On October 27th, 2014 JSI hosted the third in a series of interactive sessions the Principles for Digital Development. This meeting focused on the Principle 3: Design to Scale. It began with a discussion of how to design for scale from the very start, transitioned to a discussion of the importance of considering the implications of design beyond the immediate project, and then concentrated on designing solutions that are replicable and customizable in other countries and contexts. Joy Kamunyori (JSI) facilitated the meeting. Kate Wilson (PATH), Marion McNabb (Pathfinder International) and Sarah Andersson (JSI) presented. More information about the principles can be found here: http://ict4dprinciples.org/

1. Defining Scale for
Digital Health Solutions
Photo credit: Brian Taliesin/PATH
Kate Wilson
Director, Digital
Health Solutions
October 27, 2014

2. 10/26/2014
It’s not
about us.
It’s not about
tech.
It’s not about
money.
It’s about
IMPACT.
Source: www.ict4dprinciples.org Photo credit: Kate Wilson

3. Why most IT projects struggle to scale
10/26/2014Page 3

4. 10/26/2014
Why the whole software continuum matters?
Claims Backlog in G
*”CFS2” conditions for sustainability and scalability, “SDLC” software development life cycle, “OS” operating systems, “TCO” total cost of
ownership.
DeployDevelopDesign
Context
Problems
Users
Processes
Requirements
CFS2*
Specifications
Data Model
User Interface
Device Types
Interfaces
Standards
SDLC*
Dev Tools
Data base
OS*
Network
Road Map
User Training
Migration Plan
Infrastructure
TCO*/Budget
Support Staff
Maintenance
1 2 3 4
Analysis
Most people start hereNeed a bit more focus here

5. PATH’s definition of scale in digital health
A digital health
intervention is at scale
when the information
system product is
institutionalized in the
practices of the people
using it and the
government or
community policies
support its continued
usage after catalytic
funding ends.
Photo credits: Kate Wilson, D Lukinsky
10/26/2014Page 5

6. Health
Need
Analysis
&
Design
Develop
& Test
Deploy &
Operate
Data
Use
Scale
The PATH approach to digital health solutions
Digital Health Solutions Continuum
Impact
Photo credits: Kate Wilson
10/26/2014Page 6

7. Sources
de
Financement
Structure
d'appro-
visionnement
1er point
de stockage
2ème point
de stockage
3ème point
de stockage
ETAT BANQUE
MONDIALE
FONDS
MONDIAL
PNA
(Population)
U
S
A
I
D
UNICEF USAIDPNA
PNA
Systèmes d'approvisionnement des produits pharmaceutiques au SENEGAL. Avril 2008
F
N
U
A
P
G
A
V
I
MEDICAMENTS
ESSENTIELS
ARVs
PALUDISME
Y compris ACT TB IO
ARVs
Ped
REACTIFS
sécurité du sang
(+ test HIV)
VACCINS Préservatifs Contraceptifs
Dispositifs
Médicaux
Etat
Bailleurs
multilatéraux
Bailleurs
bilatéraux
ONG/Privé
J
I
C
A
DLSIPEV
RM
Dépôt district
CS PS
DSR
OMS FNUAPJICA
PRA
SEIPS District
CHR SEIPS
Relais
Communautaire
Centre de dépistage
VIH/SIDA
PATIENT
Grossistes
privés /
Population
Grossistes
privés
Grossistes
privés
Officines
Structure
dispensatrice
DPCHU CHN Case de Santé
I
P
P
F
G
D
F
U
N
I
T
A
I
D
C
L
I
N
T
O
N
CNTS CLINTON CNLS GDF FHI
CNTS PPJ
Banque de
sang
CCA
Cliniques
privés
PNT
Ministère de la Santé
et de la Prévention MédicaleProcurement systems for pharmaceutical products – Senegal, Apr 2008
Is this health supply chain designed to scale?
10/26/2014Page 7

8. Global Common
Architecture
• Requirements
• Standards
• Guidelines
Country Specific
Architecture
• Requirements
• Standards
• Guidelines
Global Common
Solutions
• Software
• Hardware
• Services
Country Specific
Solutions
• Software
• Hardware
• Services
Services in
global context
Products in
global context
Products in
country
context
Services in
country
context
1 2
3 4
Building blocks of scalable HIS
10/26/2014Page 8

9. Global Common
Architecture
CRDM
Country Specific
Architecture
Global Common
Solutions
Country Specific
Solutions
Services in
global context
Products in
global context
Products in
country
context
Services in
country
context
1 2
3 4
Building blocks of scalable HIS
10/26/2014Page 9

10. Global common architecture: CRDM
10/26/2014Page 10
Common requirements
developed to:
1. Provide countries with a starting
point to create local versions of
requirements tested in Albania,
Senegal, Vietnam, Rwanda
2. Prepare tenders for information
systems (e.g., Rwanda, Vietnam)
3. Provide solution providers a self
assessment tool for existing
solutions as in the case of Village
Reach, SAGE Group plc, and
Partners in Health
4. Provide implementation agencies
a tool for strengthening country
LMIS as in the case of JEMBI in
Rwanda, PATH in Albania

11. 10/26/2014Page 11

12. Global Common
Architecture
CRDM
Country Specific
Architecture
Piloted in
Tanzania and
Zambia
Global Common
Solutions
Country Specific
Solutions
Services in
global context
Products in
global context
Products in
country
context
Services in
country
context
1 2
3 4
Building blocks of scalable HIS
10/26/2014Page 12

13. 10/26/2014Page 13

14. Page 14
CRDM was used in Zambia &
Tanzania to:
1. Develop and align stakeholders to a
shared vision of computerized LMIS
2. Establish governing principles for
guiding the development and
operations of the LMIS
3. Determine and document country
specific LMIS requirements for 800
products, drugs, lab supplies, and
medical supplies
4. Develop a project scope and budget
and secure funders for implementation
5. Build local capacity and partnerships
with USAID|DELIVER, SCMS, Crown
Agents, MoH, and Medical Stores
Limited
Country specific architecture
“The CRDM process has helped us envision
a holistic information system, gather inputs
from the right people, and move forward
into system development with confidence.”
Dr. G. Syakantu, Director-Clinical Care and
Diagnostics Services, Zambia Ministry of Health

15. Global Common
Architecture
CRDM
Country Specific
Architecture
Piloted in
Tanzania and
Zambia
Global Common
Solutions
OpenLMIS
Country Specific
Solutions
Services in
global context
Products in
global context
Products in
country
context
Services in
country
context
1 2
3 4
Building blocks of scalable HIS
10/26/2014Page 15

16. Global common solutions: OpenLMIS
10/26/2014Page 16
• PATH provided technical support to the project management team in
developing a product vision and roadmap, and during the development and
implementation phases of openLMIS.

17. Global Common
Architecture
CRDM
Country Specific
Architecture
Piloted in
Tanzania and
Zambia
Global Common
Solutions
OpenLMIS
Country Specific
Solutions
eLMIS
Services in
global context
Products in
global context
Products in
country
context
Services in
country
context
1 2
3 4
Building blocks of scalable HIS
10/26/2014Page 17

18. Page 18

19. Country specific solutions: eLMIS
eLMIS started nationwide
deployment in Zambia & in
Fall, 2013:
1. Built on OpenLMIS code base
2. Country specific solution deployed by
JSI via support through USAID/DELIVER
project.
3. Adding new features to the software
solution through 2014 in both
countries.

20. If you want to go fast, go alone.
If you want to go far,
go together. --African proverb
10/26/2014Page 20