The Economics of Software Development for Global Health
Much of the digital practice in Global Health is dominated by single use, bespoke software solutions. These are often branded and marketed as ‘platforms’. The proliferation of these ‘solutions’ has led to the creation of single use software packages that do not scale outside of a single geography and/or disease area. When they do, they need to be completed rebuilt from the ground up. Technologies that run on these solutions then need to be reconfigured costing considerable amounts and requiring considerable time and expertise.
The root cause of this issue is the market distortions caused by the paucity of funds in this sector and the way in which philanthropy and governments procure and fund software development and deployment.
Philanthropic efforts and government procurement practices, though well-meaning have been the root-cause of this issue by creating distorting in the market. Philanthropies are often driven by two primary motivations – impact and the need for speed to deliver that impact. Both motivations are to be respected but they are often accompanied by siloed thinking driven by deep subject matter experts who have neither the time, expertise nor motivation to explore developments in areas outside their realm of expertise. Much of the Global Health and Development community has focused on the development of Products. Products can be deployed quickly and effectively and are what end users interact with and what have the most immediate impact for a specific health condition in a particular geography. The downside of the product-centric focus is the creation of disease and geography specific silos.
For software to be cost-effective, it relies on the ‘network effect’. While there is a lot of emphasis on delivering at scale, the fractured nature of the funding as well as the application of the software in this space does not allow for the network effect. The result of this disconnect is that rather than a thriving marketplace for innovative products, there exists a handful of companies that are completely reliant on government and/or philanthropic dollars for their financial sustainability. As funders are not structured to think long-term when it comes to software development (see above), the companies that build the software are purely responsive and have little financial incentive for innovation or to open their markets. Most pay lip-service to the concept of open-source but an analysis of their code repositories shows that there are very few contributors from the community.
