying an information system or digital health intervention. These costs may include the procurement of services to configure, extend, or model the tool within its existing architecture. As digital health tools are deployed as part of a national health information system, there may also be costs associated with aligning the tool to existing and emerging policies and strategies.

Some of the other questions answered in the guidebook are: How do I implement a global good? Where should the software be developed? And how will software users obtain technical support? These questions are important because the software isn’t proprietary; one can hire local developers to work on adapting the global good or answering tech support calls; thereby, building capacity at the local level.

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Example: DHIS2

The guidebook is a useful marketing tool for the global goods themselves like DHIS2. DHIS2 can use the two-page entry to pitch new investors and explain their work to evaluators, integrators, and designers. As a whole, the guidebook promotes the entire community of global goods, that they are part of a group of digital health tools recommended by our technical Peer Review Committee and approved by our Board of Directors, which includes well-regarded leaders and thinkers in the global health and technology sectors.

At Digital Square, we provide services to the global good community beyond investment. This tool is just one in a suite of services that include monthly webinars on topics such as governance, communications and advocacy, and resource mobilization, among others. We also have a quarterly newsletter in which we share updates on Digital Square as well as news and announcements from the global goods themselves.

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Example: openIMIS

The guidebook is a useful marketing tool for the global goods themselves like DHIS2. DHIS2 can use the two-page entry to pitch new investors and explain their work to evaluators, integrators, and designers. As a whole, the guidebook promotes the entire community of global goods, that they are part of a group of digital health tools recommended by our technical Peer Review Committee and approved by our Board of Directors, which includes well-regarded leaders and thinkers in the global health and technology sectors.

At Digital Square, we provide services to the global good community beyond investment. This tool is just one in a suite of services that include monthly webinars on topics such as governance, communications and advocacy, and resource mobilization, among others. We also have a quarterly newsletter in which we share updates on Digital Square as well as news and announcements from the global goods themselves.

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Example: OpenLMIS

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Notice A

Bahmni: Transition
Digital Health Atlas: Core Development and Implementation Support
eIDSR: Core Development
GOFR: Core Development and Implementation
iHRIS Foundation: Core Development and Community Support
Open Data Kit 2: Core Development and Transition
OpenLMIS: Core Development and Community Support

Notice B

Strengthening the OpenCRVS System
Strengthening and Expanding OpenHIM
DHIS2 Community of Practice
Illuminate Data with a DHIS2 Business Intelligence Connector
OpenMRS Sync 2.0 Module Development, Implementations, and Maintenance
Packaging OpenSRP for Scale and Community-Driven National Adoption
Global Healthsites Mapping Project
Open Source LIS Technologies Community of Practice
OpenLMIS Advocacy and Community Engagement
Expanding the Bahmni Hospital System as a FOSS Project

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Current investments

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Notice C

OpenLMIS: advancing a collaborative, open, and growing community
Strengthening the OpenMRS
Integration of the OpenELIS open-source laboratory information system with leading clinical and logistics information systems
mHero: a packaged workflow for technologists
Instant OpenHIE
DHIS2 utility suite
DHIS2 as an analytics, reporting, and visualization solution for openIMIS
Develop a claim submission, enrollment, and enrollment verification using HL7 FHIR standards, openIMIS, and OpenMRS
Integrating openIMIS with Bahmni: a Nepal-based proof-of-concept project

Notice D

Open Concept Lab (OCL)

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Current investments

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Shelf Ready Requirements

Required score according to Global Good Maturity Model

Supports standards for data exchange as appropriate

Aligns with DevOps & Cloud-Services guidelines

Aligns with OpenHIE �Architecture

Has entry in Global Good Guidebook

Global Utility Digital Health Interventions (high) Source Code Accessibility (high) Community Support Software Roadmap (medium) User Documentation (medium) Multi-Lingual Support (medium)	Software Maturity Technical Documentation (medium) Software Productization (medium) Interoperability & Data Accessibility (medium) Security (medium) Scalability (medium)

Metadata mCSD : Health Facility and Worker PRIM : Client Demographics mSVS : Terminologies GS1 : Product Catalogs	Business Domains (m)ADX : Aggregate Data Exchange mACM : Alerting CCG : Clinical Decision Support

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Questions for panel

Sharing on your experience of going through the maturity model:

What did you learn about your tool in going through the model?
How did, if it did, going through process of evaluating the maturity of your tool guide where you wanted to invest?
What as the Digital Square Global Goods investment coordination facilitate you doing that you wouldn’t have been able to do before?
What does it mean to you to be a global good?

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Thank You!�

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Global Good Shelf Components: Metadata Services

Component \| Tool	Functionality \| Software	Funding
Facility Registry \| GOFR	Import, Export and Deduplication \| GOFR Data store \| HAPI Facility Management Interface \| TBD Metadata sync with DHIS2 \| Instant OpenHIE Metadata sync with iHRIS \| Instant OpenHIE Metadata sync with Points of Service \| Instant OpenHIE	Notice A - USAID, OGAC Existing Notice E - BMGF #2 (proposed) Notice C - BMGF #1 Notice C - BMGF #1 Notice E - BMGF #2 (proposed)
Terminology Service \| OCL	Terminology Management Interface \| OCL FHIR Terminology Synchronization \| TBD Packaging \| Dockerization of OCL	Existing component Aligned – DATIM (proposed) Notice C - BMGF #1
Health Workforce Management \| iHRIS	Health Worker Management \| iHRIS Health worker communication management \| mHero SMS flow management \| RapidPro Packaging \| Dockerization of mHero, iHRIS	Existing component Existing component Existing component Notice C - BMGF #1
Client Registry \| TBD	Client Registry Management Interface \| TBD Data store \| HAPI	Aligned PEPFAR/CDC Existing component
Product Registry \| PCMT	Core functionality \| PCMT Country requirements \| PCMT	Direct - USAID FP Direct - TGF, BMGF (proposed)

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Global Good Shelf Components: Point of Service

Component \| Tool	Functionality \| Software	Funding
Facility EMR \| OpenMRS	Core functionality \| OpenMRS Operational Data Synchronization FHIR \| Sync 2.0 Client Registry Sync \| TBD	Existing component Notice B (BMGF #1) Notice F - BMGF #2
Facility EMR \| Bahmni	Core functionality \| Bahmni Community support \| Bahmni Client Registry Sync \| TBD	Existing component Notice A (BMGF #1) Notice F - BMGF #2
Community EMR \| OpenSRP	Core functionality \| OpenSRP Client Registry Sync \| TBD	Existing component Notice F - BMGF #2 (proposed)
Community EMR \| CommCare	Core functionality \| OpenSRP Client Registry Sync \| TBD Facility Registry Sync \| TBD	Existing component Notice F - BMGF #2 (proposed) Notice E - BMGF #2 (proposed)
eIDSR \| SORMAS	Core functionality \| SORMAS Client Registry Sync \| TBD Facility Registry Sync \|	Existing Notice F - BMGF #2 Notice C (unfunded)
Immunization Registry \| ZeIR-TBD	Core functionality \| ZeIR Globalization \| ZeIR-TBD	Existing component Notice E (potential)

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Global Good Shelf Components: Business Domain Services

Component \| Tool	Functionality \| Software	Funding
Health Management Information System \| DHIS2	Core functionality \| DHIS2 Aggregate FHIR Interoperability \| DHIS2 FHIR Module Summinity support \| http://community.dhis2.org	Existing component, OGAC, BMGF OGAC, BMGF (requested) Notice B - BMGF #1
Shared Health Record \| TBD	Core functionality \| TBD Data store \| HAPI Computable Care \| CQL Ruler	Notice F - TBD Existing component Notice D - OGAC (proposed)
Supply Chain \| OpenLMIS	Core functionality \| OpenLMIS Core feature development \| OpenLMIS gap functionality Sustainable business model support \| TBD	Existing component Direct investment - USAID, BMGF Notice E - BMGF #2
Health Insurance \| openIMIS	Core functionality \| openIMIS FHIR Interoperability \| openIMIS modularization Standards based claims adjudication \| OpenIMS Data analytics, Machine Learning/AI \| TBD	Existing component Notice C1 - GIZ, USAID Notice D.5 - GIZ Notice D.5 - GIZ

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Three tiers of shelves and potentials for shelf-ready tools

Business Domain Services

Shared Health Record

HAPI

Health Management Information System

DHIS2

Health Insurance Management System

openIMIS

Supply Chain Management

OpenLMIS

Point of Service Systems

Electronic Medical Records

OpenMRS

Hospital Management System

Bahmni

Community Health Worker Tools

CommCare, DHIS2, Tracker, Medic Mobile

Disease Surveillance Tools

SORMAS

Immunization Registry

ZeIR

Metadata Registries + Interoperability Layer

Client Registry

OSCR

Facility Registry

GOFR + TBD

Terminology Service

Open Concept Lab

Health Worker Registry

IHRIS

Product Registry

PCMT

Indicator Registry

OCL + HAPI

Interoperability Layer

OpenHIM

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Shelf Ready Activities Timeline

Initiated in 2019

Initiated in 2020

Notice B/C Obligation �Obligate remaining money to point of service system to get shelf ready | BMGF #1

Client Registry �Landscape analysis and technical design recommendation | BMGF #2- Measure/CDC

Notices Top-up �Review approved work packages and fund activities which are directly towards getting “shelf-ready” | BMGF #2

Notice E

Get “shelf-ready” | BMGF #2�Can we limit to entries in Global Good Guide Book?
Facility Registry management interface | BMGF #2, OGAC?
Instant OpenHIE integration - sync metadata with Registry Services | BMGF #2, USAID-SC?, OGAC?

Notice F | BMGF #2, plus others

Client Registry | BMGF #2, ...
Instant OpenHIE integration - sync operational data with Business Domain Services | BMGF #2, ...

Global Help Desk

Notice G

Cloud service integration | ?
Core functionality investments | BMGF #2, …

Component \| Tool	Functionality \| Software	Funding
Facility Registry \| GOFR	Import, Export and Deduplication \| GOFR Data store \| HAPI Facility Management Interface \| TBD Metadata sync with DHIS2 \| Instant OpenHIE Metadata sync with iHRIS \| Instant OpenHIE Metadata sync with Points of Service \| Instant OpenHIE	Notice A - USAID, OGAC Existing Notice E - BMGF #2 (proposed) Notice C - BMGF #1 Notice C - BMGF #1 Notice E - BMGF #2 (proposed)
Terminology Service \| OCL	Terminology Management Interface \| OCL FHIR Terminology Synchronization \| TBD Packaging \| Dockerization of OCL	Existing component Aligned – DATIM (proposed) Notice C - BMGF #1
Health Workforce Management \| iHRIS	Health Worker Management \| iHRIS Health worker communication management \| mHero SMS flow management \| RapidPro Packaging \| Dockerization of mHero, iHRIS	Existing component Existing component Existing component Notice C - BMGF #1
Client Registry \| TBD	Client Registry Management Interface \| TBD Data store \| HAPI	Aligned PEPFAR/CDC Existing component
Product Registry \| PCMT	Core functionality \| PCMT Country requirements \| PCMT	Direct - USAID FP Direct - TGF, BMGF (proposed)

Component \| Tool	Functionality \| Software	Funding
Facility EMR \| OpenMRS	Core functionality \| OpenMRS Operational Data Synchronization FHIR \| Sync 2.0 Client Registry Sync \| TBD	Existing component Notice B (BMGF #1) Notice F - BMGF #2
Facility EMR \| Bahmni	Core functionality \| Bahmni Community support \| Bahmni Client Registry Sync \| TBD	Existing component Notice A (BMGF #1) Notice F - BMGF #2
Community EMR \| OpenSRP	Core functionality \| OpenSRP Client Registry Sync \| TBD	Existing component Notice F - BMGF #2 (proposed)
Community EMR \| CommCare	Core functionality \| OpenSRP Client Registry Sync \| TBD Facility Registry Sync \| TBD	Existing component Notice F - BMGF #2 (proposed) Notice E - BMGF #2 (proposed)
eIDSR \| SORMAS	Core functionality \| SORMAS Client Registry Sync \| TBD Facility Registry Sync \|	Existing Notice F - BMGF #2 Notice C (unfunded)
Immunization Registry \| ZeIR-TBD	Core functionality \| ZeIR Globalization \| ZeIR-TBD	Existing component Notice E (potential)

Component \| Tool	Functionality \| Software	Funding
Health Management Information System \| DHIS2	Core functionality \| DHIS2 Aggregate FHIR Interoperability \| DHIS2 FHIR Module Summinity support \| http://community.dhis2.org	Existing component, OGAC, BMGF OGAC, BMGF (requested) Notice B - BMGF #1
Shared Health Record \| TBD	Core functionality \| TBD Data store \| HAPI Computable Care \| CQL Ruler	Notice F - TBD Existing component Notice D - OGAC (proposed)
Supply Chain \| OpenLMIS	Core functionality \| OpenLMIS Core feature development \| OpenLMIS gap functionality Sustainable business model support \| TBD	Existing component Direct investment - USAID, BMGF Notice E - BMGF #2
Health Insurance \| openIMIS	Core functionality \| openIMIS FHIR Interoperability \| openIMIS modularization Standards based claims adjudication \| OpenIMS Data analytics, Machine Learning/AI \| TBD	Existing component Notice C1 - GIZ, USAID Notice D.5 - GIZ Notice D.5 - GIZ