5 Innovations in Global Health: Maybe not what you were expecting
About two months ago, The Guardian’s Global Health team asked me to contribute five innovations that I thought would be revolutionary in global health. After kibitzing with my colleagues at D-Rev, I submitted a list, and after a few weeks received a polite note saying that my submission wasn’t really what they were looking for. They wanted a list of “specific innovations”.
A doctor walks Krista through an Indian community health clinic last year.
There is a lot of confusion in international development, global health—and even here in Silicon Valley about what exactly innovation means. To me it means something new—and effective. Try googling “global health” and “innovation” and you will see requests for proposals, new initiatives, and press releases about technology, or a research project that hopefully turns into a revolutionarily impactful product. Even though I lead essentially what is a product development company, the most innovative impact in the sector—and what we do at D-Rev—is much bigger than technology. My list reflected this with five new and novel approaches, models, and examples of implementation.
Yesterday at University of California San Francisco’s conference on “what’s next in global health”, Chris Elias of the Gates Foundation stated just this: the needed innovation in global health is with delivery, partnerships and financing. Yes! The difficulty and fear of the Ebola outbreaks underlines that technology-based solutions only get us so far. Delivery and coordination are critical.
The innovations I’m highlighting are pragmatic and effective—but above all, with measurable impact and promise of sustainability. My favorite innovations are those driven by users; users who include not just the patients, but medical practitioners, health officials, service engineers, purchasing decision-makers, and others directly in touch with the product’s successful delivery.
Small, nimble organizations that think local and big: they take a system approach. Muso in Mali sends community health workers door-to-door to refer sick mothers and babies to health care, and they address health issues at the level of the population: nutrition, clean water, safety. Three years after launch, Muso reduced the rate of under-5 child mortality to one-tenth what it was, the largest and fastest decline in child mortality ever documented.
Not logistics and infrastructure as usual. Bill Gates admitted earlier this year in Davos that while he loves searching for the “magic seeds” that will solve big global health problems, “what is most needed is a well-run grocery store”—underlining Chris’s point yesterday. Medic Mobile designs software for feature phones to prevent stock-outs in clinics and hospitals; they estimate that this project, one of many they do, covers almost 1M people in 5 Sub-Saharan African countries and Mexico. Micro-insurance, if you are thinking about financing innovation, too also has potential here addressing a financial infrastructure gap, but my conversations with health workers on the ground suggests the jury is still out on broad impact.
Affordable, high-quality context-appropriate medical devices. Medical devices designed for European and North American healthcare sectors are too expensive for most of the world’s populations. As donated products, they can break quickly and stay broken because power surges, lack of spare parts and other contextual mismatches. Gradian Health Systems’ affordable Universal Anesthesia Machine works with electricity and compressed air—and without. This too is where D-Rev has focused with phototherapy for severely jaundiced newborns, and a prosthetic knee for above-knee amputees. The best proof of concept? Target consumers in low-income countries are purchasing these products and using them, creating sustainable and scalable impact.
Flipping the model: becoming patient-centric. Old school thinking is pushing top-down behavior change (of everyone: practitioner, patient, health official), and using data to drive health change—rather than starting with user needs and requirements, and using data as a tool to develop—and iterate—solutions. In East Africa, Living Goods uses “micro-entrepreneurs”, local women often, who deliver “to the doorstep” basic products consumer want that improve health and incomes. One of their key principles is “Measure, learn, and adapt.” And like Muso, this is a departure from the crowded waiting rooms that are so often the norm in healthcare.
Reaching rural. One of the most striking discrepancies we see when we do fieldwork is the resources at flagship hospitals usually in the capital city, compared to those at every other medical facility in the country. For example, the flagship hospital may be a relatively high-functioning regional referral center, and a district hospital, one level down and a mile away, often lacks the most basic of medical equipment, standards and adequate staffing. (In one such hospital we visited earlier this year, stray cats wandered through the neonatal intensive care unit.) The smaller and more remote community and primary health clinics barely function if at all. Yet an estimated 70% of Sub-Saharan Africa’s population lives in rural areas.
A crowded hospital waiting room in India.
Two organizations are addressing this need: Last Mile Health in Liberia recruits, trains, supervises, and pays frontline health workers—“gifted women, former patients, and community-based providers”—to serve, not just reach, remote villages. Last Mile is also one of the on-the-ground organizations leading Ebola management in West Africa. Wild4Life got its start by partnering with Zimbabwe’s national park system in Hwange to test employees for HIV and found the rest of the local rural communities also came. Now they are expanding a network of high-functioning rural clinics in Western Zimbabwe.
And these organizations are just a few of an exciting emergence of global health start-ups in the last five years. Want more? Look up Health in Harmony that realized saving rainforests in Indonesia and Borneo was an issue of health; Global Health Corps that is supporting the development of global and local health leaders; Noora Health that trains family members to care for post-op patients; and One Heart World-wide and Possible that are radically changing the chance of survival in the most remote places in the world.
Innovation in global health requires stepping out of the box of definitions to understand users’ problems. What makes these organizations innovative and impactful is that they often integrate many approaches sometimes with novel technology. Fundamentally though, they are doing something new by adapting quickly to new information and changing conditions—and should be the model for innovation in global health.