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mSupply Foundation: Ethical leaders in open-source healthcare solutions

  • Open-source software can be used and modified by anyone for any purpose for free and helps bridge global healthcare equality gaps.
  • Founder Craig Drown discusses the not-for-profit mSupply Foundation in New Zealand and its ethical open-source principles.
  • The Kiwi foundation has developed Open mSupply to help developing nations manage health supply chains through providing open-source software and services.

Founder and ‘Learner-in-Chief’ Craig Drown talks to Research Features about the mSupply Foundation, a non-profit organisation that supports low- and middle-income countries to manage health supply chains. Through providing open-source software, training and mentoring, the foundation’s Open mSupply offers free and innovative solutions to global disparities in health. We find out more about how the not-for-profit trust is helping to improve universal access to essential medicine.

mSupply workshop in Colombia.

We’d love to here about your kōrero, your story, at mSupply Foundation.

Late last century, I worked for an NGO in Nepal supplying medicines to hospitals and health projects. We needed to replace an old text-based system that was no longer supported – and couldn’t find anything suitable. So, we developed mSupply software. Amazingly, the NGO is still using mSupply 25 years later!

“When you’re working in countries with a long history of being exploited by others, shifting the power balance back in their favour is valuable.”

Forming the mSupply Foundation made our values explicit. Our Mātāpono (a Maori concept to describe our principles) leads with ‘working out of our ethic of love for others’. Starting with a deep sense of the value of every life, our particular area of focus is just a small contribution to the shared task of sustainably building a world where everyone is not just free but also loved – even as we work on seemingly intractable health and economic problems.

Team members at a new hospital in Fiji, April 2022.

Our main work focus is on developing the Open mSupply software system. It’s free and open source, and designed to (eventually!) do everything low and middle-income countries need to manage their health supply chains, all the way from running international procurement through to dispensing to patients in a tiny rural clinic.

Why is open source important for developing countries?

Our move to open source evolved from several good reasons. Firstly, commercial licensing comes with a certain power dynamic. Venture capitalists talk approvingly of ‘stickiness’ – where a software product locks in the user. But when you’re working in countries with a long history of being exploited by others, shifting the power balance back in their favour is valuable.

Open source has advantages for building a community and security. We welcome contributions from anyone and hope to build a community that transfers development skills to low- and middle-income countries. From a security perspective, all our code is available for anyone to audit, which contributes to secure, robust applications that keep everyone’s data safe.

We’re now working in almost 40 countries around the world, and the software is translated into six languages, so there’s huge potential to build both a system and a community that make a significant difference.

How can we improve access to essential medicine?

I’m reminded of Tolstoy’s ‘Happy families are all alike; every unhappy family is unhappy in its own way’. I take from that that there are lots of ways to fail, and to be successful you have to address them all. Firstly, getting everyone access to essential medicines is about people, and only secondarily about systems.

Local partner in Myanmar conducting training.

Most health systems have too few people and the competent ones get stretched to breaking point. What we have found works is utilising a superpower that humans have, and that’s persistence. Donors tend to work on 2 or 3-year cycles, whereas it realistically needs a decade or two of careful, sustained, coordinated work to make a lasting difference. We’re committed to the long haul.

On the systems side, we’re hoping that our Open mSupply becomes so good that it’s widely adopted and there’s a virtuous cycle of more input making it better, and wide adoption reducing costs per facility to the point where using it is a no-brainer.

DTAC is a project that improves healthcare access. Please tell us more!

In 2020, we launched DTAC, the Indo-Pacific Health & Supply Chain Data & Technical Assistance Centre. DTAC is a project to improve access to essential medicines and support long-term health system development in the wider Indo-Pacific region and is generously funded by the New Zealand government. It currently covers six countries in the Pacific – Tokelau, Tonga, Tuvalu, Niue, Samoa and the Cook Islands. The challenges they face are huge. These countries have very small medicine budgets – typically around $10 per person per year. Our role is to help them get the best possible outcomes with what they’ve got and to train local staff to achieve even better results without us in the future.

The local team in Myanmar.

We continually find the most dedicated, smart, kind people working quietly away in some remote corner of a country’s health system. We feel privileged to work with them to increase their skills, to acknowledge their service, and to help build the leaders of tomorrow. Often our help takes the form of mentoring – ‘let’s work on the annual tender together this year, next year you can do it yourselves, but still call us if you’re stuck.’

Which mSupply Foundation project are you most proud of?

Oh, that’s a hard one! I think our secret sauce has been our synchronisation system – this means that each facility can work offline. A synchronised system acts like it’s a fully connected system when there’s internet and ‘catches up’ after an internet outage. Without synchronisation during an internet outage, a user can’t access the system to carry out tasks. Now you might think ‘Elon and his Starlink will save the day’, and well they might, but our experience is that internet failures happen because a rat chews through a cable, or because someone forgets to pay the bill to the ISP – we’re not sure Elon’s going to solve those problems!

What’s your role at mSupply Foundation?

Craig Drown is ‘Learner-in-Chief’ at mSupply Foundation.

I am living proof of the maxim that people get promoted until they are incompetent at their job. Fortunately, I have been surrounded by a team who are fantastic. I hate the typical titles that my role has, but I would be OK with learner-in-chief. My learning these days is around how to work with teams, how to bring out the best in others, how to level up opportunities for the less privileged, and what challenges we need to navigate in this fragile world. A lot of this learning comes from my team! I also liaise with customers and donors and chart a course that applies our resources to where they’re most needed. We’re incredibly lucky to have roles that bring a tangible sense of making others’ lives better.

What exciting projects are in the pipeline?

For the last three years, we’ve been using generous funding from the Australian government to work on Bluetooth-enabled temperature sensors to monitor vaccines and other items needing low-temperature storage. We’re the only system in our sphere that integrates this with stock management. So, rather than just saying ‘this fridge had a temperature breach’ we can say ‘these batches of vaccine were exposed to these three temperature breaches at these locations’. This finer-grained picture enables large savings by only discarding what needs to be. We’re about to extend this system to cover vaccines in transit between facilities.

“The open-source community is a tremendous gift to humanity, with millions of hours given by some of the brightest people there are.”

We’re also interested in low-energy systems. We’re writing our software to use low energy, so it can then run on low-power hardware. This contributes to a world where every device is as efficient as it can be, minimising the cost of energy production and storage.

Finally, we are keeping a close eye on machine learning and see an application for the likes of Gradient Boosted Decision Trees (GBDTs), algorithms for solving prediction problems such as working out how much of an item to order by using large amounts of existing data. But we’re also aware that for most of our users the problem is someone forgot to place an order on time or the delivery truck has a flat tyre – not that their ordering algorithm isn’t AI-powered. We’re building in reminders for important actions with deadlines and maintenance schedules for equipment, so we might even help with that flat tyre!

Craig Drown with the local team in Timor-Leste, June 2022.

Tell us your final thoughts on open‑source software.

The open-source community is a tremendous gift to humanity, with millions of hours given by some of the brightest people there are. However, those people were only able to donate because someone else was paying them a wage, or at least feeding them, so while open-source software is thought of as free, it is actually produced with a lot of costs. The world is now totally reliant on core systems built on open-source projects that are grossly under-resourced. While the big tech companies are starting to contribute staff, that brings new challenges – certainly the temptation to steer these projects in directions that meet the wants of their shareholders rather than the needs of the world.

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Contact Details

e: [email protected]
t: +86 21 66137007*801
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Cite this Article

Drown, C, (2022), mSupply Foundation: Ethical leaders in open-source healthcare solutions. Research Features, 149.

DOI: 10.26904/RF-144-3485727984

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(CC BY-NC-ND 4.0) This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Creative Commons License

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