Kiwix: Hospital-in-a-Box

4 billion people worldwide have no Internet access. In a technology-focused world, this severely stifles the impact of healthcare institutions. Poor connectivity critically limits access to medical information to diagnose, advise, and treat patients.

Kiwix has provided offline copies of WikEM and WikiMed through our existing Mobile, Desktop, and Hotspot software to over 3 million users worldwide, but we want to do more. 

We plan to package the NIH Drug Information Portal, Open MRS (an open-source patient management system) and medical encyclopedias to create Hospital-in-a-box (HiaB). HiaB leverages Kiwix's Hotspot technology, ported through a low-cost, single-board computer (e.g. Raspberry Pi) to allow up to 30 users simultaneously to access information through the plug-and-go network.

Our solution offers healthcare professionals the opportunity to access the medical information necessary to detect and protect against the spread of infectious diseases; poignant in the wake of the COVID-19 pandemic.

Poor connectivity hits healthcare hard. In the developing world, hospitals and dispensaries staff still often lack access to otherwise common resources. This is particularly problematic in cases of complex diagnoses and treatments, or when specialised or up-to-date information is required.

When finding the right information is so time-consuming, diagnoses can be slow or inaccurate, with negative outcomes. The frustration comes in knowing that healthcare issues could have been avoided if the right information were available at the right time, to the right people. COVID-19 has made us painfully aware of these issues of access to information; the pandemic has exposed the shockingly wide health inequities across global healthcare. 

Progression in Internet connectivity has plateaued recently, and budget cuts often mean that many health facilities have to do more with less. Yet, 68% of those in Latin America and the Caribbean own a smartphone. If data packages are often unaffordable, especially for the high usage required for medical files, an offline solution that would bypass this bottleneck would prove invaluable.

Hospital-in-a-box brings healthcare data to the poorly serviced parts of the world that need it most. For less than 100USD, healthcare professionals are no longer restricted in their knowledge by outdated and impractical reference books and expensive data plans. 

Hospital-in-a-Box combines professional-grade content packages into a plug-and-play device. A hotspot powerful enough to connect up to 30 users at the same time delivers medical resources directly onto staff' smartphones or personal computers.

A single box contains: 

• the NIH Drug Information Portal 
• Open MRS - an open-source patient management system
• WikEM - the largest emergency medicine open-access reference
• WikiMed - the largest available medical encyclopaedia.

The whole concept is based on off-the-shelf technology; using a Raspberry Pi, an inexpensive, low-consumption, single-board computer, it can be obtained for under 100USD in most countries. All content included is open-source and open-access, and stored on commercially available microSD cards smaller than a postage stamp. 

Once installed, HiaB is completely independent and requires no maintenance. 

Although initially aimed at helping healthcare professionals, particularly in Latin America and the Caribbean where we know the need is high, this tool could easily be adapted for use with medical students or even younger learners. 

Once this project has been successfully implemented, the Kiwix Hospital-in-a-Box package will provide an easier solution for all departments and areas of diagnosis and treatment in healthcare centres, including remote rural areas. It makes searching for information easy, and the breadth of information much wider. This means that a range of diagnoses can be explored, meaning that effective treatment will be easier to deliver, and more quickly. 

In short, the community impacted by our proposal will be one step closer to being as equally equipped as their online counterparts for healthcare technology information. In light of the COVID-19 pandemic, it is more important than ever for reliable information to be readily available to all. With Hospital-in-a-Box assisting in diagnoses being faster and more accurate, we can help healthcare professionals and their patients access the information they need to prevent the further spread of disease.

The problem: a lack of Internet access prevents healthcare institutions in underserved areas from accessing the information they need to effectively detect and combat outbreaks.

Our solution: With relevant information available offline in an easy-to-use digital tool, we can make healthcare professionals' lives easier. Healthcare institutions are therefore better equipped to handle patients, monitor their progress, and increase the efficacy of their limited resources.

Target population: Hospital-in-a-Box supports healthcare workers with a knowledge tool for rapid response. HiaB is globally scalable, but will initially focus on Latin America and the Caribbean.

Since being founded in 2017, Kiwix quickly built to 1 million users on the initial Android and Desktop formats.

By 2019, we had founded our partnership with the Wikimedia Foundation, been selected in the Global Good 100, and as a Top 100 Innovator by HundrEd, and won the Mozilla Open Source Support award. We released the Kiwix installer for the Raspberry Pi hotspot, and reached 3 million users. 

We are building on what we have learned over the previous 4 years and rolling out a wider deployment of Kiwix, with more specialised technology and content; HiaB being an example of this. Through scaling up in this way, we aim to reach 100 million users by 2025, with 60% via hotspots/server distribution, 20% on Android, 10% on Desktop, and 10% through other miscs. (e.g. iOS, KaiOS).

Hospital-in-a-Box takes a problem of lacking (Internet access), and uses existing resources (smart phones to access a local hotspot) to provide a solution.

Healthcare centres in developing countries struggle to refresh their existing information sources regularly, and to easily and quickly access answers to the specific questions they have. All this could be resolved with a reliable Internet connection, but the infrastructure and the funds are lacking to implement this. Our proposal removes the barrier presented by Internet connectivity as a requirement for better resources, by creating the technology to access the information needed, all completely offline. 

Our solution consequently creates an opportunity for all potential users, as it can scale pretty seamlessly. Each low-cost single-board computer that is used can serve up to 30 people at no additional cost than the initial 100 USD purchase price. As it is deployed in a place that will serve the whole community in providing better healthcare, the project's impact casts the net wide. This resource ultimately results in large-scale improved medical care and understanding; as better learning resources increase, and patient records management is streamlined, more patients can be treated appropriately in a shorter space of time. As Kiwix holds to technology to turn any website offline, the tool has the potential to be adapted for training of medical students or more specific medical environments. 

This project offers a self-sustaining, inclusive solution, with little maintenance and cost.

Kiwix has an estimated user based of 3 to 4 million people in 202 countries and territories as of the end of 2019, although due to the nature of offline, this data is difficult to track. We rely on server statistics as well as direct feedback from deployment partners and our numbers should be seen as a conservative estimate. In fact, for many users the anonymity is the reason why they choose us. We have anecdotal evidence from different countries that Kiwix is also distributed laterally (meaning that one person will download the application and contents and share or resell them with friends and neighbours).

Based on current trends and strategy, we expect our user base to roughly double every year meaning 6 million users by the end of this year, and 100 million by 2024-25.

Our impact is measured through the SMART framework:

- Specific: We have identified key areas of need for improvement in the Kiwix platform and are actively searching for funding from sources who specifically target these topics (e.g education-related content).

- Measurable: We look at numbers of downloads and contents hosted, where these are most prevalent, and who this leaves out in the global offline figures.

- Achievable: Kiwix is easily scaled, adaptable, and has already impacted the lives of millions worldwide. We know that it is within our capabilities to continue to provide online information to offline communities.

- Relevant: Technology is advancing at an unprecedented rate, and while developed countries are continuing to get better tech, many are still missing out on basic access to resources. This has come to light more than ever during the COVID-19 pandemic when many children have had to be homeschooled with the limited digital resources accessible without an Internet connection. 

- Time-bound: As mentioned above, we have a plan of projects and user expansion for the next 1-5 years.

9 staff/6 FTEs  + around 50 volunteers developers from around the world.

As a technology, Kiwix simply is the only content-agnostic solution to bringing internet content to people without connectivity. Most other platforms we  are aware of that cater to the offline world are there to sell/promote/distribute the content of their funding organisation alone. This has helped us become the default solution for a wide range of initiatives, as we have no issue white-branding our product and passing it on for someone else's work. As a non-profit, our mission and vision are to bring knowledge to as many people as possible, a user-oriented philosophy that helps us corner the offline market. 

On the team side, just under half of Kiwix’s coders are located in the Global South (Mali, Ghana, India) and have hands-on experience with connectivity issues. Kiwix’s advisory committee is also comprised of five members representing its main areas of deployment (US, Africa, Middle-East, South-East Asia, South America) and are tasked with providing user and deployment input.

The very purpose of Kiwix is for diversity and inclusion, and we are particularly working on developing more content available in more indigenous languages. We follow the Wikimedia Foundation’s non-discrimination practices, but do not devise our own. We pledge the contributor's covenant for all projects.

Our reasons for applying are simple: we believe that Solve could help us further our cause greatly, and we believe that our proposal fits well within this challenge's priorities.

We meet the Solve criteria in that we have a successful solution to our problem (lack of Internet connectivity affecting livelihoods globally) which has been successfully implemented, and has grown significantly since its implementation. We are now looking to scale our solution so that it can grow in range (of informational material we provide) and spread (who we provide it to). Our proposal is also simple, yet highly effective, and easily replicable for a variety of different contexts. 

The offer of connection with experts would be a huge benefit to the deployment and development of Kiwix. As a non-profit, our ultimate aim is to connect the unconnected and to ensure that our software satisfies the needs of those who are most lacking in Internet resources. To have expert advice (be it technical, administrative, communicative, or other) would help us to streamline our processes and get our software where it needs to be more effectively. 

Working with local partners hugely helps to understand local users' needs and to adapt the tool accordingly, but we know that we can do more. There are still significant communities with no Internet access who are yet to hear of Kiwix, and we want to be able to reach them with our resources. Finding the right support to help us break into these places would be key to helping us further our mission and vision of connecting the unconnected.

We want to work with medical and/or digital solutions organisations, who could use Kiwix as a tool to bring Internet content as an informational tool for the advancement of a community.