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It feels like there aren't a lot of people in this thread that have spent any time in this space, specifically health care in East Africa or the wild wild world

It feels like there aren't a lot of people in this thread that have spent any time in this space, specifically health care in East Africa or the wild wild world of NGOs / aid there. This has the same breathless and "six weeks of hacking to save babies" feel to it that every other project starts out with. What exactly is different? There are a zillion mini-EMRs operating in East Africa, especially Uganda, what most lack is real integration and cooperation with the government to make them sustainable and scale. What is the story there for Watsi? Why will Watsi avoid the complexity of a real EMR like OpenMRS? Are you integrating with them? There's a slide somewhere that I think UNICEF put together of all the NGO (as in non-UG-government, not just non profit) health projects active in Uganda. It is this hilarious demonstration of the crazy amounts of bootstrapped projects exactly like this and just how much they overlap. To the founders, have you read The White Man's Burden? If not, please bump it to the top of your list. Source: I lived in neighboring Rwanda for 5 years and work in this space, including projects in Uganda. It is a fascinating space with lots of opportunity for good, but also one that requires real introspection on why you are pursuing particular strategies and whether that is being driven by ego or truly because you think it is the best for the people. Almost always the answer is that no, a new thing isn't required, but rather you should be pitching in with someone else or building upon an imperfect system to better it, because that system is government owned and managed and thus will be sustainable and gives the country and people agency. This is why aid is hard work, because most good organizations have moved past the "hey, look what we built you stage" to instead trying to build capacity and institutionalize changes. That is so much more difficult but much better tack, though my beliefs are still more in the camp of direct cash transfers these days.

beaconstudios 9y ago
I don't think it's fair to bring up the White Man's Burden in this case. It doesn't matter what background and ethnicity people come from, surely we should all be doing what we can to help those in need? Understandably it's an incredibly hard problem, especially for NGOs without government support, but if each of those NGOs can help just one local community doesn't that add up to a meaningful difference to those living in poverty in Uganda?
- nicpottier 9y ago
  Have you read the White Man's Burden? (the book) I'm not sure you are qualified to say it isn't fair to bring it up if not, as it deals exactly with this. (and yes it isn't about race, nor is the book, but about how broken the approach to aid has been in Africa in particular) And yes, indeed, bringing small local NGOs to help one local community can be more harmful than not. Among other reasons because you are only adding to the fragmentation of health care services in a country that is desperately trying to unify them and just seeding confusion within that system. EMR's like what it looks like Watsi is doing have been going on since before I was there in 2007 and like I said are constantly popping up because everybody is like "hey, I can build an EMR". That should be the first clue that it isn't the core problem at hand.
  - beaconstudios 9y ago
    I thought you meant the White Man's Burden, the poem, as it's the one I'm familiar with. I wasn't aware there was a book.
chaseadam17 9y ago
Thanks for your thoughts. I've worked in the nonprofit space for a long time and agree that there are way too many fragmented projects. We did the pilot in Uganda because we were invited by the community. They wanted to implement a community health insurance system (similar to the mutuelle system in Rwanda) but they didn't have the capacity to administer it. The community and the Uganda Catholic Medical Bureau designed the insurance system and are currently running it with our technology. The government (both the Ministry of Health and the district health office) were involved in the project and even drove out to speak at the launch. They are interested in national health insurance, and we've been invited to participate in their technical working group to share our learnings. At request of the government, our system will integrate with DHIS2 and EMR's like OpenMRS, however, we've found that very few providers actually have an EMR in use. Our system isn't an EMR - it's health insurance administration (enrollment, claims, etc.) which is very different and we haven't found anything like it for LMI countries, beyond CarePay which is mostly focused on payments. Another government in East Africa has already approached us about using our software to administer their public health insurance system, but the Rwandan government would be an ideal next partner. I'd love to talk more if you're interested and we're always open to feedback, especially from people like you with lots of experience in the space. Please reach out at connect@watsi.org if you have a few minutes. Thanks again.
- nicpottier 9y ago
  Sent you a note, thanks for the reply.

beaconstudios 9y ago

I don't think it's fair to bring up the White Man's Burden in this case. It doesn't matter what background and ethnicity people come from, surely we should all be doing what we can to help those in need? Understandably it's an incredibly hard problem, especially for NGOs without government support, but if each of those NGOs can help just one local community doesn't that add up to a meaningful difference to those living in poverty in Uganda?

nicpottier 9y ago
Have you read the White Man's Burden? (the book) I'm not sure you are qualified to say it isn't fair to bring it up if not, as it deals exactly with this. (and yes it isn't about race, nor is the book, but about how broken the approach to aid has been in Africa in particular) And yes, indeed, bringing small local NGOs to help one local community can be more harmful than not. Among other reasons because you are only adding to the fragmentation of health care services in a country that is desperately trying to unify them and just seeding confusion within that system. EMR's like what it looks like Watsi is doing have been going on since before I was there in 2007 and like I said are constantly popping up because everybody is like "hey, I can build an EMR". That should be the first clue that it isn't the core problem at hand.
- beaconstudios 9y ago
  I thought you meant the White Man's Burden, the poem, as it's the one I'm familiar with. I wasn't aware there was a book.

chaseadam17 9y ago

Thanks for your thoughts. I've worked in the nonprofit space for a long time and agree that there are way too many fragmented projects. We did the pilot in Uganda because we were invited by the community. They wanted to implement a community health insurance system (similar to the mutuelle system in Rwanda) but they didn't have the capacity to administer it. The community and the Uganda Catholic Medical Bureau designed the insurance system and are currently running it with our technology. The government (both the Ministry of Health and the district health office) were involved in the project and even drove out to speak at the launch. They are interested in national health insurance, and we've been invited to participate in their technical working group to share our learnings. At request of the government, our system will integrate with DHIS2 and EMR's like OpenMRS, however, we've found that very few providers actually have an EMR in use. Our system isn't an EMR - it's health insurance administration (enrollment, claims, etc.) which is very different and we haven't found anything like it for LMI countries, beyond CarePay which is mostly focused on payments. Another government in East Africa has already approached us about using our software to administer their public health insurance system, but the Rwandan government would be an ideal next partner. I'd love to talk more if you're interested and we're always open to feedback, especially from people like you with lots of experience in the space. Please reach out at connect@watsi.org if you have a few minutes. Thanks again.

nicpottier 9y ago
Sent you a note, thanks for the reply.