Global Health Technology 2.0

By Aya Caldwell, Anna Young, Jose Gomez-Marquez, and Kristian R. Olson

Global health development assistance has increased threefold in the last decade, and policymakers are recognizing the need for accessible health technologies aimed at low- and middle-income countries (LMICs) [1], [2]. However, developing such technologies is not simple [2]. It requires a delicate departure from top-down, sophisticated engineering toward user-enabled designs that are elegant, simple, and field tested and tailored. In this scenario, the stakes are higher, technologies must succeed with a unique set of design challenges and address a higher burden of global illness. To ensure that these technologies are aligned with end users’ needs, codevelopment with innovators in LMICs and multiple iterations with end users’ feedback are needed for ultimate translation to practical use.

The Global Health Initiative (GHI) at the Center for Integration of Medicine and Innovative Technology, the Center for Global Health at Massachusetts General Hospital (MGH), and Innovations in International Health (IIH) at Massachusetts Institute of Technology (IIH@MIT) have formed a collaboration that puts our research and development model, Global Health Technology 2.0, to work and advances a growing global health portfolio. Using device examples, we highlight a series of design innovation practices.

CIMIT GHI, Center for Global Health at MGH, and IIH@ MIT—A Collaborative Approach Based on Cocreation CIMIT GHI and the Center of Global Health at MGH are multiinstitutional collaborative effort focused on LMIC health-care provider training and supports the integration of medical technologies and trainings. These two groups work in Indonesia, Cambodia, and Ethiopia. Across the Charles River in Cambridge, IIH@MIT works with CIMIT and the Center for Global Health at MGH to invent and fabricate low-cost medical devices by bringing together multidisciplinary teams in a Skunkworks environment, where collaborative relationships augment traditional laboratory resources. Through this model of lean, interdisciplinary teams, IIH accelerates medical technology design for LMICs.

Global Health Technology 2.0
Using a few examples, we outline key insights into creating a center of excellence with our evolving model of collaborative research and development.

Training 2.0
Using devices as a hallmark of professionalism can catalyze the uptake of new protocols and continuing medical education for personnel. In Aceh, Indonesia, after the 2004 Tsunami, CIMIT GHI and MGH helped design a novel community-based midwife training program focused on peribirth emergencies as one of the first steps in rehabilitating the primary care services.

In parallel, IIH created a series of prototyping kits called the MEDIKit aimed at health-care workers eager to create their own solutions (Figure 2). MEDIKits is a platform technology for device prototyping and fabrication.

Rapid Prototyping
Experiencing a solution through a prototype offers a substantially different experience than a concept on the paper. By forming rapid design and prototyping teams, IIH creates affordable prototypes for user testing in a matter of days and deploys them into the field soon after. Prof. Catherine Klapperich of Boston University created the system for nucleic acid preparation (SNAP) portable DNA isolation system (Figure 3).

Lean, Collaborative R&D Structures
In response to a constrained funding environment for health technologies, we have instilled a model of collaborative resource sharing.

Field Innovation Network
The ability to take a device from the laboratory to a field site 4,000 mi away within 48 h allows innovation teams to get realtime valuable feedback.

An example of such innovation is CoolComply, shown in Figure 4. Cool- Comply addresses two fundamental problems with multidrug resistant tuberculosis (MDR-TB) – the difficulty of monitoring patient adherence at the home given the long treatment time (18-24 months) and maintaining adequate temperatures (15C) for the medication [3].

Team Diversity
Our model goes beyond multidisciplinary teams and into discipline shifting. Cocreation discourages participants from being pigeonholed and specialized. The best ideas may come from individuals who have limited background in the subject area but are willing to explore ideas and prototyping.

Conclusions
Technological innovations have the potential to change the lives of millions of individuals living in resource-limited settings; yet, many of these technologies are unused and broken, and providers are disempowered [4]. The high failure rate is, in part, a result of devices not being designed for these settings. Technology product development should be based on cocreation with specific end users’ adoptability and feedback. These should be incorporated to modify designs so that the effectiveness and durability in the intended clinical setting is optimized. There is a sizable need for technologies that are simple to use, meet required performance metrics, and ruggedized to operate under harsh-use conditions.

Collaborations and cocreation with end users allow for a unique group of individuals from various disciplines, institutions, and sectors to innovate for the challenges currently faced in global health and technology development. These, in turn, act as an impetus to develop specific solutions for the intended user to successfully translate their research. The successful implementation of technologies has the potential to augment health-care provider’s impact and catalyze the improvement of patient care and outcomes not only in LMICs but developed countries alike as these concepts are relevant globally. This process of extending the novel languages of innovation is just the beginning of Global Health Technology 2.0.

Aya Caldwell (acaldwell1@partners.org) and Kristian R. Olson (krolson@partners.org) are with the Center for Global Health at Massachusetts General Hospital (MGH), CIMIT’s Global Health Initiative. Anna Young (annakyoung@gmail.com) and Jose Gomez- Marquez (jose.gomez.marquez@gmail.com) are with Massachusetts Institute of Technology (MIT) Innovations in International Health.

To find out more about this topic read the entire article as printed in IEEE Pulse, July/August 2011