Open source adoption in health sector: Understanding the stakeholder relationships in a resource constrained setting

Abstract

Free and Open Source Software (FOSS) is increasingly being the choice to strengthen health information systems (HIS) in Low and Middle Income Country (LMIC) contexts. FOSS is becoming a commercially viable option in today's software industry. In LMIC context, bridging the gap between generic open source design and specific local contexts calls for the participation of multi-sector stakeholders to realise FOSS implementations. This multi-sector stakeholder network, together with the FOSS platform can be theorised to form a software ecosystem (SE) around FOSS implementations in a resource constrained setting. In this new paradigm, governing the open source acquisition and implementation process becomes a central challenge, which is distinct from the governance of open source developer communities. This paper attempts to identify the essential stakeholder categories involved in FOSS HIS implementations in a LMIC context and to understand the stakeholder interactions in this SE at different stages. The analysis is based on a longitudinal case study of two open source HIS implementations and an attempt to establish a FOSS governance body in the State health sector of Sri Lanka during the period 2011-2014. The paper contributes by suggesting a model to understand the essential stakeholder categories and their interactions in FOSS implementation SE in resource constrained settings.