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Free and open source software (FOSS) offers tremendous advantages to the health sector of developing countries. The session "FOSS in healthcare" at InWEnt's 1st Interdisciplinary Alumni Conference Southeast Asia in Hanoi in July 2010 discussed these advantages. The session also offered hands-on opportunities to test drive actual FOSS electronic health records and eHealth applications in Southeast Asia. It drew on experiences by the "International Open Source Network" (IOSN) in ASEAN as a main partner in the InWEnt programme "it@foss - Promoting Free and Open Source Software in Southeast Asia" (2005-2009). Based on this, the session explored opportunities for further network building and capacity building in ASEAN in the area of "FOSS in healthcare" to strenghten open health systems as part of a regional integration framework in Southeast Asia. For the outcomes of the session, see below in section "Outcomes of the Workgroup IX".



The International Open Source Network (IOSN) is a Center of Excellence for FOSS in the Asia-Pacific Region. It shapes its activities around Free/Open Source Software (FOSS) technologies and applications. The IOSN is tasked specifically to facilitate and network FOSS advocates and human resources in the region. The vision is that developing countries in the Asia-Pacific Region can achieve rapid and sustained economic and social development by using affordable yet effective FOSS ICT solutions to bridge the digital divide.

The IOSN ASEAN+3 Regional Node is hosted by the University of the Philippines Manila National Telehealth Center and serves the ASEAN countries (Brunei, Cambodia, Indonesia, Laos, Malaysia, Philippines, Thailand, and Vietnam) including China, Japan and Republic of Korea. See and

About InWEnts it@foss programme

it@foss supports the development and application of local innovative software solutions and business models based on free and open source software (FOSS) in the ASEAN region. From 2005 to 2009, InWEnt and IOSN Asean+3 have trained and connected more than 1000 experts and trainers from Indonesia, Cambodia, Laos, Vietnam and the Philippines in more than 30 training courses under the it@foss program. This has lead to increased decision making information shared with more than 13.000 stakeholders from public and private sector in Southeast Asia. For more information, see

Intro to Open Source in health initiatives in Southeast Asia

The application of FOSS in healthcare has been happening in small pockets in Southeast Asia. In Indonesia, Anis Fuad and team at the Public Health Department of the Faculty of Medicine, Universitas Gadjah Mada (UGM) has created open source versions of SIMPUS (Sistem Informasi Manajemen Puskesmas = Primary Health Care Information System) which is accessible in UGM Website using user:demo and password:demo. It has been implemented in several districts, including in Wonosobo district. In the Philippines, the UP Manila National Telehealth Center has been at the forefront of FOSS for health with their home-grown Community Health Information Tracking System and OpenMRS implementations.

A feature of "FOSS for health" initiatives in Southeast Asia with interviews, examples and background info is now online at the InWEnt Alumni-newsletter (in English, Spanish an German).

Check the feature here:

and here:

and here:

There are substantial benefits for deploying open source for health. Dr. Marcelo maintains a blog about this at

Objectives of the working group

Based on the above, the session had the following objectives:

  • increase awareness of the working group and of all participants of the conference on what is Free and Open Source Software in general and how FOSS is advantageous to the health sector in particular
  • increase appreciation of the open source software methodology as a catalyst to building capacity in health IT - building on the respective expertise of all participants in the field of healthcare and/or informatics.
  • increase regional networking in ASEAN on the issue of FOSS in healthcare
  • increase buy-in for FOSS in general from us as a group by allowing all participants of the session to learn a new FOSS application (Mediawiki, statusdotnet) which we can use to strengthen their community before, during and after the event

Facilitating Team


  • Dr. Alex I. Gavino, Coordinator for Telehealth Services, University of the Philippines UP Manila - National Telehealth centre (lead)
  • Ariel S. Betan (co-lead)
  • Dong Calmada (documenter)  
  • Secretariat: Hoang Viet (InWent volunteer)
  • Rapporteur(s):
    • Session A: Cecile Benavidez
    • Session B: Dr. Anis Fuad
    • Session C: Ariel S. Betan

Outcomes of the Workgroup IX

Day 1


  • Session was moderated by Mr. Balthas Seibold (InWent).
  • There was a round of introduction by all 25 participants. Introduction revolved around their names, current work/involvements, involvement with InWent, expectations, and their favorite team to win in the World Cup.
  • An overview of FOSS and its application in health care was provided by Dr. Alex Gavino. In the process of his presentation, the following points were discussed and emphasized:
    • Health professionals' lack of awareness on use of IT, much less FOSS.
    • Policy environment (priorities, incentives, etc.) affects FOSS/IT adoption in health work
    • Patient satisfaction also affects adoption of IT
  • Based on the discussions arising from Dr. Gavino's input, participants were asked to write on flip charts their needs as users (health professionals, health workers, etc.) and services as providers/technologists/software developers.
  • Dr. Cecil Granada-Benavidez volunteered to report back to the plenary session.

Expectations from the workgroup sessions


  • share experiences on successes and challenges in FOSS for healthcare
  • learn, if there are reports on how IT / FOSS increases key indicators of success in healthcare (such as patient satisfaction etc)
  • "have a blind date with open source"


  • learn about OpenMRS and dictionaries
  • get good programme for hospital management
  • open source payment systems
  • sort out the different aspects / functions / solutions of IT in healthcare (electronic medical records, la btest, billing , e-prescription, pharmacy, statistical system etc...)


  • compatibility of FOSS / data exchange / (open) standards
  • regional integration: which standards to use? what to share?
  • learn, if and how new (FOSS) systems be combined with previous data of old systems
  • learn about solutions for data sharing for public health reporting


  • how to overcome challenges from user side
  • learn about licence and other costs of different software models
  • how to deal with change management


  • developing applications
  • promoting FOSS in e-health

Questions about FOSS for Health

From the 1st session:

  • Azham from the Faculty of Medicine, Jember University has been using information systems to store medical record data. He would like to hear any suggestion on how to combine the old database with the upcoming adopted FOSS software (most probably OpenMRS).
  • Arif (Karyadi Hospital, Semarang, ID) would like learn about FOSS for hospital management, especially for human resources management.
  • Anis (Universitas Gadjah Mada) would like to hear other countries experiment regarding electronic standards for public health report data exchange.

Day 2


Reports from Case Study Sharing Sessions

Session Summary

  • e-prescription (by Irma [Indonesia])
  • Telemedicine System with Multi-Communication Links
    • (led by Soegi [Indonesia])
    • It consists of a mobile unit and base unit
    • Different types of telemedicine applications have been discussed
    • Telemedicine has great potentials in: a) improving community health care services; b) extending health care services in underserved rural and remote areas, c) supporting health care in disaster/emergency management
    • A number of challenges should be solved for sustainability
  • SIMPUS (by Didieb [Indonesia])
  • HIMS (by Thanh [Vietnam])

Summary of Reports

  • Using FOSS in electronic health info systems can be implemented with their benefits/advantages
    • May be adapted to particular contexts and needs (e.g., disaster management)
    • Facilitates procedures (e.g., prescription, patient data gathering, making reports)
    • Cost-efficient
    • Various technologies may be adopted
    • (See 4 freedoms)
  • Issues/Challenges:
    • Political environment (policies, political will, etc.)
    • Sustained support (hands-on, mentoring, 'support tickets', etc.)
    • Change management
    • Standards (data, reporting, public vs. private data, etc.)
    • Identification of specific needs
    • Lack of awareness on e-health (use of IT in health care)
    • Lack of infrastructure (e.g., using e-health in far-flung areas)
  • Solutions/Strategies:
    • Look for/link with local developers and independent software vendors (ISVs) using/'selling' FOSS
    • Search and register in e-forums, mailing lists, etc.
    • Capacity building
  • Notes:
    • Not all problems in electronic health management may be solved by FOSS.

Outcome of discussion on concrete capacity building initiative

As InWent Alumni coming from different professions, we can contribute to regional integration through interdisciplinary collaboration, sharing common norms and values we share our knowledge and skills with one another and others.

As part of Working Group IX coming from the IT and health professions, we contribute to regional integration through our partnership, building a community for FOSS in health care and sharing our different knowledge and skills to the development of more accessible and affordable health care as follows:


provide information to all group members on different FOSS software solutions, including information on strengths and weaknesses of different software, assessment for software


- starting point: [1]


Case studies: best practices and "worst practices" (= lessons learned) and problems encountered and business models and health management problems

- demo of working solutions.

and: assess national initiatives in FOSS for health: overcome language barrier and add content: e.g. Indonesian initiatives to be added.

Several university programmes on health informatics / look at curricula - make inventory of existing training initiatives

Where: [2] who: everyone

3) NETWORKING AND INTEGRATION THRU FINDING COMMON LANGUAGE - GLOSSARY OF REGIONAL TERMS e.g. definition for the group of what terms like "electronic health record" mean to the different stakeholders in Southeast Asia / taxonomy of key terms

Where: our wiki who: (glossary soegi upload)

also inviting health professionals and professional organizations:


(including OpenMRS), also invite other southeast asian delegates - post natinonal conferences to group - repository of national and international conferences (including

those, who use different terms but also deal with core issues).


5) REGIONAL NETWORKING AND CAPACITY BUILDING THROUGH VIRTUAL CONFERENCES: - look at "shops m-health" conference: open virtual conference

(problem of time difference with western time) - medium-term: organize own regional virtual conference (without

time shifts). - Idea Holden: provide a virtual conference system (server

needed)... OPEN SOURCE big blue bottom / integrates with moodle

- idea of lectures via skype


first step: - share knowledge within group (particularly between non/health IT/people and IT knowledge for non-IT) - [make explanations of key terms] "medicine for non-doctors" and "IT for doctors" training/seminars

- e-learning?

second step: - training course for IT personnel for provincial level

(cost-sharing, but not in the province itself, so that everyone is

concentrated): learned how to do website for province via joomla,

then public health, then medical records ...

- idea: share advocacy material on FOSS for e-health and other

topics regionally. creative commons?

who: holden, soegi if tranlation possible,

- suggestion: blend FOSS with other CB-courses such as e-learning.

- integrate one lecture on e-health in health manager courses of


other future steps: - Bandung volunteers to be potential node for capacity building in FOSS for healthcare - most difficult: for decision maker - idea of framework for capacity building


- exchange and collaboration, not sameness


- expand the group.

How We Do It (best practice and lessons learned)




Getting started

Related Events

IOSN / InWEnt 2009: Asia Source 3 meeting reinforces Asian Free and Open Source Software movement

One example of regional integration through FOSS cooperation is the regional gathering Asia Source 3 in November 2009. Asia Source 3 gathered 150 representatives in the Yen Center to discuss developments in open source, including in the health sector. With funding input by the ASEAN Foundation and German BMZ, the event was organized by the International Open Source Network (IOSN) and InWEnt - Capacity Building International of Germany. The Federal Ministry for Economic Cooperation and Development of Germany (BMZ), the ASEAN Foundation and the Open Society Institute funded Asia Source 3, with the aim to increasing awareness and adoption of free and open source software. Asia Source 3 campers represented a large cross section of non-governmental organizations, small businesses, youth networks, and technology entrepreneurs from 15 countries. While technology issues permeated the discussions, it took place with an emphasis on the economic and social context of cooperation among developing countries

IOSN / InWEnt 2008: Regional Conference-Workshop on Demonstrating Open Source for Healthcare (IOSN-InWEnt), Penang, Malaysia More information here: [3]

Open Source in Health with the Open Source Health Care Alliance (OSHCA), Federal Hotel May 2007, Kuala Lumpur, Malaysia


Target group

  • health professionals (including alumni of InWEnt health programmes such as xxplease addx and InWent FOSS Trainings)
  • project managers
  • software developers in the health field
  • IT SMEs who intend to offer FOSS for health solutions and continuing support services to local health stakeholders
  • academics and researchers focusing on health informatics

Archive: Guiding questions

  • What is free and open source software?
  • How is FOSS advantageous for the health sector?
  • What are several of the best practices, breakthroughs and recent trends with regard to FOSS in the health sector?
  • What particular criteria are used for selecting software applications and how does FOSS fare in each criterion?
  • What next steps to take to maximize the value of FOSS in the health sector?
  • How can we as a group make best use of our professional resources and networks to foster networking and integration in the field of "FOSS in healthcare" within ASEAN? Networking Mechanisms?
  • What do we as a group and network think of useful future capacity building projects in the area of "FOSS in healthcare" to strenghten open health systems as part of a regional integration framework in Southeast Asia?
  • What actions can the group (and other actors) take to build such concrete initiatives?

Archive: Programme

  • Introduction of participants
  • What is FOSS?
  • Why FOSS for health?
  • What experiences and initiatives do the members of the working group have in IT for healthcare and FOSS for healthcare and how can these be leveraged?
  • Economics of electronic health records and sustainability models
  • FOSS Electronic health records
  • Other FOSS for health applications (see : List of FOSS Projects and Applications in Health for reference)
  • Moving forward with FOSS for health in your community
  • Brainstorming on future capacity building projects in the area of "FOSS in healthcare" to strenghten open health systems as part of a regional integration framework in Southeast Asia

After each of the three sessions: Report back to the plenary on:

  • A) After first and second sesssion: main findings and recommendations
  • B) After third session: main recommendations with focusing on the following guiding questions:
  • How can we as a group make best use of our professional resources and networks to foster networking and integration in the field of "FOSS in healthcare" within ASEAN? Give Specific Networking Mechanisms?
    • Possible output/s:
      • Continue and strengthen networking at existing regional working networks (InWent Alumni Network, IOSN ASEAN+3) through continuous sharing of professional resources, discussion, collaboration. The network will be the venue for this.
      • Strengthen networking at the country level (suggestion: participants can be the core to initiate country level networking)
      • Initiate possible mechanism sharing of expertise/knowledge/experience for formulating common open standards (e.g. common concept dictionary for electronic medical records)
  • What do we as a group and network think of useful future capacity building projects in the area of "FOSS in healthcare" to strenghten open health systems as part of a regional integration framework in Southeast Asia?
    • Possible output/s:
      • Health Informatics Knowledge and Skills capacity building (e.g. Health terminologies, standards, "medicine for non-doctors", workflow, etc. for non-health IT people and IT knowledge for non-IT health people) with focus on Free and Open Source Software.
  • What actions can the group (and other actors) take to build such concrete initiatives?
    • Possible output/s:
      • Action Plans, Commitments: Individual & Organizational

Archive: Message from Balthas Seinbold: Draft message by Balthas to participants (archive, sent by e-mail on 25.06.2010)

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