How many languages does your software speak?
By: Sovello Mgani, Luciana Rajula, and Linda Taylor
While numbers speak a universal language, the software systems that support health data overwhelmingly speak English. For health workers in a non-English-speaking country, the lack of a native-language user interface (UI) for data and digital health software applications and resources is a major barrier to adoption and use. For this reason, Digital Square considers multilingual support as an indicator when assessing the maturity (shelf-readiness) of global goods. By customizing global goods to accommodate different languages, either through direct translation or by providing translation guidance or tools such as artificial intelligence (AI)-powered translation, developers can widely expand the reach and accessibility of their content and help improve health outcomes for diverse populations.
To support the need for more multilingual applications of global goods—as well as ongoing needs to increase cybersecurity—Digital Square launched a request for applications (RFA) in March 2024 for Global Goods Rapid Projects – Multilingual Support and Security. This RFA was aimed at digital innovators looking to enhance the maturity of their existing Digital Square-approved software global goods in the areas of multilingual support and/or security through projects lasting only three-to-four months.
After receiving and evaluating 21 applications, Digital Square selected six award recipients. All projects were completed by mid-October 2024. Here’s what we were able to accomplish together.
OpenMRS: Enhancing cybersecurity guidance and bolstering a translator network
OpenMRS is an open-source electronic medical records platform designed to support healthcare delivery in low-resource settings by managing patient data, tracking medical histories, and streamlining healthcare workflows. OpenMRS used the investment to bolster a sustainable translator network as well as enhance its cybersecurity posture and guidance.
For language translation support, the team worked with potential translators to understand what information and support they needed to perform accurate and effective translations of the OpenMRS interface and metadata content into other languages. Through the award, the team developed and published a clear Translation Guide for OpenMRS. The guide explained the need for translators and instructions on how to contribute to peer-reviewed translations. This guide proved immediately useful for an OpenMRS translation into Spanish, as shared by Grace Potma, OpenMRS’ Director of Product:
“I wanted to share with you a very quick success story that is only just happening right now thanks to the translation guide that we were able to write through Digital Square's support recently. Amazingly, a team in Peru contacted us just last week wanting to help translate OpenMRS in Spanish. Within the last few days after giving them access to our translation guide, they have already contributed more than 150 translations for the community project. In my last four years at OpenMRS, I've never seen this speed of onboarding for translators! What a wonderful immediate point of feedback on the work done so far.”
For cybersecurity, OpenMRS first completed remediation of outstanding vulnerabilities in the OpenMRS application discovered through recent penetration testing. The team triaged the list of findings and curated issues for a team of Cybersecurity Fellows—who were supported by this award—to resolve. Additionally, OpenMRS developed an incident response plan for the OpenMRS community by outlining procedures for detecting, responding to, and recovering from cybersecurity incidents on OpenMRS. The team also developed a security implementation guide for OpenMRS implementers, addressing common security considerations and providing step-by-step instructions for setting up secure environments in OpenMRS.
OpenLMIS/SolDevelo: Enhancing accessibility for right-to-left languages
OpenLMIS is an open-source, cloud-based electronic logistics management information system (LMIS) purpose-built to manage health commodity supply chains. Their improvements through the award were outsourced through SolDevelo. Activities included conducting a security audit and enhancing accessibility for right-to-left (RTL) languages—such as Arabic, Hebrew, Persian, and Urdu. These activities strengthened OpenLMIS’ capabilities as a reliable and secure digital health solution. To learn more about what the team did and how they approached these two activities, read SolDevelo’s blogs on RTL language support and penetration testing. Further, the RTL support can be tested on the demo site.
The SolDevelo team shared how the work improved the system’s reliability and accessibility to new regions:
“Our recent work on OpenLMIS included a thorough security audit, leading to targeted fixes that strengthened the system’s overall security and stability. These enhancements are crucial for safeguarding user data and protecting the system from potential threats, ensuring a reliable platform for the community. Furthermore, by adding RTL language support and an Arabic version, we made the system accessible to new regions, particularly those using RTL languages, thus broadening OpenLMIS’s usability and supporting more inclusive health supply chains worldwide.”
Ona: Supporting AI-enabled translations of FHIR texts within OpenSRP2
Ona, the developer of the open-source electronic health record software OpenSRP 2, used the investment to develop a translation tool to support more efficient translations of FHIR Questionnaire texts and other data elements within the OpenSRP 2 mobile application. This tool makes the translation process much faster, more efficient, and less prone to human error. Previously, the translation process required manually adding translated text for UI components to the Questionnaire files. By contrast, the new tool can automatically extract the Questionnaire texts into a format that can be used within Transifex—an AI-powered translation service—and then append the translated text back to the file.
This enhanced capability renders the application more usable across diverse linguistic backgrounds, contributing to the ability of OpenSRP 2 to implement health workflows by adopting WHO SMART Guidelines implementation guides. The documents developed by this process have been made available on GitHub and an OpenSRP2 demo version is available on the Google Play Store in English, French, and Spanish.
Regenstrief Institute: Promoting health information exchange learning in French and Spanish
The Regenstrief Institute used the investment to enhance language accessibility for those working to better understand concepts related to health information exchange (HIE)—which is the electronic mobilization of health care information across organizations within a region, community, or hospital system to promote efficiency and evidence-based health decision-making. Through the award, Regenstrief completed the translation of two of the online, self-paced courses available on its OpenHIE Academy—courses 101 (Introduction to the Fundamentals of Health Information Exchange) and 320 (Identity Management)—into Spanish and French. Previously, the courses had only been available in English. A translation service company translated the content of these two courses, and then Regenstrief partnered with Spanish- and French-speaking OpenHIE community members to review the translations for clarity and accuracy. Finally, the translated courses were published to the academy website and promoted to the larger community.
The translation of these fundamental courses expanded the international reach of the OpenHIE Academy platform. By making these courses accessible to a broader audience across French- and Spanish-speaking regions, the translation fosters greater inclusivity and encourages wider adoption of HIE concepts to improve health systems and health outcomes.
ODK: Improving security
The investment improved the security of ODK (Open Data Kit), a platform for data collection used by many public health entities, including the World Health Organization for disease surveillance. First, ODK commissioned an independent security audit and penetration testing to identify potential issues or deviations from best practices. The team then mitigated all critical issues found in the security audit and will be sharing a public document with results of the audit and test. An overview of ODK’s current security practices and deployment recommendations has also been published.
Yaw Anokwa, the CEO of ODK, highlighted the value of the award for strengthening ODK and sharing their learnings with the global goods ecosystem:
"Thanks to Digital Square’s security award, ODK has further strengthened the security and privacy of the hundreds of millions of submissions that flow through our platform. As a Global Good that is committed to enhancing the ecosystem as a whole, we are especially thrilled that this award will enable us to share the techniques that keep ODK a fast, reliable, and secure tool for digital health." – Yaw Anokwa, CEO @ ODK
Dimagi: Packaging data security guidance for global goods in a playbook
For Dimagi, the investment was used to develop and disseminate comprehensive, practical data security guidance to global goods through the development of a Data Security Pipeline Playbook. To develop and hone the playbook, Dimagi completed interviews with a diverse set of users of CommCare—Dimagi’s platform for frontline work that enables data collection, reporting, and service delivery for social impact and health programs—about their own data security use cases and considerations. Additionally, third-party security firm Jemurai conducted a validation of the playbook before it was published on Dimagi’s website, ensuring accessibility for other global goods implementers.
This comprehensive playbook encapsulates the advanced security practices honed through Dimagi’s extensive experience with CommCare and is applicable to other organizations developing digital health global goods. The playbook is organized into distinct sections that align with the organization’s current level of maturity, providing a clear roadmap for progression to subsequent stages as they evolve.
By creating a comprehensive Data Security Pipeline Playbook that offers step-by-step guidance on implementing advanced security practices, the playbook helps organizations improve their security posture at various stages of development, safeguarding the privacy and security of data within digital health systems.
Expanding the impact and shelf-readiness of global goods through language inclusion and security
These six rapid projects accomplished concrete benefits for multilingual support and cybersecurity in a short time. We are grateful to have worked with these global goods partners to strengthen the security and accessibility of their data and digital health resources. By enabling the safer and broader use of global goods among more linguistic groups, we can help improve their impact on health equity.
