Open Source Health Workforce Information Systems

This post was originally published on the Global Health Workforce Alliance Members’ Platform. CapacityPlus is the featured member in March. We encourage you to join and contribute to the discussion.

The World Health Organization recognizes a key component to achieving universal health coverage is “a sufficient capacity of well-trained, motivated health workers.” For many countries, successfully managing the distribution of their health workforce is reliant upon a human resources information system (HRIS). The better systems are developed with a user-centered approach and focus on data use. Good HRIS turn data into information that can inform the decision-making process.

Open source vs. proprietary software
Software systems are generally grouped into two business models: proprietary or open source. Proprietary software is licensed under exclusive legal right of the copyright holder. Users typically pay a fee and are restricted from making modifications and sharing or accessing the source code. On the other hand, open source software is licensed by the owner as public domain software, which is not subject to copyright and can be used for any purpose.

Open source software is collaboratively designed and developed by a community of volunteers and paid stakeholders who communicate and work together mostly via social media technologies. The source code is free and accessible to anyone who wishes to download a version to test it out and give feedback or make improvements. Proprietary software is developed and maintained by paid technicians, thus users must purchase the programs and pay yearly license fees.

Click on the videos below to hear how Uganda is benefiting from open source health workforce information system technologies:

Nineteen countries use iHRIS
The USAID- and PEPFAR-funded CapacityPlus project supports the free, open source iHRIS software. Nineteen countries are now using iHRIS to support over 800,000 health worker records. It would cost more than $149 million in licensing fees alone for these countries to support a similar number of records with a proprietary system purchased from for-profit companies.
iHRIS applications

  • iHRIS Manage supports ministries of health and other organizations to track, manage, deploy, and map their health workforces.
  • iHRIS Qualify enables professional councils and associations to maintain a database of registered and licensed health professionals to support increased quality of care.
  • iHRIS Plan is a tool used to project the likely changes in the health workforce under different scenarios and compare them with projected needs.
  • iHRIS Retain is a tool developed in collaboration with WHO to help countries plan and cost retention interventions.
  • iHRIS Train enables organizations to track and manage health worker training activities at the national level.

From paper files to an electronic HRIS

Interoperability among different systems
Health systems depend on many types of information related to patients, health workers, health centers, and health conditions. This vital information is usually held in different systems and locations in varying formats, making it hard to know what information is most complete, accurate, or up-to-date. The prevailing solution is to use open source technologies that can work together. At the heart of this effort is the PEPFAR-funded Open Health Information Exchange (OpenHIE). The OpenHIE community works to help underserved environments better leverage their electronic health information through standardization and interoperability among systems.

An OpenHIE sub-community led by CapacityPlus is developing an open source technology called the OpenHIE Health Worker Registry. Such a registry provides a big-picture view of a country’s health workforce, aggregating data from various systems in both the private and public sectors. The OpenHIE Health Worker Registry is capable of doing this because it uses a common language that all systems can adopt and use to exchange data.

One of the great benefits of open source technology is the ease with which new applications and solutions can be built upon prior open source work. For example, the social service sectors of Tanzania and Malawi are now using a version of iHRIS adapted for the social service workforce, schools participating in the Medical Education Partnership Initiative (MEPI) are beginning to use iHRIS to track medical graduates, and the One Million Community Health Worker Campaign is building on iHRIS and OpenHIE technologies to develop national community health workforce registries. Open source technologies are not just a solution for the problems of today, but can—with careful planning and foresight—lay the foundation for the solutions of tomorrow.

For discussion
The implementation of iHRIS has revealed a number of questions that each situation prompts, but often does not provide ready answers. We invite you to comment on the following:

  • Implementing open source solutions is a process, not a one-time event. Donors cannot simply go into a country, install iHRIS, leave, and expect the implementation to succeed. Even after the implementation has ended, regular monitoring and updating of the system will keep it useful and used. How can ministries of health and other organizations advocate for the resources needed to initiate and sustain the system?
  • Planning is important, but so is flexibility. The unexpected will arise. Even after thorough planning, there will be last-minute changes. Plans can and should be adjusted throughout the process. How have you utilized agile or iterative approaches in contexts where such an approach may be unfamiliar or lacking in support?
  • An information system is valuable only to the degree to which its data are used. This can be challenging in countries that do not have a culture of data use. What approaches have you seen succeed (or fail) to promote a culture of data use and effective feedback loops?
  • We described some of the emerging health workforce problems that open source health workforce technologies are helping address. From your perspective, what other health workforce problems could benefit from stronger information system technologies?

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