This work closely aligns with the DPGA’s Health Community of Practice (CoP) which brings experts, including representatives from DICE, together to support the discovery, assessment and advancement of open source technologies with relevance to immunization delivery management. Through these convenings it became even more clear how critical access to digital health  global goods are in addressing Covid-19.

Well before the pandemic, countries were making significant strides in their digital transformations. COVID-19 has provided a galvanizing moment to support these efforts, but pandemic responses should utilise the immediate opportunity but with a long-term goal. We must support digital transformations not just for vaccine roll outs, but far beyond COVID-19. DICE accounts for this by providing technical assistance for countries to operationalise their national COVID-19 pandemic response plans, including vaccine deployments, in a way that improves service delivery more broadly, and enables data-based decision making which will strengthen health and immunization information systems.

We are pleased to support DPGA co-host, UNICEF, and the organisations behind DICE as they provide technical assistance that builds strong global digital systems. Read more on DICE below.

A multi-agency COVID Digital Health Centre of Excellence (DICE) co-led by the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) launched on April 29th, to provide coordinated technical assistance to national governments and partners on digital health interventions that address health priorities in the context of the COVID-19 pandemic, as well as post-pandemic health system needs. 

The COVID DICE is a consortium of partners, including the Bill & Melinda Gates Foundation (BMGF), GIZ, the US Centre for Disease Control, the European Commission, The Global Fund, The Foreign, Commonwealth & Development Office (FCDO), the Gavi Alliance, USAID, and the World Bank. It is co-hosted by a UNICEF-WHO virtual secretariat that will be managing day-to-day activities, including coordination with technical partners like Digital Square.

The COVID DICE is currently funded by a donation from the BMGF, and is designed to provide coordinated technical assistance to low- and middle income countries (LMICs) to support sustainable and scalable deployment of carefully chosen mature digital global goods for planning distribution of commodities and vaccines, tracking patients and supplies, surveillance and case detection, monitoring coverage of services, training health workers, and communicating with the general population to generate demand and reduce misinformation. 

Although the initiative is currently focused on addressing the immediate needs of the countries in the context of the COVID-19 response, the COVID DICE will also aim to fast track WHO’s Global Digital Health Strategy, thereby laying the foundation for a more comprehensive mechanism for harnessing the power of digital health technologies for overall health systems strengthening, in response to COVID-19 and beyond.

“UNICEF, WHO, and DICE partners are receiving a steady stream of requests for technical support for establishing digital solutions from governments, as they grapple with the unprecedented challenges brought by the COVID-19 pandemic,” said Aboubacar Kampo, UNICEF’s Director of Health. He continued, “the DICE will provide critical coordination and technical assistance to support the pandemic response and vaccine delivery, while balancing this with countries’ long-term vision for strengthening of health systems more broadly.”

As countries are operationalizing their national COVID-19 pandemic response plans, including deployment plans for the COVID-19 vaccines, they are turning to digital health interventions to amplify efforts to improve service delivery, make decisions based on actionable data, and strengthen health and immunization information systems more broadly. 

“Countries have already made significant investments in digital health systems, and many of these platforms can be expanded to provide substantial support to COVID-19 vaccine delivery and beyond,” said Bernardo Mariano Junior, Chief Information Officer and the Director of Digital Health and Innovation at WHO. “However, the enabling digital environment in Lower Middle Income Countries is often fragmented and not geared towards the support of large-scale vaccination delivery to the population.”

Carine Gachen from the Gavi Alliance shares this concern: “Poorly designed or inappropriate digital interventions, as well as vertical approaches geared only for COVID-19 vaccines, risk undermining and weakening national health systems. Countries must rapidly assess, identify, adopt, cost, and deploy robust and ready-to-scale digital health solutions to meet the demands as a pivotal preparation step for successful COVID-19 vaccine delivery.”

DICE will initially leverage existing partner capabilities so that it is operational immediately, and will seek additional funding and partnership support to coordinate and scale its ability to meet rapidly growing demand for assistance to select and deploy global goods for the COVID-19 response. 

DICE is creating a roster of consultants, volunteers and partner agencies to respond to country requests. Apply to the consultant roster before May 21st 2021. If you would like to get involved or support in other ways, write to: contact@digitalhealthcoe.org with the subject line “SUPPORT” with what services you are able to offer.

The Digital Public Goods Alliance looks forward to working closely with DICE on advancing relevant digital global goods via this exciting initiative.

Globally, significant progress has been made to harness the momentum of digital innovation and translate it to the healthcare sector. We’ve seen this, for example, in the unprecedented global cooperation on vaccine development. While these advancements are considerable, more must be done to support countries in their transition to digital health beyond the pandemic. COVID-19 has underscored the need for innovative solutions that have the ability to not only help countries respond, but also to strengthen digital cooperation and promote equitable access to health solutions. 

In recognition of this need, in 2020 the Digital Public Goods Alliance (DPGA) convened a Health Community of Practice (CoP) with UNICEF Health which focused on identifying DPGs for immunization delivery management. 

The DPGA Community of Practice Model

The DPGA convenes expert CoPs to support the discovery, assessment and advancement of digital public goods (DPGs) with high potential for addressing critical development needs in low- and middle-income countries. Currently, there are ongoing CoPs for climate change adaptation, health, and financial inclusion. Within these broad topics, each CoP narrows in on particular focus areas by considering relevance and potential impact of DPGs.

Aligning Initiatives for Digital Health

Several organisations within the development sector have been working to identify and support digital health technologies including WHO’s ClearingHouse and Digital Square’s Global Goods Guidebook. Though there are differences in criteria across these initiatives (discussed in the paper), in the health context, global goods can be considered mature digital public goods, and there are considerable opportunities for alignment that have the potential to accelerate the discovery and adoption of global goods.

In the coming weeks, the DPGA will be releasing a list of solutions identified by this CoP that meet all of the criteria to be recognized as both digital public goods and global goods of high relevance for immunization delivery management.

For more information, continue reading the full paper Understanding the Relationship between Digital Public Goods and Global Goods in the Context of Digital Health. 

Pathfinding pilots must adhere to three criteria: 1) include local capacity building for creation of new DPGs, and/or adaptation and implementation of existing DPGs; 2) outcomes of the pilots must adhere to the DPG Standard; and, 3) pilots must be conducted either in direct cooperation with and/or with the endorsement of a relevant government entity.

Some of these pilots are already underway. Below, we showcase the work of digital public goods DHIS2 and DHIS2 for Education as they, with support from Norway, launch pathfinding pilots in The Gambia and Uganda.

DHIS2 – A Digital Public Goods Case Study 

Digital Public Goods Introduction 

Endorsed by the UN Secretary General’s Roadmap for Digital Cooperation, the Digital Public Goods Alliance defines digital public goods (DPGs) as: “open source software, open data, open AI models, open standards and open content that adhere to privacy and other applicable laws and best practices, do no harm, and help attain the SDGs.”

When operationalised, DPGs have proven to be much more. They have the ability to connect individuals and communities to vital services, improve data-based decision making capabilities, and build the infrastructure that societies rely on to respond to crises. 

The Digital Public Goods Alliance (DPGA)’s mission is to aid the discovery, development, use of, and investment in DPGs. Amplifying success stories of DPGs to show their value, and highlighting implementation strategies from around the world is key to accelerating our mission. Strengthening understanding and awareness of DPGs is critical to fostering trust and interest in open source projects, and can help propel adoption. 

One success story is the free and open source platform DHIS2, which is helping to attain the SDG’s in 73 low- and middle-income countries by supporting the management of education and health programs.

Background

From climate change to education, healthcare to transportation, digital public goods have the opportunity to solve some of society’s greatest challenges. This can be exemplified by District Health Information Software 2 (DHIS2), an open-source software project first created to identify and address gaps in health data collection. The software has recently expanded to show value not just in the health sector, but in the education sector as well. DHIS2 was developed by the Health Information Systems Programme (HISP) at the University of Oslo (UiO) in collaboration with partners in the Global South. It is shared for download at no cost and its open source software and source code is hosted on Github.

The first version of this software, DHIS, began in 1998-99 fueled by the belief that collecting and layering granular data can help facilitate governments to make informed decisions. Initially, DHIS was developed to track routine monthly data from Primary Health Centers in Cape Town, South Africa.(1) Today, DHIS2 is the world’s largest health management information system (HMIS) platform, used in 73 low- and middle-income countries.(2) An astonishing 2.4 billion people, or 30% of the world’s population, live in countries where DHIS2 is used. 

Over the last decade, DHIS2 has expanded beyond traditional HMIS reporting to include the collection of individual-level data feeding into shared health records including: lab results; disease surveillance; contact tracing and more. Seventy-seven countries and Indian states utilise the DHIS2 Tracker for case-based data entry, and 33 are using the DHIS2 Android app for data capture on mobile devices.(3)(4)

Proving its versatility beyond government ministries, DHIS2 is also used for data management by leading health organizations including Doctors Without Borders and the World Health Organization (WHO). As a Collaborating Center with WHO, the HISP team at the University of Oslo works with global and country experts to create downloadable standards-based configurations of the software for specific health domains, lowering the barrier to entry for many countries, and improving data quality within and across countries.(5)(6)

Building on the same theory of change developed for expansion in the health sector, DHIS2 is two years into piloting “DHIS2 for Education”. Crucially, DHIS2 for Education builds on the existing DHIS software platform in countries where it is already deployed in the health sector to support the collection, analysis, visualization, and use of individual and aggregate data from institutions of learning.(7) This includes not just health and education data, but socioeconomic indicators as well that can help contextualize the health and education data. 

Through these work streams, DHIS2 is directly addressing UN Sustainable Development Goals 3 (Good Health and Well-Being) and 4 (Quality Education) which call for the use of data to guide improvement in both health and learning outcomes as well as equitable access to education. It also touches on a number of other SDGs including reducing inequality and eliminating poverty. 

By the Numbers 

• 73 countries use DHIS2 
• 5 countries use DHIS2 for Education
• 2.4 billion people live in places where DHIS2 is used
• 38 countries are using the software to combat COVID-19 

 Innovations 

DHIS2 by the numbers alone is impressive, but that only tells part of the story. DHIS2 is a widely trusted platform that promotes holistic growth and impact by providing innovative solutions, including:

Accessibility

DHIS2 is both physically and financially accessible. It can capture data on computers, tablets and smartphones and most solutions work offline, enabling improved reach in locations with poor connectivity. The platform integrates easily with other software platforms bringing logistics, human resources, grading systems and payroll onto a single dashboard. DHIS2 is free to use aside from the cost of servers and internet connectivity and, because it is open source, it can be accessed and adapted to scenarios in any country. 

Capacity Building 

To ensure holistic, sustainable growth, and to combat brain drain, the Health Information Systems Programme (HISP) has built a community of users and experts in regions where DHIS2 is used through initiatives including the DHIS2 Academy and DHIS2 Community of Practice. As DHIS2 implementation varies based on local context, this also facilitates shared learnings and implementation strategies.

Versatility

“DHIS2 has a modular, layered architecture with a strong and open application programming interface (API).”(8) In practice, this means that native applications can run off of it. Currently, approximately 60 native applications do just that to perform different functions, and software developers can easily build their own external applications on top of DHIS2 making it more adaptable. DHIS2’s API also allows it to exchange data with other software, facilitating interoperability between systems. This agility means that DHIS2 teams can work closely with users or government representatives to explore different needs and scenarios that arise and adapt accordingly.

COVID-19 Response 

DHIS2 has led projects that assist countries and regions responding to COVID-19. It has been evaluated as a leading digital solution for COVID-19 response by Johns Hopkins University, the United State’s Center for Disease Control & Prevention (CDC), and Digital Square. Understanding their ability to quickly respond and adapt to growing health concerns, DHIS2 released a digital data package to accelerate case detection, reporting, surveillance and response. 

The package was inspired by the Sri Lankan Ministry of Health’s pioneering design of a DHIS2 tracker for COVID-19 which draws on years of DHIS2 collaboration with the WHO on designing standardized packages for key health programs. The tracker is operational in 38 countries and in development in 14 more.(9) In Uganda, for example, local health authorities are transmitting infection results digitally. In Rwanda, the health care system is fully digitalised, allowing data to arrive instantaneously.(10) 

This innovation extends to the education sector as well. DHIS2 for Education uses an educational management information system (EMIS) that layers in health data and will provide long-term and sustainable responses to COVID-19 and other health challenges. One example is school-level vaccination campaigns which can synergize health and education data.

DHIS2 and Digital Public Goods Alliance Pathfinding 

DHIS2 has been reviewed against the Digital Public Goods Standard, qualifying it as a digital public good which can be found on the DPG Registry. 

DHIS2 software is developed in line with the Principles for Digital Development, and it advances the SDGs in a number of ways. DHIS2 for Education is currently being deployed as an EMIS in several countries, facilitating effective communication between health and education programs (for example, vaccination campaigns targeting school-aged children), as well as supporting purely education-related goals like student enrollment and attendance, resource allocation, and infrastructure management. DHIS2 has identified opportunities to address and overcome similar challenges in both the health and education sectors such as data collection, where there is often no common approach to collecting valuable educational system data, such as human resource data for teachers or student’s tests results, that link with district or national systems. You can read more about this initiative here: https://www.dhis2.org/education.

Over the next three years the DHIS2 in Education pilot will be expanded. The pilot will focus on integration and scalable solutions in specific country contexts. It will draw from different regions with varying languages, norms, and traditions which will help shape its ability to respond to different countries with different needs.

Norway, a founding member of the DPGA, has been a funder of DHIS2 since 1994 and will partner with them to use this extended pilot as one of the key pathfinding cases for the DPGA. Pathfinding pilots help inform the development and roll out of DPGs for future use cases. Supporting this effort is of strategic importance to Norway’s efforts to highlight how DPGs developed for one sector can be relevant for other sectors, and hence help break down silos in international development cooperation.

Conclusion 

DHIS2 exemplifies the power and potential of digital public goods. Not only has it successfully scaled in market, it has done so in a way that brings us closer to the achievement of the Sustainable Development Goals. Additionally, its development has been holistic and localisable, allowing countries to leverage their existing capacity and expertise. And, DHIS2 has adapted to various sectors and challenges including scaling for COVID-19 response and addressing challenges in education.

From its beginnings in Cape Town, DHIS2 has grown to significantly cover health data and information, and now education. It is this opportunity to break the silos of development, and address challenges holistically, that is particularly interesting to us at the DPGA. Digital public goods like DHIS2 present an opportunity to innovatively address longstanding societal issues. 

Resources

(1) https://en.wikipedia.org/wiki/DHIS
(2) https://www.dhis2.org/
(3) https://dhis2.org/tracker/
(4) https://dhis2.org/android-in-action/
(5) https://www.who.int/healthinfo/tools_data_analysis_routine_facility/en/
(6) https://dhis2.org/who/
(7) https://www.dhis2.org/education
(8) https://www.dhis2.org/about
(9) https://www.dhis2.org/in-action
(10) https://www.aftenposten.no/norge/i/qARnOz/fra-husokkupasjon-til-smittejakt-naa-hjelper-et-norsk-verktoey-tre-av-t

Last week we kicked off a four part series. In each part, we will share exciting work from one of the Co-Founders of the Digital Public Goods Alliance. This week we’re featuring Norway.

If you missed Part 1 on iSPIRT last week, you can see it here.

As we said last week, one of the fundamental strengths of the Digital Public Goods Alliance (DPGA) is its decentralized, yet coordinated structure. Each member of the current Interim Strategy Group (ISG) – consisting of iSPIRT, Norway, Sierra Leone and UNICEF – brings their own areas of expertise and interest to the DPGA which makes it stronger and more diverse in its reach and potential impact. As the DPGA is built out over time, membership will expand and change to include more stakeholders. In this four part series, we’re pleased to offer a snapshot of the exciting work being led by each of the current ISG members. This week we focus on Norway. 

Norway

Norway believes in the deployment of digital public goods as a means to help countries accelerate the attainment of the Sustainable Development Goals and is a proud champion and co-founder of the DPGA together with the government of Sierra Leone, UNICEF and iSPIRT.

Their work funds high-impact digital public goods in several sectors including health, early grade reading, climate and weather services, and plant pest management. 

In the wake of the COVID-19 pandemic, Norway has worked on expanding existing digital public goods in both the health and education sectors. One example is DHIS2, an open source, web-based software platform for data collection, management, and analysis, used by governments and NGOs in more than 100 countries. Starting with a pilot in Sri Lanka, more than 30 countries have deployed standardized DHIS2 COVID-19 surveillance digital data packages since the pandemic began. 

Norway has also seen a rapid scale up in the use of the Global Digital Library platform for openly licensed early grade reading resources, and together with ADEA and UNESCO are also supporting a number of countries in translating early grade reading books into local languages, and fast-tracking the availability of learning resources.

As the DPGA develops, Norway would like to engage other bilateral and philanthropic donors in conversations on how each can best contribute to supporting the global architecture around digital public goods.   

You can find out more about Norway’s commitment to digital public goods by reading their white paper for Digital Transformation and Development Policy or watching this address from Prime Minister Solberg. 

Norway is co-hosting the DPGA and will engage at the forefront of the Climate Adaptation Community of Practice. 

Visit their website or follow Norway on Twitter to learn more.

Since its launch, the Digital Public Goods Alliance — an initiative co-founded by iSPIRT, Sierra Leone, The Government of Norway and UNICEF — has been working to identify, support and promote digital public goods to implement recommendation 1B from the June 2019 Report of the UN Secretary-General’s High-level Panel on Digital Cooperation.  

Get Involved

Only by working together can we make this happen. The Digital Public Goods Alliance is, itself an open project, and we seek engagement and support from any governments, businesses, civil society, technology providers, donors, and experts wishing to help us achieve our aim.

Learn more about the Digital Public Goods Alliance on our website.

Follow our blog, or join our mailing list.

Want to contribute with funding, technology, or expertise? Sign up here. 

Nominate digital public goods through this form.