The next big thing in global health innovation? A little less innovation, a little more implementation

A post like this should come with the qualification that I am no luddite when it comes to technology and innovation in global health. Quite the opposite actually. I have dedicated my entire career to championing ideas. Whether that was working in academic research evaluating new ways of helping people with chronic diseases live well or researching the technology and innovation pipeline to help healthcare organizations make decisions on what technologies and innovations to invest in; I have been and will continue to be a health technology and innovation advocate (and when I talk about innovation, I’m not just talking about clinical and biological technology or information and communication technology but more broadly about new programs, interventions, etc).

Five years ago I embarked on a new career path in global health which transformed the way I now think of innovation. One of my first projects was to help a local partner organization implement a logistics management information system to manage their post-rape care medication inventory. Since then, I have helped our partners through the process of implementing other technologies and in that short time, I learned the many pain points of implementing innovations.

When you have spent a good part of your career as I did working in controlled research environments where the protocol is often laid out months ahead of time with little room for deviance and with study participants who are often given incentives to participate, working on the last mile problem required a skill set refresh and a change in the way I viewed the innovation pathway. Whether it is learning how to integrate an innovation into a user’s workflow; getting users to trust you enough to tell you when something is just not working for them; finding out how to get innovations to stick; making mistakes and reiterating; using real-time data to enable feedback loops; understanding (and dealing with) organizational politics and leadership; mapping out relationships, etc. – graduate training in public health does very little to prepare you for the trial by error approach required for these undertakings. Researching and evaluating is very different from implementing. So many of us in this field spend much of our time working on research studies and programs based on the models and theories we’ve learned in school that we very rarely think closely about whether or not the studies or programs we work on are scalable, sustainable, or even ethical.

I recently attended a panel at Stanford consisting primarily of philanthropic organizations discussing how those of us working in the social sector and those of us supporting the work need to rethink innovation in terms of scale. One of the things that struck me during the discussion was that when it came to what metrics we use to define success we’re often talking about success on a small scale.  And too often they’re developed with the mindset of pleasing the donor or funder. When we think success metrics, we usually talk about some quantitative statistic that goes something like this: X% reduced morbidity or mortality in our sample size of N. At the end of the study or funding period, we leave the site, taking with us our intervention. We then go on to write a paper about it, submit it crossing our fingers it gets accepted in a high impact journal, we publish it, we present our ideas at conferences. We then call it a success and move onto our next grant.

While this is often the gold standard of success for academics and should still remain an important part of the innovation pathway, there are parts of this road to innovation success that are concerning, especially in the low-resource settings we work in. Firstly, is it ethical to put in an innovation into a site and then remove the intervention once the study period is over if we know it has helped them? Would the site be even able to afford the innovation once it passes the research phase? Secondly, is it enough to define the success of an innovation by saying the intervention did what we wanted it to do? After all, I’m pretty sure a company like Facebook didn’t call themselves a success after running a small study of 250 users that found that everyone liked the product and it changed their lives. They are successful because they have 1.94 billion daily active users worldwide (scale) and have been around for 14 years (sustainability) and they have changed the way we connect with others.

Dear global health colleagues, we have an enormous task at hand. One that requires us to roll up our sleeves and stop thinking small and start thinking big. Let’s end this epidemic of health technology pilotitis and start innovating in the implementation space. Let’s start thinking about ways of innovating outside of the academic space and in real-world settings with real-world obstacles. Implementing innovations demands collaboration so let’s also make sure that we influence those around us. We need to change the conversation on impact and start asking our colleagues and the organizations that support our work to start thinking about the long game. From there we need to make it easier to decide which technologies and innovations to adopt. Let’s also not forget about training our next generation of public health professionals to focus on creating true impact by teaching effective implementation in schools.

Implementation work is incredibly unsexy and a risky investment but needs to be the next big thing in global health as its value proposition is substantial. It is of notable importance when the future of funding for global health is becoming more uncertain. We need now more than ever to deliver long-lasting solutions, not just short-term fixes.

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A study looking at the proportion of children’s health grants funded by the US National Institutes of Health and the Bill and Melinda Gates Foundation found that 97% of grants were for developing new technologies and only 3% for improving delivery and use of existing technologies. Additionally, they found that new technologies would only reduce child mortality by 22% compared to 63% if existing technologies were fully utilized.”

Although this study looked only at children’s health grants, the implementation gap can be found universally throughout global health. Learn more about how to bridge the “3/97” gap:

 

Global News Round Up

Politics & Policies

With a budget on the table that leaves science and lives around the world vulnerable, we’re reading about impacts and a better way.

Cutting the NIH budget is bad for health and business, says Kenneth C. Anderson, president of the American Society of Hematology and a hematologic oncologist at Dana-Farber Cancer Institute.

Programs, Grants & Awards

The University of North Carolina at Chapel Hill’s Gillings School of Global Public Health and 2U announced a partnership today to offer a suite of online graduate degrees for public health professionals across the country.

June 14th is World Blood Donor Day. This year’s theme stresses the importance of donating now before a disaster strikes.  This requires good storage facilities (and strong systems) in countries where disasters may occur, which may not always be the case.

The Duke Medical Alumni Association announced recently that it will honor Duke Global Health Institute (DGHI) director Michael Merson with the Distinguished Faculty Award during Medical Alumni Weekend in November.

To those of us who knew Babatunde Osotimehin, MD, he was simply “Prof.”
Yes, he had many distinguished titles in his career.  At the time of his death, Babatunde was the 4th executive director of the UN Population Fund (UNFPA) and the under-secretary-general of the UN. He also co-chaired the Family Planning 2020 (FP2020) Reference Group, alongside Christopher Elias of the Bill & Melinda Gates Foundation.

Research

Following the launch of the The Lancet’s Health in Southeast Asia series in Bangkok on 25 January 2011, the series has now been launched in Malaysia.  This Lancet series is the first to address the current and pressing health issues confronting the Southeast Asian region and the launch highlights the key health issues and findings for Malaysian stakeholders.

In a decision public health activists are calling both landmark and long overdue, the World Health Organization has placed snakebite envenoming on its list of top 20 priority neglected tropical diseases — giving it the highest possible ranking for diseases of its kind.

People with low levels of vitamin A who live with individuals who were sick with tuberculosis (TB) were 10 times more likely to develop the disease than people with high levels of the nutrient, according to research led by investigators at Harvard Medical School.

According to a new report in the New England Journal of Medicine, obesity rates have doubled in more than 70 countries and nearly 2 billion people are overweight or obese.

Diseases & Disasters

More than one in eight couples of childbearing age have difficulty conceiving or carrying a pregnancy to term, according to the Centers for Disease Control and Prevention. Delegates at the 2017 AMA Annual Meeting voted in support of WHO’s designation of infertility as a disease.

Gun-related violence killed three people in the US every two hours in 2015, according to data collected by the Global Health Data Exchange. Despite a rather steady decline in gun deaths in the past decade, firearms remain a significant issue for the country.

Nearly a third of the world’s population is obese or overweight and an increasing number of people are dying of related health problems in a “disturbing global public health crisis,” a study said on Monday.

At least two people have died and nearly 750 people fell ill after a meal to break the Ramadan fast in a camp for Iraqis fleeing the Mosul conflict.

Technology

Researchers at Penn State have received a grant through the Grand Challenges Exploration for their project using high-throughput microfluidics screening to identify novel contraceptive agents.

For the past 14 years, Project ECHO (Extension for Community Health Outcomes) has leveraged its innovative technology-enabled model for healthcare education to address global disparities in healthcare access for complex chronic conditions such as hepatitis C, HIV, tuberculosis (TB), and opioid use disorder.

Environmental Health

The rise in multidrug-resistant bacteria is usually attributed to the overuse of antibiotics in human medicine and farming. A new study, published in the journal Infection, suggests that there is a third source: globalized drug manufacturing.

The first national assessment of Canada’s freshwater ecosystem shows that the country’s major watershed face multiple environmental threats. This is a cause for concern since Canada has jurisdiction over 20% of global water supply.

Examination of 740 production systems for more than 90 different types of food has revealed that global diets and farming practices must change in order to reduce the impact of agriculture on the environment.

Equity & Disparities

Earlier this month the WHO published its 20th Model List of Essential Medicines (IPW, WHO, 6 June 2017). This essential list of medicines “have been successful in facilitating access to treatment and promoting affordable prices, particularly in low-resources countries,” the release says, adding that same results would be expected for diagnostic tests.

Researchers have developed a new reliable, validated and brief survey tool to measure resilience among adolescents displaced by the Syrian conflict.

Fifteen years after legalizing abortions in Nepal, researchers find that gaps in equity, quality and access still exist. Some of the gaps identified include small number of private pharmacies that distribute medical abortion medications, costs associated with the procedure, perceived stigma and diverse terrain.

Maternal, Neonatal & Children’s Health

The UK and the US are at the bottom third of the rankings for five of the six dimensions of child well being analyzed in a new UNICEF report. According to the report, 1 in 5 children live in poverty in rich countries.

Religious groups must get more involved in the campaign against HIV/AIDS and educate their followers on the need to have their children screened for the disease.

2017 APHA Student Assembly Annual Meeting Scholarship Application Now Open

The time has come…the 2017 APHA-SA Annual Meeting Scholarship Application is now OPEN. Apply by July 9th at 11:59pm EST to win one of the 50 available scholarships! The scholarship covers early bird registration for the 2017 Annual Meeting and the 2017 National Student Meeting as well as a $250 stipend to used on travel expenses for the Annual Meeting.

The APHA-SA Annual Meeting Scholarship (formerly the Leadership Challenge) was established in 2011 by M. Lyndon Haviland, DrPH, MPH to encourage APHA leaders to give matching funds to award scholarships for student APHA members to attend the Annual Meeting. Since its inception, Ayman El-Mohandes, MBBCh, MD, MPH joined Haviland to increase the match from $5,000 to $20,000.

Applicants must be a current APHA student member and either enrolled in a college or university or have or will graduate during the 2017 calendar year.

Scholarship recipients will be responsible for:

  1. Attending a pre-Annual Meeting webinar explaining the terms of the scholarship
  2. Attending the APHA Student Assembly National Student Meeting on Saturday November 4, 2017 beginning at 9am EST
  3. Attending the Hotlanta – Come Chill With Us session on Sunday November 5, 2017 beginning at 4pm EST
  4. Attending the APHA Student Assembly Business Meeting on Tuesday November 7, 2017 beginning at 6:30 pm EST
  5. Attending at least one oral or roundtable scientific session and three poster presentations and taking a photo at each to submit with the post-Annual Meeting survey and
  6. Bringing two hand-written thank you note addressed to Dr. Lyndon Havilland and Dr. Ayman El-Mohandes to be presented to them at the Awards Ceremony during Hotlanta – Come Chill With Us! for their leadership in establishing these scholarships.
  7. Submitting a post-Annual Meeting survey giving feedback about their experiences at the APHA Annual Meeting and be available for an interview after the Annual Meeting ends. Surveys will be due November 30, 2017.
  8. Engaging in an approved APHA component activity. Winners will receive training on what qualifies prior to the Annual Meeting and will have to provide proof of activity on the post-Annual Meeting survey.

You cannot save and return to your application once started, therefore it is highly recommended that you review the scholarship guidelines, the application rules and regulations found on the application, compile the necessary documents and your essay, and then go online to submit your application. The scholarship application should take approximately 60-90 minutes to complete. Feel free to email Student Assembly Chair, Rachael Reed, at rmitchapha@gmail.com, if you have any questions. Good luck!

Graduate Student Fellowships In Humanitarian Shelter and Settlements (Habitat for Humanity International/USAID)

The deadline however for submission is June 23rd, 2017.

Fellowship Description: USAID/OFDA seeks to support the thesis or professional report writing efforts of two Fellows during the summer of 2017. Fellows will be graduate students currently enrolled full-time in accredited North American graduate school programs or North Americans studying abroad in similar graduate programs, in the following disciplines:

  • City, Urban, Environmental, or Regional Planning, and
  • Architecture or Architectural engineering

Ideally, successful candidates would be first-year, Masters-level, graduate students, in the programs listed above, who are interested in commencing work on a thesis or professional report as a requirement for graduation. The topic of this graduate student research would be focused on any of the following topics of interest:

  • Managing the transition of humanitarian shelter to permanent housing
  • Linking and incorporating hazard mapping efforts into settlements planning to promote risk reduction
  • Post-disaster neighbourhood-level planning efforts designed to promote safer, sustainable, and resilient shelters and settlements
  • Post-disaster emergency urban planning to reconfigure disaster-affected settlements to promote risk reduction, increase shelter opportunities, and accelerate recovery
  • Measuring the contribution of humanitarian shelter to the recovery of disaster-affected households and/or communities.
  • Identification and review of assessment tools (including GIS and open source mapping technologies) intended to better understand and deal with the urban context, thereby informing efforts to support effective and expeditious humanitarian S&S sector activities
  • Informal land management and tenure mechanisms that promote risk reduction or ensure occupancy of land and housing for displaced/vulnerable populations.

 

https://drive.google.com/open?id=0B7JS6r4wXAqWeUZuRGdpUHdtRGs

Global News Round Up

Politics & Policies

Member governments of the World Health Organization are increasingly talking about how to bring about “fair” pricing of medicines.  And what’s clear is that it should not be based on how much you would pay to save your life, a senior WHO official said this week.

“More than 11 million people are alive today thanks to this man’s creation of PEPFAR, the US AIDS program that has been saving lives and preventing new HIV infections for over 10 years, with strong support from political leaders right, left, and center,” the musician captioned a photo of the activists on Instagram. “That progress is all at risk now with President Trump’s budget cuts, which will mean needless infections and lives lost.”

Tom Frieden, head of the CDC from 2009 to 2017, told graduating medical students that we face challenges from pathogens, and from politicians.  “Einstein wrote, ‘Striving for social justice is the most valuable thing to do in life.’”

The Trump administration’s budget recommendation may take a “wrecking ball” to foreign aid but the development community needs to seize this opportunity to build a broader constituency, according to the chief executive officer of CARE USA.
Trump would cut the annual global health budget by about 26 percent, or around 2.2 billion in the 2018 fiscal year that begins October 1, decreasing it from about $8.7 billion in the current fiscal year budget to less than $6.5 billion.  The program that would be hit hardest would be family planning.

Canada has scored well in a global study to assess how effectively countries use their healthcare systems to avoid preventable deaths, but the country still has plenty of room for improvement.

Applause, cheers, Ethiopian flags, mobile phones held high and a crush of well-wishers greeted Tedros Adhanom Ghebreyesus Tuesday evening after his election as WHO’s next Director-General.

Programs, Grants & Awards

UGA’s Global Health Institute begins search for Holbrook Endowed Professor in Global Health.

“When it comes to the issues of health, there are no walls dividing impoverished and the wealthy.  Illness and disability know no borders.  In today’s global environment, disease is no longer confined to one population, but has the potential to impact millions in disparate regions of the world in a very short period of time. That’s why the work of the Old Dominion University Center for Global Health is so vital.”

Research

Inhibition of programmed death-ligand 1 (PD-L1) with atezolizumab can induce durable clinical benefit (DCB) in patients with metastatic urothelial cancers, including complete remissions in patients with chemotherapy refractory disease.

In high-income settings, the prevalence of tobacco use has been shown to be significantly higher in people living with HIV than among HIV-negative individuals of the same age and sex distribution. This at-risk pattern is one of the biggest threats to the number of years of life saved with antiretroviral therapy (ART).

A new study reports the identification and early validation of a drug for treating cryptosporidiosis, a diarrheal disease which is a major cause of childhood mortality in low and middle income countries.

Diseases & Disasters

The Indian health ministry has confirmed its first cases of the Zika virus, the World Health Organization has said, the latest nation to be affected by the mosquito-borne virus that sparked global concern.

A new study led by Colorado State University researchers found that Aedes aegypti, the primary mosquito that carries Zika virus, might also transmit chikungunya and dengue viruses with one bite.

Indian officials who were aware of the country’s first Zika case months ago, failed to alert the public.

With rising number of measles cases, Germany plans to fine parents who do not seek medical advice on vaccinating their children.

A new Ebola vaccine is on its way to the DRC to help fight a recent small outbreak.

Unrefrigerated vaccine and syringe reuse has led to the death of 15 children in South Sudan.

Technology

Alma Sana, an immunization advocacy group has won a share of the $1 million Global Healthcare innovation award for a baby’s bracelet that would be punched every time the child gets vaccinated.

LimbForge, a non-profit organization is training local doctors and humanitarian NGOs in Haiti to create low cost, culturally appropriate prosthetic limbs for using 3D printing technology.

Environmental Health

Kabwe is the world’s most toxic town, according to pollution experts, where mass lead poisoning has almost certainly damaged the brains and other organs of generations of children – and where children continue to be poisoned every day.

Paraguay has made the most progress in providing access to safe water to about 94% of its rural population (up from 51% in 2000).

According to a new WHO report, resource intensive tobacco farming is environmentally costly and its impact include soil degradation and non-biodegradable litter in the form of cigarette butts.

Equity & Disparities

According to a survey conducted by the Human Rights Watch group, people with disabilities and older people are more likely to be caught in the fighting in South Sudan.

The first class of 24 students from 12 countries graduated from the University of Global Health Equity (UGHE) in Kigali (Rwanda) this year.

A new study of the mortality data between 2000 and 2013 after the roll out of universal health coverage in Brazil, reveals greater decreases in mortality rates among blacks and mixed race Brazilians.

An Indian TV soap that tackles domestic violence, acid attacks and abortion of female fetuses has become the most watched TV show with nearly 400 million viewers.

Maternal, Neonatal & Children’s Health

The murder of a 3 year old girl in South Africa has put the spotlight back on the high child and adolescent homicide rates in the country.

UNICEF warns that the number of suspected cholera cases in Yemen might reach up to 130,000 in the next two weeks.

According to a new study that analysed the death rates among twins in sub-Saharan Africa, nearly one in five children born as a twin die before they turn five years old.