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an illustrative example. In 1989, while still under extensive international sanctions, academics at the University of Stellenbosch forged a digital link to the University of Oregon and suddenly South African universities were on the Internet. In spite of this, the growth of Internet access in Africa has been slow as challenges ranging from a lack basic access to power, to high communication access costs, to lack of human capacity to build and manage networks have slowed the pace of Internet growth.
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explicitly open approaches to intellectual property, or more generically through collective contributions and action, open opportunities to tap into human potential in ways that until a few years ago were inconceivable. Yet, understanding and measuring the value of open is extremely challenging. Measuring the impact of open is complex even in traditional settings. Digital goods can have several functions simultaneously. For example, a piece of Open Source software can simultaneously be a source of revenue for consultants, a platform for others to build on, a tool that can solve the same problem in multiple locations simultaneously, a learning environment, a focal point for community, the underpinning of Software-as-a-Service (SaaS) industries and/or the basis for other commercial software. The deep value of being connected to a digital network is generativity. The more ideas and innovations people are exposed to the more learning and the more potential for new ideas and innovations to emerge. Yet,it is over simplistic to say that the more open a network is, the more generative it is. Something can be free and open but if the cost of accessing via a digital network is too high then any generative value of openness is lost. A digital service may be completely closed from a traditional Open Source point of view but if access to the service is very low cost and the extent of the network reach is large enough (think Facebook, Twitter, Gmail) then it may still constitute a generative environment. For example, Facebook is a wellknown for its walled-garden approach to its network but because the transaction cost of accessing it is so low and its network reach so pervasive, it was able to play a powerful generative role in the Arab Spring in Tunisia and Egypt. This is not to paint Facebook as an ideal environment for generativity but rather to point out that when the transaction cost of human communication is low enough, generativity happens but at a social level not a code level.
Layers of Openness
It is worth exploring the idea of layers of openness. The Internet is built on a layered model. The OSI Modeliv separates aspects of connectivity into layers so that parts of the access infrastructure can evolve or change without affecting the overall connectivity. Thus, it doesn't matter whether you are connected to the Internet via a copper wire, a fibre optic cable, or a wireless connection as that physical layer of connectivity is independent of the other functional aspects of connectivity such as error correction, encryption, web servers, VoIP, etc. The next layer up from the physical infrastructure of the Internet which manages the flow of bits from one place to another is unconcerned with the underlying physical technologies. Similarly, applications on the Internet such as web servers are unconcerned with the underlying routing of digital traffic on the Internet. Finally people are generally unconcerned about what applications they use as long as they are able to share knowledge effectively with others. It might be an interesting framework of analysis to examine generativity and the importance of openness from a layered perspective. Inspired by the OSI model, perhaps one might develop a layered model for openness.
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Physical Access to Spectrum, Open Access to Fibre Backones, Access etc Transport Open versus closed networks, censorship, walled gardens, interconnection fees, etc. Platforms Availability of the building blocks of the Internet, web servers, programming and scripting languages, etc. Applications Availability of easy to adapt tools such as blogs, social sites, etc. People general availability of human communication and networking tools
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platform tools can be hard to measure though because their effects are so fundamental that value can only inferred from markets enabled by them. Other examples of open platform tools are the many web-scripting languages such as PHP and others and, more recently, web frameworks such as Ruby-on-Rails, Django et al as well as popular blogging and content management systems such as Wordpress and Drupal. An Africa-specific example of an Open Source platform application is OpenMRS (http://www.openmrs.org), a collaborative open source project to develop software to support the delivery of health care in developing countries. Avenues for Exploration It would be challenging to evaluate the impact of most platform tools simply because they are so pervasive and non-exclusive. There are few instances where one can say that a particular digital platform is used here but not there. However, OpenMRS may offer a unique opportunity to examine the impact of an Open Source platform for a few reasons: a) It is relatively young. At seven years old, it is possible to chart the entire history of OpenMRS in some detail; b) It is developing-country specific. OpenMRS was created to specifically address a developing country challenge; c) It has commercial alternatives. OpenMRS is a FLOSS alternative to commercial medical record systems which can offer comparative benchmarks on a variety of levels from performance to financial to systemic; and, d) At a country level, there are countries where OpenMRS has been implemented and countries that have no instances of OpenMRS. The above opens the possibility of making a reasonable comparison of OpenMRS implementations versus other approaches. Perhaps more ambitiously, it could be used to examine links to health policy and general health information ecosystems in countries where OpenMRS has been implemented versus non-implementing countries. Research Summary An Open Source platform like OpenMRS offers an alternative approach to innovation, capacitybuilding, learning, and sustainability than that of commercial software platforms. OpenMRS may have the potential to be the Apache web server of the electronic medical record industry but issues of sustainability, competitiveness, and ecosystem are not well understood. This research would attempt to compare and contrast Open Source and proprietary approaches with the intention of better understanding the strengths and weaknesses of each. Projects to Investigate Carry out a comparative analysis of three different Medical Record System implementations. 1. Open Source System OpenMRS (http://en.wikipedia.org/wiki/OpenMRS): A collaborative open source project to develop software to support the delivery of health care in developing countries. It
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would be possible to choose one or more of the lead implementation countries for OpenMRS. A case study could be chosen from Rwanda, Kenya, Haiti, or Pakistan. 2. Publicly-Funded Proprietary System SmartCare (http://en.wikipedia.org/wiki/SmartCare): An electronic health record system (EHR) developed by the Centers for Disease Control and Prevention (CDC) in Zambia in collaboration with the Ministry of Health (MOH) Zambia and other implementing partners. This is an example of a publicly-funded (PEPFAR, CDC, et al) yet proprietary medical record system. 3. Commercial Proprietary System Meditech (http://www.meditech.co.za/): A comprehensive and integrated Electronic Health Record (EHR) system that can be adapted to a variety of medical management needs. Meditech South Africa is a subsidiary of Meditech, a Boston-based privately-held company. Meditech's deployments in Kwa-Zulu Natal and/or Botswana could be used. Analysis Perspectives Financial Analysis Claims that Open Source software is cheaper than commercial software have been challenged in the past by commercial software providers who have argued that the Total Cost of Ownership (TCO) of Open Source software is higher than that of commercial software. The lack of a single standard methodology for measuring TCO has meant that the results of TCO analyses have been quite varied. Thus this debate remains largely unresolved. However, this is still an important point of investigation for an initiative such as OpenMRS and there are useful methodologies to draw on such as this TCO-Model approach developed by the Swiss governmentv. An investigation should then calculate the Total Cost of Ownership (TCO) of each three implementations over a 5 year period using a recognised TCO methodology, including: key system differentiators hardware and software costs cost of customisation support and capacity-building costs hidden costs reliability and risks security There may be some challenges in comparing publicly funded projects and commercial software. It could be argued that publicly funded software, such as the case of the CDC medical record project in Zambia, is all customisation since the software was purpose-built for the application. Nevertheless it is likely that a rationally justified line in the sand may be drawn for each project. Innovation Analysis Arguably more important and generally under-examined is the role that each software system plays in catalysing innovation, learning, and growth in the social and economic ecosystem in
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which they operate. To what extent do these systems: facilitate replication? act as a platform for new products? build capacity of implementers and users? stimulate innovation? embrace collaboration? encourage standards? cultivate sustainability? produce unexpected benefits?
This part of the research would examine the innovation ecosystem around each of the MRS platforms used. Determine the extent to which they have enabled new businesses, innovations, capabilities. Using a exponential discriminative snowball samplingvi methodology, researchers would begin by interviewing the person(s) principally responsible for the overall strategic development of the software with a structured set of questions designed to elicit the positive outcomes listed above. Each interviewee would then would be asked to name five people who most exemplify some of the positive outcomes described above. These fifteen people would be interviewed in a similar manner. These too would be asked to identify five people who exemplify the above criteria although it is likely that a subset of these selected people will be required to round out the analysis of each project. These interviews should provide a rich comparative base to explore the strengths and weaknesses of the three approaches. Learning and Empowerment Analysis Estimate the extent to which each implementation fostered an ecosystem of learning around which the capacity to strategically implement a medical record system. Carry out an analysis of the learning and support community created by OpenMRS including Google Summer of Code, online communities, problem-solving, etc. as compared with Smartcare and Meditech. Embed research questions in econometric research above designed to elicit sense of ownership and commitment that project owners feel towards their medical record system implementation.
Comments The field of electronic medical records in the developing world is necessarily constrained but it is the constrained nature of the sector that offers hope of an effective comparative analysis between open and proprietary approaches. As an Open Source initiative, OpenMRS has grown dramatically since its humble beginning in Eldoret, Kenya. Yet, proprietary medical record systems continue to thrive as well. This research will explore the full value chain of both approaches and produce a deeper understanding of the impact of open versus proprietary which should inform policy-makers, health system professionals, and entrepreneurs alike.
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There is a small but growing recognition from development professionals. Economists from Harvard University, the Canadian International Development Agency (CIDA), and the International Development Research Centre (IDRC) have joined Stuart Kauffman in calling for recognition of the importance of diversity and generativity in developing economiesx. This is a very broad and challenging question that naturally extends well beyond ICTs and development. However, generativity is central to the current debate around Internet protocols and standards and is recognised as a core element of open networks and tools. Having seen the catalytic power of communication networks, is it possible to interrogate the role of open networks and technologies in increasing diversity and generativity in developing country economies. Hausmann and Hidalgo have developed a useful proxy for understanding diversity in countries by contrasting the number of exports in a given country with the relatively ubiquity of product. They use scarcity of a product as a proxy indicator of the complexity of the product itself. Avenues for exploration There is an interesting research analogy to explore here in the context of ICTs and Development. Traditional macro analyses of the impact of ICT infrastructure have tended to focus on penetration as a correlate of GDP growth. It would be interesting to explore whether there is something that can be said about ICT diversity as an indicator of growth. In particular, it would be interesting to contrast the impressive growth in Kenya's ICT sectorxi (see graph at right) both internally in comparison with other sector as well as with other economies in sub-Saharan Africa. The challenge in pursuing this angle of inquiry would be to find a useful metric to measure digital diversity. Hausmann and Hidalgo's use of exports as a proxy indicator allowed them to avoid the thornier question of what diversity is specifically made up of. In their analysis it is simply all that it takes to produce a product for export. I've tried but haven't yet come up with a fruitful angle of inquiry into this.
It is possible that one might develop an ICT diversity framework against which one might come up with an aggregate score for the ICT sector but I fear that this would end up being too subjective as a lens for analysis. My instinct is there is some interesting avenue of exploration along the lines of diversity and also density of connections that might produce some interesting insights but I haven't worked out where a suitable data or proxy data might be found.
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Are there cases where Open Standards have had a significant impact in the developing world? It is of course possible to look at the general suite of Open Standards around the Internet and look at its growth but this is too high a level of analysis to tell us anything useful. Possible standards for exploration: GSM versus CDMA in wireless networks Closed versus open messaging networks (BBM, Facebook, Twitter, SMS, etc) Document formats PDF, MSWord, ODF, etc Standards for data communication setup on 3G phones. Cheap chinese phones don't work out of the box but more expensive phones do, better supported by the operators. Points to a lack of standard for 3G connectivity.
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the market so it would be difficult to estimate an impact in the developing world of the Android OS. Equally there are many open aspects to Android beyond the power of View Source. In South Africa there has been significant development of value-added industries where entrepreneurs have taken Open Source applications such as Wordpress, Drupal, and others and adapted them for clients. The ability to View Source has been fundamental to the development of this market. One might also credit the early growth of the ISP industry in many developing countries to the power of View Source where new ISPs could emulate larger and more well-established ISPs in the industrialised world by viewing and adapting standard configurations for Open Source tools.
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This concept is not particularly new. The concept of Communities of Practice was developed by Etienne Wenger and has since become entrenched in the framework of corporate knowledge management good practice. However, Open Source communities share the benefit of being able to share a common code base allowing for very deep knowledge sharing and skills development. A particularly power example of this has been the African Network Operators Group (AFNOG http://afnog.org) is a community of technical operators of Internet networks in Africa. The community exists to share knowledge and to build technical capacity across the continent. The group, founded in 2000, meets annually to share knowledge and carry out workshops and training for people new to the field. They represent a powerful professional association that are enabled through open licenses and open standards to share knowledge freely, problem-solve, and support each other. Another more recent example is the Information and Communication Technologies for Community Health Workers (ICT4CHW) Google groupxviii which is a remarkable community of technical experts from with the field of community health work who are pioneering new technologies to facilitate community health services. They don't have the same level of organisation as AFNOG but are another remarkable example of knowledge sharing particular in the application of Open Source mobile tools for data collection and dissemination. Avenues for Exploration An interesting research avenue to pursue here would be to carry out some longitudinal studies of community members who have been enabled through their membership of these digital Open Source communities.
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Open Development: A New Theory for ICT4D - Matthew L. Smith, Laurent Elder, Heloise Emdon http://itidjournal.org/itid/article/viewFile/692/290 Vodacom warns against 'a dramatic reduction of charges http://mybroadband.co.za/news/business/9988-vodacom-warns-against-a-dramatic-reduction-ofcharges.html 13 Oct 2009 (Accessed on 18 Dec 2011) Mobile Termination Benchmarking: The Case of Namibia - Christoph Stork - Towards Evidence-based ICT Policy and Regulation Volume TWO - Policy Paper 3 2010 http://www.researchictafrica.net/publications/Policy_Paper_Series_Towards_Evidencebased_ICT_Policy_and_Regulation_-_Volume_2/Vol%202%20Paper%203%20-%20Mobile%20Termination %20Benchmarking%20-%20the%20case%20of%20Namibia.pdf OSI Model - http://en.wikipedia.org/wiki/OSI_model TCO-model and TCO-tool are part of the implementation of the OSS-Strategy of the Swiss Government. http://www.tcotool.org/index_en.html Snowball Sampling Experimental Resources - http://www.experiment-resources.com/snowballsampling.html Reference Stuart Kauffman, Tim Harford, Steven Johnson, Eric Beinhocker Paul Romer http://www.econlib.org/library/Enc/EconomicGrowth.html The building blocks of economic complexity - Cesar A. Hidalgo and Ricardo Hausmann - PNAS June 30, 2009 vol. 106 no. 26 NPR - Beyond The 'Washington Consensus:' Economic Webs And Growth http://www.npr.org/blogs/13.7/2010/01/beyond_the_washington_consensu.html Learning from a Kenyan revolution - Wolgang Fengler - 2011-11-28 http://blogs.worldbank.org/africacan/learning-from-a-kenyan-revolution The Wikipedia entry for Open Standards illustrates that there is some variance in the details of what is an Open Standard - http://en.wikipedia.org/wiki/Open_standard Business Insider Chart of the Day - http://www.businessinsider.com/chart-of-the-day-android-is-takingover-the-smartphone-market-2011-11 Adobe Logic - http://piracy.ssrc.org/adobe-logic/ CNN Money - Author Paulo Coelho's profitable Net obsession 1 Feb 2008 http://money.cnn.com/2008/02/01/technology/kirkpatrick_coehlo.fortune/index.htm Tacky and Proud: Exploring Tecnobregas Value Network - Ana Domb Krauskopf http://www.valuenetworksandcollaboration.com/images/C3TecnobregaWhitePaper.pdf African Economic Forum 2011 - http://africanspotlight.com/2011/04/african-economic-forum-2011/ ICT4CHW Google Group - http://groups.google.com/group/ict4chw TxtEagle is now JANA.
Apologies for the complete absence of any sort of consistent endnote formatting. To be corrected.