Scaling technology-driven innovation successfully

Challenge

Innovations can make a significant difference in the response to development challenges. Many Development Assistance Committee (DAC) members therefore support innovation efforts and leverage innovation capacities that exist in their own countries. However, when innovations are designed in and for high-income countries, transferring them to low- or middle-income countries often leads to suboptimal outcomes, as they often depend on well-developed infrastructure and are designed for users with different behavioural patterns. The traditional North-South technology transfer approach to innovation undervalues local innovation capacities and the potential of grassroots and frugal innovators, with the risk of distorting local innovation ecosystems.

Approach

Since the beginning of the Health Information Systems Programme (HISP) in 1994, in post-apartheid South Africa, Norway’s development co-operation agency Norad has funded a project of the Norwegian University of Oslo and the South African University of the Western Cape to develop the District Health Information Software 2 (DHIS2) to manage health data in developing countries. To increase the likelihood of bringing DHIS to scale, Norway and the project team ensured the following:

• High degree of country ownership: An adaptable approach that can complement health ministries’ existing systems in resource constrained contexts. Data ownership rests with each user institution.

• Open source: This avoids constraints around licensing and fees, while facilitating learning and improvement with potential contributors from across the globe. An open and well-documented architecture also helps to facilitate interoperability with other national information systems.

• Capacity-building: Over 135 DHIS2 “academies” have provided training and support to platform users, building local capacity in each country of deployment, while regional network groups, co-ordinated by the University of Oslo, provide training and implementation support.

• Sustained engagement: Norway has supported the DHIS2 for over two decades, contributing to its expansion and continuous improvement through multi-year projects which are renewed upon achievement of predefined objectives. Norway has also advocated for other partners to support the project in order to improve its financial stability, reduce donor-driven development, drive strategic direction, and reduce risk.

Results

The success of the initiative has allowed it to expand and sustain growth over time, attracting substantial funding from large development co-operation partners in the health sector. DHIS2 has become the world’s largest health-information management system, used by 73 low- and middle-income countries in 2021.

Thanks to DHIS2, governments can better plan and co-ordinate their health sector interventions. For example, Sri Lanka used DHIS2 to quickly launch a national COVID-19 tracking system, Malawi uses DHIS2 to monitor stock-out rates and consumption for health supplies, and Afghanistan makes performance-based payments to healthcare providers using DHIS2 dashboards. Accountability actors can also better assess progress, and development co-operation partners can similarly plan and track the effects of their support.

The open and simple architecture as well as the widespread use of DHIS2 software has enabled cross-sector applications, such as in water and sanitation, agriculture, education and other sectors. This is supported by a robust DHIS2 user, implementer and developer community, the growth of which has been facilitated by DHIS2 “academies” and other capacity-building activities.