Technological innovation has always been a driving force behind better healthcare. Yet despite an explosion in digital and consumer health solutions, when it comes to global health real innovation needs to happen at the edge and trickle inwards and upwards rather than from the top down.
In a nutshell: technology, healthcare, and the quality of life
In OECD countries, 20th century medical advances and technological innovations have dramatically improved life expectancy and quality of life. Examples of widespread infectious disease or death at childbirth are virtually unheard of here in the United States.
Many early innovations, such as the use of antibiotics, are already being applied in global health. Yet a lack of funds and infrastructure prohibits the level of access to basic healthcare required to eradicate or reduce certain health problems around the world.
In Rwanda, a staggering 63 percent of deaths in 2010 were caused by communicable, maternal, perinatal, or nutritional conditions. In comparison, only six percent of deaths in the US were attributed to these often easily preventable conditions. In Switzerland, the number was four percent.
Now that we have entered an age of data-driven digital health, technology is quickly lowering barriers to entry for consumer health solutions. Citizens of countries like the US can manage diabetes in the cloud, track heart rate with a wearable sensor, or even perform an EKG using a smartphone app.
Sequencing a human genome, which takes just a couple of days and offers incredible insight into disease prevention and targeted therapies, costs less than $5,000. And 23andme’s DIY DNA kit is just $99. We have mind-controlled artificial limbs, after all, and are on the cusp of 3D printing human organs.
But with so much technological enthusiasm focused on digital and consumer healthcare solutions and tech-enabled medical breakthroughs, especially here in the Silicon Valley, the question is can these solutions be translated or even transported to global health?
The role of technology in global health
In June 2013 as part of the World Economic Forum Debate Series with the University of Geneva, swissnex collaborated on an event about the future of the global health landscape. Amongst a vivid debate on the rise of noncommunicable diseases worldwide and different models of universal healthcare, the role of technology in global health quickly emerged as a crucial component of the discussion.
The conclusion was nuanced. Technology can provide real solutions to traditionally costly and lengthy care. And while this is relevant to many cases—from improving maternal health in rural India, to building a national open health information exchange in Rwanda, to managing HIV/Aids in Malawi—new problems arise at the intersection of technological innovation and global health.
Dr. Caricia Catalani from the University of California, Berkeley School of Public Health, a senior research associate at Innovative Support to Emergencies Diseases and Disaster (InSTEDD), identified three emerging concerns around technology in global health:
- Technology needs to be holistic and avoid data silos.
- Technology’s impact on health systems and outcomes must be measurable.
- Technology needs to be equitable and user-centric.
According to Catalani, limited public health dollars mean that sometimes underlying or contributing health issues cannot be addressed, at least not as easily as they might be here in San Francisco or back in Zurich.
Often, the infrastructure required to support new technology is not available. In Malawi for example, UNICEF had at one point hoped to gain better, real-time data on HIV/Aids cases using smartphones and tablets. That turned out to be too expensive and too reliant on data networks that simply did not yet exist.
Indeed, the smartphone glucose monitors that help diabetics in OECD countries lead normal lives have little to no use on the ground in rural developing areas where many people are unable to afford a smartphone, unable to communicate findings to a physician via the Internet, and sometimes unable to read instructions altogether.
In other cases, rural clinics may have up-to-date machines, instruments, and medications. Yet if villagers need to walk several days on foot to get there, or if there aren’t enough hospital beds or trained healthcare workers, the newest technology quickly becomes irrelevant.
Innovation, however, doesn’t always mean adopting or creating new technologies. It can also mean finding better and smarter uses for technology that already exists.
Innovation is being smart about technology
In the case of UNICEF’S HIV/Aids project in Malawi, simple text-message based solutions turned out to be an incredibly efficient and powerful resource. RapidSMS, as the tool is called, is a free and open-source framework provided by UNICEF for dynamic data collection, logistics coordination and communication, leveraging basic short message service (SMS) mobile phone technology. It has also proven successful in Rwanda.
After a decade of genocide and war, the government of Rwanda, with the help of international organizations and private actors, was able to build a basic yet functioning healthcare system from the ground up based on a national open health information exchange built on RapidSMS.
This innovative use of SMS has literally saved lives: Maternal health has dramatically improved and, at a per capita health expenditure of only $63, the country has recently been hailed a healthcare miracle.
In rural India, mobile health technologies—or mHealth—are yielding results. Medic Mobile, a San Francisco based startup in the global health technology sector, deploys basic mobile phones and SMS-based technology there to connect clinics and community healthcare workers with patients and collect valuable information.
They describe their method as using lowest common denominator mobile infrastructures to overcome the communication gaps with community healthcare workers, improving quality and access to care.
At swissnex, Dr. Catalani shared another success story from rural India, where expecting mothers living in remote areas without resources, some of whom are illiterate, passed around a mobile phone that contained a short how-to video on basic sanitation and other tips for pregnancy and childbirth.
While innovative use cases like these show the potential of technology to address specific global health issues, the smartest applications in global health also take cultural factors into consideration. In a recent Fast Company article, for example, Jaspal Sandhu from the University of California, Berkeley’s School of Public Health explains the crucial importance of human centered design in public and global health.
He cites the World Food Program’s effort and ultimate failure to address micronutrient deficiencies among the inhabitants of Kakuma Refugee Camp in Kenya. Only 30 percent of camp inhabitants picked up the free vitamin sachets they delivered, as the package design was reminiscent of a condom wrapper and therefore embarrassing to be seen with. This is a reminder that in order to provide thoughtful, lasting solutions, we need to think about the user and their needs.
Trickle up innovation
Global health does not operate in a vacuum. It is closely tied to local economic, environmental, and social systems. Sure, technology can be applied to health problems. But the most successful outcomes require understanding of and flexibility in working with conditions on the ground, from social and cultural determinants, to simple infrastructure prerequisites.
As Atul Gawande puts forth in a recent The New Yorker story, innovation also spreads the fastest when people on the ground talk to other people. Innovation is personal. Health innovations often happen at the periphery, where specific local problems inform specific local—and thus more accurate or more sustainable—solutions. The complexity of global health is a prime example of the need for a holistic understanding of local determinants and also the inefficiency of universally applying technology to solve a problem in a top-down approach.
To really and meaningfully impact health outcomes, innovation must trickle up, not down.