WHCC Affordable Health Innovations

The healthcare industry is one where the boundaries are always being pushed for better and better procedures, drugs and treatments. Joint replacements are among the most common surgeries with more than 70,000 knee replacement procedures performed in England and Wales each year. There are many factors that can affect the success of procedures like this, and many different ways that innovation can improve them.

Knee Replacement Surgery

There are two types of knee replacement surgery or athroplasty, total replacement and partial replacement. Total replacement involves the removal of the damaged bone and the replacement of it with a prosthesis made from metal, plastic or ceramic. This is usually the preferred choice of those who suffer with rheumatoid arthritis as it affects the whole joint. Partial replacement involves the replacement of one compartment of the knee for osteoarthritis as this usually means that only one part of the knee is diseased.

Innovations

The innovations in this area involve the use of arthroscopy, a minimally-invasive method of viewing designs within the body and performing surgery on a joint. The arthroscope is a fibre-optic instrument inserted through a tiny incision, enabling remote viewing of the joint through a data processor screen. This method enables surgeons to make evaluations on the knee without having to completely open it up, and perform surgery with less of a risk of infection as the joint is not open.

Risks

The risk of deep vein thrombosis, or a blood clot in the vein, is also a considerable risk for knee surgery patients. Anti-coagulant drugs can also reduce this risk. Another recent study into a new drug has found an anti-coagulant that doesn’t cause bleeding, like others tend to. The drug could be used broadly to prevent deep vein thrombosis or pulmonary embolism in many different therapeutic settings, including stroke, myocardial infarction and with surgeries such as knee or hip replacement, where additional safe and effective anti-thrombotic drugs are needed. This drug hasn’t been licensed yet, but it could be an exciting move forward for reducing this risk.

The Prosthetic Joint

There are different designs to the various prosthetic joints themselves. Usually made out of metal or ceramic, most designs replicate the human body’s. Future arthrobotic applications may consist of complete joint replacement with bionic prostheses and neuro-computer interfaces for limb control from neural impulses in the brain. This means that amputees may be able to control artificial limbs that are connected to them internally, rather than ones that they strap on.

Recovery

There is a range of different things that can help to aid the recovery of knee replacements and get a patient walking with ease again. One of the most important factors is physical therapy. A recent study has shown that the longer that a patient continued with their physical therapy after knee surgery, the better their recovery, but many patients didn’t attend, despite being below their pre-operative performance levels.

Ashoka Changemakers is partnering with Robert Wood Johnson Foundation’s Pioneer Portfolio to launch the international competition, Innovations for Health: Solutions that Cross Borders.

 Ashoka seeks health solutions from around the world that have the potential to be applied in other countries to improve health and health care. They are especially interested in those innovations that have the potential to help vulnerable and underserved populations in other countries that are experiencing similar barriers to health.

Examples of breakthrough innovations they would  like to see include those that:

• Deploy the full spectrum of health care workers and providers, thereby improving the capacity, reach, and quality of health care services;
• Use simple, low-cost interventions to improve medical, preventive, and dental care;
• Help people find and access the health information, services, and providers they need through new tools and processes;
• Provide high quality and personalized care in non-traditional settings; and
• Find new ways to engage patients in their care, particularly patients with chronic illnesses.

 The 3 winner solutions will win a prize of US $10,000 each. The final deadline for entries is February 13.

 To enter your idea, just visit http://www.changemakers.com/innovations4health. If you have any questions, please contact Natalie Zuniga at nzuniga@ashoka.org.

WHCC Health Innovations would like to share the opportunity below from the International Partnership for Innovative Healthcare Develivery (IPIHD). The organization grew out of the World Economic Forum and is housed at Duke University. Its mission is to expand accesss to sustainable health care projects, especially in developing countries. IPIHD is partnering with the 9th Annual World Health Care Congress, coming up April 16-18 in Washington, D.C.

IPIHD  is accepting innovator applications for IPIHD Network membership.  All innovators with active operations are welcome to apply (free of cost).  IPIHD believes that the achievement of global access to cost-effective and high-quality healthcare is a critical component to achieving the fundamental aim of reducing healthcare delivery inequities in the world.  As such, membership is free to healthcare innovators.  Innovators can apply to join here: http://www.ipihd.org/joining-ipihd/innovators

IPIHD leadership will review and select applicants based on defined criteria within the next month.  Others interested in following and connecting with IPIHD, including innovators, can join the IPIHD Community here for updates tailored to individual interests.  All are invited to ‘like’ IPIHD on Facebook and follow @IPIHD on Twitter.    

Background to IPIHD : http://www.ipihd.org/about-ipihd/background-to-ipihd

A typical hospital room doesn’t exactly induce serenity. Glaring neutral-colored walls crowded with medical devices clash with chilly linolium tile floors. The view out the window – if there even is a window - might be of another building, a parking garade or a sea of ashphalt.  For ailing patients, the scenery probably isn’t going to help put them at ease.

But can images of snow-capped mountains, a Carribean beach paradise or a meandering forest brook brighten a patient’s mood and accelerate the healing process.  Ernesto Rodriguez thinks so, and so do more than 500 hospitals around the globe.

Rodriguez is CEO of Sereneview, a California company that produces hospital curtains and other similar products filled with rich nature imagery.  There are mountains, forests,  lakes and rivers that fill wall-sized backgrounds for hostipal room. Rodriguez has spent several years as a nature photographer and was inspired to start Sereneview after hiking among the redwoods of northern California. He had visited a friend in the hospital and was struck by how nurturing the forest felt in contrast to the hospital. Rodriguez fused his training in psychology and design to focus on creating relaxing nature imagery that could take the edge off the sterile hospital environment and even inspire wellness.

To Seneneview, the benefit of nature imagery in the hospital is evidence-based.

“Forty-years of research documents the link between viewing nature photographs and lowering blood pressure, lowering anxiety, reduced need for pain medication, shorter hospital stays and less complications after surgery,” according to Seneneview website. “ Exposure to a Nature scene affects the autonomic nervous system and enhances the healing process.”

“The human body is a walking pharmacy, ” Rodriquez said during a recent conversation with WHCC Health Innovations, meaning human biology has enough healing mechanisms to battle many diseases – but only under the right conditions. If there’s too much stress or an unfavorable environment, the healing process isn’t likely to work as well.

An increasing number of  hosptials are paying attention to how thier patient rooms appear rather than just what kind care they are equipped to deliver.  The U.S. Veterans Administration uses the curtains in its hospitals.

“An environment that’s reminding people about life outside the hospital, and giving them a vision of where they’re going – I think – keeps people’s hopes up,” said Graham H. Creasey, MD Chief, Spinal Cord Injury Service, VAPalo AltoHealth Care System, in a testimonial on the Sereneview website.

Rodriquez said the current practice of how people are hospitalized dates to centuries ago to when Europe was cripled by the bubonic plague. People infected with the deadly virus were walled off in large institutions to prevent them from infecting the general populations. The practices of housing patients in fortress-like structures persisted.  

Sereneview has gone global with its designs and hopes to convince more hosptials to adopt nature imagery as a tool for imporving a patient’s outlook and overall health. The company plans to display a poster at the World Health Care Congress Middle East in Abu Dhabi next month.

A new study led by the London School of Hygiene & Tropical Medicine “Good health at low cost – 25 years on” concludes that countries with relatively low income can make big improvements to the health of their populations by adopting a winning formula for strengthening health systems. Countries studied were Bangladesh, Ethiopia, Kyrgyzstan, Tamil Nadu (India) and Thailand.

 The report picks up where a 1985 Rockefeller Foundation report left off, which found that Sri Lanka, Costa Rica, China and the Indian state of Kerala achieved levels of health comparable to those of wealthier countries.

 To mark the 25^th anniversary of the original Good Health at low cost report, the LSHTM-led team returned to the original research questions and found that today’s study countries have made substantial improvements in health and access to essential services beyond what might be expected on the basis of their income level.

 WHCC Health Innovations recently asked project participants Tracey Koehlmoos, PhD, Programme Head, Health & Family Planning Systems Programme, International Centre for Diarrhoeal Disease Research, Bangladesh and Dina Balabanova, Senior Lecturer, Health Systems/Policy, Department of Global Health & Development, LSHTM about the study:

 Much has changed in health care delivery in the past 25 year, particularly with the emergence of new technologies that did not exist in the late 1980s. How much has a widespread embracing of technology affected the success of the heath systems you studied?

 Less so than the embracing and wide-spread distribution of high technology, high cost treatment across developing countries, particularly Bangladesh. What we see is the strengthening of means to bring low technology, low cost solutions to the population. Examples of this will be improvements in means of family planning like door step delivery or increases in the uptake of childhood immunization. In Bangladesh we specifically benefitted from the door to door scale up of Oral Rehydration Solution (ORS) and now are trying to build up on that success by scaling up zinc. The manufacturing of the product is done locally through a technology transfer but the use of the product is easy, the intervention is sold over the counter, and the cost is minimal; however, zinc for childhood diarrhea can save upward of 50,000 child lives per year in Bangladesh alone.

 In Bangladesh, many people live off the power grid, yet mobile phone access is tremendous and use of phones is very inexpensive. Thus, we are seeing more and more of a combination of low tech and high tech solutions, such as the use of mobile phones to remind women to have their depo provera injections and we just completed extensive testing of the use of mobile phones to enable skilled birth attendants to engage with pregnant women in the villages and to receive guidance from physicians when women are delivering.

 The research shows Bangladesh, Ethiopia, Kyrgystan, Tamil Nadu, India and Thailand have outpaced other countries with similar income levels. Is there a particular country among these that has shown the most substantial improvement in the past quarter of a century?

 The study countries have made substantial improvements in health and access to essential services beyond what might be expected on the basis of their income level. Each of the study countries has achieved improvements in different areas reflecting their specific contexts (in terms of disease burdens, health system setup and resources). The advances are both in terms of health indicators and in access to health care.

 Bangladesh and Tamil Nadu have among the longest life expectancies for men and women in their regions.Bangladesh has achieved huge improvements in maternal mortality, known internationally as the ‘Bangladesh miracle’. Ethiopiahas gone from being one of the worst performers in under-5 mortality to outperforming neighbouring Tanzania and Uganda. Thailand, a country that has achieved all the health MDGs, has now adopted MDG+, a set of targets that go well beyond the internationally agreed goals.

 All countries have made large advances in access to key services responding to population needs. Bangladesh now provides almost universal access to vaccination services, as measured by the percentage of children under 1 year of age who receive BCG (a vaccine against tuberculosis). This increased from 2% in 1985 to 99% in 2009. Ethiopia scaled up the innovative Health Extension Programme, seeking to reduce geographical barriers to care. As a result between 2004 and 2008, the percentage of births with a skilled attendant doubled, and the percentage of women receiving antenatal care and of infants fully immunized increased by over 50%. Thailand and Kyrgyzstan have achieved universal health care coverage through expansion of health insurance schemes.

 Many of these positive trends were sustained or accelerated over long periods of time.

 If a high income population is not necessarily a prerequisite for a successful health care system, is there one driving factor that appears to be essential?

 The book identifies government leadership as being critical in achieving progress. In each study country there were strong individuals who had a vision of where they wanted the health system to be and the ability to inspire those around them to get the job done. This included charismatic political leaders, inspirational and influential health sector and health care professionals and talented and committed technocrats, although leadership and vision alone would not have been as effective without the presence of strong institutions that were resilient in the face of political and societal changes and that retained institutional memory.

 Another aspect of leadership was the ability to seize a window of opportunity. Economic and political shocks and other external events can also catalyse health systems change and lead to the creation of new capacities and learning. This ultimately promotes health system strengthening.

 Government leadership has also been manifested in inter-sectoral action, combining policies and programmes that strengthen health systems with efforts to improve literacy levels, road infrastructure and political openness that can improve health more effectively.

 The research concludes that piecemeal approaches to health care challenges ultimately do not have a long-lasting substantial impact. Why is this?

 The research demonstrates that only comprehensive and long term approaches to improving health systems and constant monitoring of the target outcomes will work. Continuity, including stable, professionalised bureaucracies, is a staple ingredient in building effective health systems. This process requires time, ability to prioritise and sustained effort.

For example, the Manas and Manas Taalimi programmes inKyrgyzstancovered a 15-year period surviving three major political upheavals as well as a series of economic shocks, providing continuity for the health system. Thailand had a long succession of 5 year plans.Bangladesh has demonstrated strong political commitment to health and despite rapid changes in the political landscape many health policies have been sustained for significant periods of time.

 Are there plans to leverage the findings of the porter to encourage other countries to adopt similar strategies?

 The book seeks to stimulate debate among international and national health actors and advocates about the need to keep building strong health systems on the policy agenda of governments and donors. The book cautions that even countries currently seen as success stories are vulnerable to global economic shocks and increasing urbanisation, a growing private sector and an upsurge in non-communicable diseases. It suggests that both learning from the past and new approaches are required to adapt health systems

 The book and forthcoming activities on the project website (http://ghlc.lshtm.ac.uk/), Twitter (@healthatlowcost and @dinabalabanova), aim to catalyse dialogue, enable sharing of knowledge and inform action at national and international level. Drawing on the study countries and further country experience, we will continue to make the case that success is possible even at relatively low level of resources despite facing multiple economic, political and social challenges. The book reinforces the key goal of theRio declaration: to address broad determinants of health, while emphasizing that health systems remain more important in improving health than ever before.

Water supplies are often abundant in developing countires, but drinkable water is not.

This was the dilemma Timothy Whitehead discovered during a trip to Zambia, a sub-Sararah Arfrican Country of roughly 13 million people.

“There seemed to be so much water around, but you couldn’t drink it,” said Whitehead, a design and technology graduate from Loughborough Univesrity in the UK who has gone on to found Pure Water Technology.

The answer fpr sterilizing the water was chlorine and iodine tablets, which is  time consuming and negatively affects the water’s taste. In search of a better solution, Whitehead developed a sleek bottle that can scoop up water from virtually any source and make it safe to drink within two minutes. It removes 99.9 percent of contaminents.

WHCC Health Innovations recently spoke with Whitehead about the technology and his plans for the product.

The Pure water bottle is about the size of a regular water bottle and holds a litre of water. An ultraviolet light bulb steralizes the water with the aid of another filter. The bulb only needs to be replaced every 8,000 litres and the filter every 500 litres. The device can be recharged by a hand crank, thus removing the need for an exteranal power supply.

Whitehead oringally intented the bottle be used by travelers and tourists who found themsevlves in a rural area that lacked adequate drinking water. But he has since realized there are addtional markets, including local populations, that can benefit from the device. In addtion to providing clean drinking water for rural populations, Pure may also be a sound solution to providing clean water to natural disaster areas.

The global technology world has taken notice. The INDEX 2011 Design to Improve Life Awards, IDSA 2011 IDEA Award, Core 77 Design Awards and James Dyson Award have also recognized Pure. Whithead took home  the UK Dyson Award in 2010 for the design.  

Pure is in the prototype phase,  but Whitehead said he is looking to build out the devices’ production and distribution.

One of recurring themes in inadequate health care among the world’s poorest populations is many problems can be alleviated with simple solutions. The problem is getting a simple solution to people who need it the most can be daunting challenge.

The New York Times has run an interesting series called “Small Fixes“, which explores many of the simpler solutions to providing what often amounts to life-saving interventions. Some of the innovations highlighted, such as the stamp-sized liver function paper test engineered at Diagnostics For All, have been featured in our WHCC Health Innovations program.

Many of the most interesting innovations are those that repurpose parts from everyday devices.  At our health innovation poster exhibit in Washington D.C.  in 2009, we saw a wheel chair made from used bicycle parts. We’ve also featured an infant incubator built from spare car parts! Along a similar theme “Small Fixes” features a device that helps newborns breath by providing continuous positive airway pressure, or CPAP. What’s particulalry interesting is a Rice Univerity student designed a “bubble CPAP” that employs pumps used in a typical home fish aquarium, a plastic Nalgene water bottle and a straw.

There are many other fascinating innovations featured in the series that rely on some amazing imagination and ingenuity.

To put a new twist on an old Coca-Cola slogan: ”Have and Coke and . . .some hydration salts?”

While many commercial products never find their way to all of the world’s countries, you’d be hard-pressed to find one that doesn’t have Coca-Cola. The ubiquitous soft-drink, with its trademark red and white label and logo, can be found wherever there are people to drink it.

  Coke, and its renowned global distribution system, is the inspiration for the non-profit start-up ColaLife. The idea is to “hitch a ride” on the unused spaces in crates that carry Coke and other products and disperse life-saving health care products, such as oral rehydration salts and zinc supplements. About 1 in 5 children in the developing world die before age five from simple preventable causes like dehydration from diarrhea.

   ColaLife is the vision of Simon Berry, a longtime innovator and social entrepreneur. Based in the United Kingdom, he and his wife Jane have given up regular employment to volunteer their time to launch to the company.  The WHCC Health Innovations Blog recently spoke with Mr. Berry about their endeavor.

   The organization started as an online ‘movement’ in April 2008 and has more than 10,000 online supporters that have given it the power to engage Coca-Cola, UNICEF and other key stakeholders. Coke supports the idea and ColaLife is working to secure funders and partners to get the project up and running.

   ColaLife uses a simple yet elegantly-designed container called an AidPod to hold small products that are needed in developing countries. The wedge-shaped device slips between the necks of rows of crated glass Coke bottles. Two ridges located on either side of wedge allow the container to lodge beneath the bottle caps, thus ensuring it will not fall out during transport. It’s possible to “piggyback” the AidPod  on products that are destined for remote areas that have a need  

    The AidPod has gone through several design phases (it’s on number 5) in order to reduce production costs and allow it to work more efficiently. The current design is about half the length of the previous one. A slide-off cap used on a previous version has been replaced by flip-up cover.  

    Plans call for using private industry to distribute the AidPods, with each point of distribution earning money for their efforts.

    ColaLife has chosen the sub-Saharan African country of Zambia for its trial run. Both Simon and Jane Berry will be relocating to the country while the trial in underway. They are in the process of raising funds and lining up supporters and distributors. Visit here to donate to the ColaLife effort.

There is an interesting article in the Fall 2011 edition of Stanford Social Innovation Review about how mhealth is positvely impacting the devilvery of care in developing and developed countries. The piece is written by Jaspel S. Sandhu, PhD, a global health care innovation advocate and partner at Gobee Group.

In the article, Dr. Sandhu discusses the global explosion of mobile phones (more that three-quaters of the 5.3 billion phones out there are in developing countries!) and many of the mobile health (mhealth) innovations that are already paying dividents. Dr. Sandhu also explores the idea of “reverse innovation”, a term GE execs coined in 2009 that proposes innovations developed for and implented in the developing world can eventually be employed in developing countries.

The Innovation Working Group (IWG), headed by U.N. Secretary-General Ban Ki-moon, today published its report “Innovating for Every Woman, Every Child”. The report focuses on innovations that are “home-grown and self-sustaining” rather than on development aid. The innovations can reduce maternal and infant maternal rates in developing countries.

Some of innovations highlighted, such as Cell-Life, has been featured in our WHCC Health Innovations program.  Cell-Life’s vision is to improve the lives of people infected and affected by HIV in South Africa through the appropriate use of mobile technology.

There are many other interesting innovations featured in the report. A PBS NewsHour article highlights many of them.