Launching a user-centered CPAP device for newborns in East Africa
Earlier this year, Kota Uyeda conducted extensive research for D-Rev on the newborn health and medical device landscape in Rwanda, Kenya, and Uganda. His work aided greatly in assessing the need and feasibility of bringing D-Rev’s neonatal CPAP device to low-resource hospitals in East Africa.
The first time I walked into an under-resourced neonatal intensive care unit (NICU) in rural Rwanda, I was overwhelmed. Although I considered myself knowledgeable about the healthcare space, most of that experience came from analyzing the market entry strategies of large life-science companies, and the revenue cycles of well-resourced, multi-facility hospital systems.
It was a completely different experience to enter this NICU and see nurses and doctors treating premature newborns with whatever resources they could find.
Forty NICU visits, four months, and three countries later, I gained a new appreciation for user-centered design in health care and how lives can be saved if health solutions are designed to address the actual experience and needs of the end-user.
My research goal was to deeply understand the newborn health context in East Africa and its medical device landscape in order to expand access to quality and contextually-appropriate newborn health care in the region. Within this framework, I honed my focus on the need and feasibility of D-Rev designing and delivering a continuous positive airway pressure (CPAP) device to treat newborn respiratory distress syndrome (RDS).
RDS is the leading cause of premature infant mortality. Effective respiratory support can improve a neonate’s survival rate by more than 70%. However, while the market offers a range of respiratory assist devices, no product effectively meets the reality of an over-burdened, under-resourced hospital. As a result, respiratory distress contributes to 1.5M – 3.6M neonatal deaths per year in low-income countries. Through my research in East Africa,I estimate that 318,000 premature babies born in Rwanda, Uganda, Kenya require CPAP therapy each year. The reality is that many of these newborn babies don’t receive it. Newborn RDS that goes untreated, or is not properly treated, almost always ends in mortality.
First, I completed over 40 need-finding visits in hospitals throughout Rwanda, Uganda, and Kenya (many of them in hyper-rural areas) to better understand how these facilities were currently managing newborn respiratory distress issues and where there are the largest gaps in treating newborn RDS. Second, I developed relationships with international NGOs, ministries of health, and medical devices distributors to streamline the supply chain so that when the CPAP is ready to launch, we can quickly deliver it to the hospitals with the greatest need. Finally, with D-Rev engineers, I conducted a human factors study of our CPAP prototype to test and receive usability feedback with doctors, nurses and other clinicians. To do this, we brought our CPAP prototype into NICU settings and asked hospital staff members interact and test the prototype in the actual environment where the finished product will actually be used.
Dr. Bob Okeyo, Clinical Officer at Kijabe Hospital outside of Nairobi, Kenya, testing the CPAP prototype. Note: The CPAP prototype is confidential, and as such, has been hidden in photo.
Like everything at D-Rev, my three pronged research approach placed the user at the center of each phase of my in-depth analysis. The feedback I received from the users was critical in shaping D-Rev’s neonatal Smart CPAP launch strategy in East Africa. My research included countless learnings, many of which can be categorized under two main themes:
Go beyond the product and invest in the entire healthcare ecosystem: For most medical equipment, utilization is driven by the availability of training, repairs, and consumables. These post-sale services are almost always offered through procurement contracts, rarely through donations. As a result, I saw closets full of top-of-the-line equipment that was donated (with good intention) to low-resource hospitals that could not be used due to lack of training on how to use and/or repair the device and inability to replace expensive or hard to find but necessary consumable parts. For D-Rev to have meaningful impact with our neonatal CPAP device, the entire ecosystem must be supported through increased investment in the region and deeper partnerships.
Empower the nurses: Unlike in the United States where the nurse-to-baby ratio in a NICU setting is typically 1:1 and there are numerous neonatologists, many of the East African facilities I visited had a NICU nurse-to-baby ratio of 1:15 or even 1:20. They also had very few pediatricians, let alone neonatologists. At these facilities, I saw that nurses were the major drivers in advancing health care in the region. Facilities where the nurses had full responsibility for the diagnosis and treatment of newborns had dramatically better outcomes. Therefore, D-Rev designed our neonatal Smart CPAP with heavy input and influence from nurses in low-resource settings.
Although my research taught me a lot about creating product launch strategies for global health NGOs, I was most inspired to see how nurses and doctors in East Africa are taking ownership of problems and creating solutions to address them. For example, I met a nurse in East Kisumu who, seeing the need, became a specialist on RDS. She travels to hospitals throughout Kenya to increase other clinicians’ awareness and knowledge of CPAP devices. Dr. Victoria from Kampala is taking on the prevalent issue of newborn malnutrition by creating the first milk bank in Uganda to serve the 40% of preterm babies who don’t receive breast milk.
Yes, international aid is still welcomed in most of the region, but it must be designed and delivered in close partnership with those who are on the frontlines of the issues the aid is meant to help. They are the end-users of the solutions, and most often, the experts.