A new spin on women’s groups

PATH visitors sitting outside with large group of village residents.

A women’s group in India meets with PATH visitors. Photo: PATH/Sanjay Kumar Chauhan.

Editor’s note: PATH friends and board members traveled to India to see programs that improve children’s nutrition, immunize children against the deadly Japanese encephalitis virus, and help women’s groups save and borrow money to bolster their families’ health, education, and earnings. This is the second report in a three-part series.

Thursday, November 13—To meet the women of Anjani village in Bihar State, we walked narrow dirt alleys between their homes, stepping among cows and children.

We passed cakes of cow dung slapped on the walls next to us like rows of cookies baking to dry out and use later for cooking fuel.

A widow waved us into her home, eager to show us where she hosts meetings of a local women’s group. The dark, mud-brick shelter had a woven cot in a small room that sleeps five people. An adjoining room was for the family’s water buffalo that provides their livelihood, she told us, and a third room held fodder for the animal.

“In Bihar, we have a very strong caste system. Within that, we work with the most marginalized people,” said Tarun Vij, PATH’s country leader in India. “The families from the lower caste have all kinds of deprivations imposed upon them.”

Bihar is one of the country’s poorest states, with very high rates of maternal and newborn mortality and a literacy rate of just 64 percent. Anjani village sits along a tributary of the Ganges River and is home to some 500 families who work the nearby rice paddies.

Women sitting with their children on their laps.

The women’s groups pool their money—each contributing 40 rupees (the equivalent of US$.66)—in order to grant one another loans. Photo: PATH/Sanjay Kumar Chauhan.

Once a week, groups of 10 to 15 women gather to pool their money—each contributing 40 rupees (the equivalent of US$.66)—in order to grant one another loans. PATH works through these “self-help groups” to provide the women health tips on pregnancy, childbirth, family planning, nutrition, and sanitation, and to inform them of their rights to government services.

“We help them learn how to take collective actions and help other women,” Vij said. “If individually, you don’t have negotiating power or courage, you need to come together and access those services that you are entitled to.”

In Anjani, dozens of women gathered on the ground next to a temple to tell us how the groups have affected them. A 32-year-old mother of four said that she had delivered her first three children at home. When pregnant with her fourth, group members encouraged her to give birth in a facility where trained health workers offered best practices for her newborn’s health and development.

One woman said she joined the group to learn information that will help her children get into a better level of society, and to learn about sanitation and cleanliness so that her children will not get diseases.

“Coming to the group is like being together,” another said. “We feel happy that we come together and we get more information. Among us, unity has also improved.”

Such groups have been used successfully in many countries. What’s unique about PATH’s work in Bihar, which has the potential to transform lives for the state’s poorest people, is the use of data from the program to inform the government’s plans for 1 million self-help groups in the state.

“We have started to decode what is needed in this population. There’s a certain art to it,” said PATH’s Nityanand Deepak, who oversees knowledge management for the program. “They are starting to catch up to the higher caste level.”

Surveys of 3,800 group members in 2013 and 2014 found an impressive increase in key health indicators, such as immunization, breastfeeding, mothers’ skin-to-skin care for newborns, and delivering their children in institutions with health care providers instead of in homes.

“We need to sift the data, break the data down geographically, and try to understand the patterns,” said Dr. Lysander Menezes, team leader for maternal and child health and nutrition. “PATH is in the sweet spot of being the organization that can solve this for the country.”

In five years, PATH’s work has reached 225,000 women in 17,000 self-help groups across Bihar. PATH trains the trainers of the women who facilitate the groups, and oversees community monitoring to track facilitators’ performance.

PATH visitor Dorcas Mguge talks with a local man.

PATH’s work in Bihar has the potential to transform lives for the state’s poorest people. Photo: PATH/Sanjay Kumar Chauhan.

PATH also supports community health workers to strengthen village health committees to hold the health system accountable for services.

“We have lots of learning. Now it’s important to give that information to the government so they can scale up across all of Bihar,” said Deepak.

The PATH Journeys program offers donors an opportunity to experience firsthand the health innovations they support and to meet the people whose lives they are changing.

This is the second report in a three-part series from Lynn Heinisch, director of Executive and Internal Communications at PATH.

Coming next: An immunization delivers a brighter future.

Posts in this series

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How to feed lunch to 130,000 school kids

Man in factory stirring giant steaming vat.

The Akshaya Patra organization kitchen in Mathura, Uttar Pradesh, in northern India. The organization runs the world’s largest nonprofit midday meal program. Photo: PATH/Adarsh Minocha.

Editor’s note: Recently, PATH friends and board members traveled to India to see programs that improve children’s nutrition, immunize children against the deadly Japanese encephalitis virus, and help women’s groups save and borrow money to bolster their families’ health, education, and earnings. This is the first report in a three-part series.

Tuesday, November 11—At 5:30 this morning, I learned how to feed 130,000 Indian kids lunch.

It takes a three-story kitchen, with steamy cauldrons holding 1,200 liters of lentils each. A conveyor belt that spans across two rooms, churning out hot rotis by the hundreds. Dozens of men pouring and stirring, and loading stacks upon stacks of metal containers with rice.

It takes 79 trucks and a dispatch operation that routes each truck to roughly 28 schools, covering 72 miles with such precision that every meal arrives by the 1:00 p.m. lunch break.

And, most importantly, it takes a team of people appalled that 40 percent of Indian children are undernourished.

The Akshaya Patra organization, whose kitchen we visited in Mathura, Uttar Pradesh, in northern India, is the world’s largest midday meal program run by a nonprofit. Currently, the group feeds more than 1.4 million children across ten Indian states.

“To sit with the kids, spend time with the kids, and see their smiles, that is what it’s all about,” said Sreenivasa Rao, assistant general manager for operations. Akshaya Patra’s widespread reach positions PATH and one of India’s largest food-processing companies, Usher Agro Limited, to help children across the country by introducing fortified rice into the program.

PATH’s Ultra Rice® technology packs vitamins and minerals, including iron, zinc, vitamin A, folic acid, and other B vitamins, into fortified grains that are mixed with traditional rice. PATH advanced the technology and licensed it to Usher Agro and producers in other countries.

Clinical trials found that children between 5 and 12 years old who ate fortified rice showed a significant increase in iron stores. This is important because 75 percent of Indian children under 5 suffer from iron deficiency, which reduces cognitive function, and nearly half of Indian children under 5 are stunted due to micronutrient deficiencies.

The United Nations World Food Program uses Ultra Rice in the eastern state of Odisha for a meal program that feeds 98,000 children. And Akshaya Patra plans to serve Ultra Rice to 450,000 children across 2,600 schools in the southwestern state of Karnataka.

Factory worker standing in front of conveyer belts and hundreds of bags of rice.

PATH licensed our Ultra Rice technology to Usher Agro. Soon the fortified rice will reach 450,000 children across 2,600 schools in the southwestern state of Karnataka. Photo: PATH/Adarsh Minocha.

As we toured the Usher Agro factory in Mathura, the company’s Vipin Malhotra described their plans to produce and sell Ultra Rice both domestically and internationally once the Indian food safety regulatory agency grants approval to do so.

Over the din of mixers, extruders, and conveyor belts, we watched as the rice was produced.

“If the country gets the standards, if kids start getting the food, if Usher Agro gets to start exporting their products to other parts of the world, that’s a great role for PATH to have played,” said Tarun Vij, PATH’s country leader for India.

Hand holding rice grains.

PATH transferred the technology to Usher Agro for no fee, with the company agreeing to provide the rice to public-sector programs at a preferential price. Photo: PATH/Adarsh Minocha.

PATH transferred the technology to Usher Agro for no fee, with the company agreeing to provide the rice to public-sector programs at a preferential price. PATH also provided technical support to Usher Agro for procuring and installing the necessary equipment and standardizing the manufacturing process for fortified rice.

Usher Agro has the capacity to process 1 million tons of rice per year, Malhotra said, and the worldwide market for rice continues to grow. “We see a very bright future overall for fortified rice,” he said.

As for PATH’s involvement once Usher Agro receives the governmental approval that enables them to start selling Ultra Rice in mass quantities?

Board member Kevin Reilly, who joined the PATH Journeys trip, summed it up like this: “You put some technology in, you build someone up to be self-sustaining, and then you can hand it over to the local community.”

And move on to the next innovation.

The PATH Journeys program offers donors an opportunity to experience firsthand the health innovations they support and to meet the people whose lives they are changing.

This is the first report in a three-part series from Lynn Heinisch, director of Executive and Internal Communications at PATH.

Next posts: “A new spin on women’s groups” and “An immunization delivers a brighter future.”

More information

Ultra Rice is a registered US trademark of Bon Dente International, Inc.

Friday Think: what’s so innovative about failure?

Friday Think logoHere’s a weird story about a successful business based on failure in the Silicon Valley.

What the what?

Meet Weird Stuff, a Silicon Valley business that reaps goods from start-ups that grow, but mostly goods from start-ups that fail. Enough to pack a 27,000-square-foot warehouse with office cubicles, keyboards, used laptops, chairs, clocks, and countless whiteboards.

But the real story behind this piece is how the lifecycle of innovation is speeding up and what that means for all of us.

In the New York Times Magazine article, Adam Davidson writes:

A collection of reclaimed clocks.

Weird Stuff’s collection of reclaimed clocks. Photo: The New York Times/Michael Vahrenwald.

For decades, entrepreneurs and digital gurus of various repute have referred to this era, in a breathlessness bordering on proselytizing, as the age of innovation. But Weird Stuff is a reminder of another, unexpected truth about innovation: It is, by necessity, inextricably linked with failure. The path to any success is lined with disasters. Most of the products that do make it out of the lab fail spectacularly once they hit the market. Even successful products will ultimately fail when a better idea comes along. And those lucky innovations that are truly triumphant, the ones that transform markets and industries, create widespread failure among their competition.

The story continues:

The life span of an innovation, in fact, has never been shorter. An African hand ax from 285,000 years ago, for instance, was essentially identical to those made some 250,000 years later. The Sumerians believed that the hoe was invented by a godlike figure named Enlil a few thousand years before Jesus, but a similar tool was being used a thousand years after his death. During the Middle Ages, amid major advances in agriculture, warfare and building technology, the failure loop closed to less than a century. During the Enlightenment and early Industrial Revolution, it was reduced to about a lifetime. By the 20th century, it could be measured in decades. Today, it is best measured in years and, for some products, even less. (Schuetz receives tons of smartphones that are only a season or two old.)

Read the full story in the New York Times Magazine.

Each week, we scour the news for the hottest stories on innovation. Our weekly feature, The Friday Think, highlights one we’ve found particularly fascinating.

Our ode to commodes on World Toilet Day

A young boy sweeps the floor of a single-stall bathroom covered in floral tiles.

Students learn healthy habits and help maintain school toilets in the GIZ Regional Fit for School Programme in Cambodia. Photo: Ivan Sarenas.

No matter where you go

Toilets around the world have a few things in common: they’re rarely uniform and they’re often customized. And those, gentle reader, are but two reasons why they make great subjects for photos.

This marks the second year a toilet-shaped, loo-themed calendar has been published by PATH’s Defeat Diarrheal Disease (DefeatDD) team. The calendar, “Oh, the places we go: public health’s humble hero,” serves as a colorful reminder that hygiene truly does improve people’s lives.

But first, here are some photos

A woman stands in front of a toilet set into a concrete block next to firewood.

Munni Jatav is delighted as she stands near her toilet in Gwalior, Golpahaba Slum, Madhya Pradesh, India. Photo: Marco Betti/WaterAid.

A low-cost latrine using bamboo stems and leaves.

This low-cost latrine in the remote Nga Wa Village of Paletwa Township in Myanmar uses natural materials: bamboo stems and leaves. Photo: Kyaw Kyaw Soe/International Rescue Committee.

DefeatDD’s Hope Randall says that this year, QR codes were added to the calendar so folks with smartphones can scan the codes and share child health issues with friends, family, and colleagues. Hope adds,

Image of the calendar

Click to download the calendar and see additional photo entries.

Sanitation and hygiene education have reached some remarkably remote places. We advocate for toilets because they improve people’s lives. In the end, it’s not just about toilets really. It’s about health, safety, women’s empowerment, and so much more.

Get a whiff of the competition

It takes something to make a splash in the heralded pages of DefeatDD’s calendar. As you can imagine, competition was stiff. Here are a few outhouses that didn’t make it to the big time, but we loved them so much we had to share.

Five outdoor concrete toilet stalls, painted 'BOYS' and 'keep clean.'

These clearly are the boys rooms. Photo: Tendai Tendere/Practical Action.

A roofed two-story structure including a solar panel and container for rain water collection.

This loo has it all: rain water harvesting, passive solar heat, a shower, sink, and a double vault toilet. Photo: Hilary Lewis.

 Warthog lies in a field

A warthog lounges in front of an outhouse, reminding us that doors often provide a service beyond mere modesty. Photo: Sarah Bramley.

Toilet painted with hippos and a pair of cow horns on a shelf, next to an open door overlooking trees and hills.

This toilet, painted with Kiboko (hippos in Swahili) and topped with a pair of Ankole cow horns, overlooks a waterhole in Lake Mburu National Park, Uganda. Photo: Sarah Bramley/Save the Children.

"Tourist's toilet" wooden sign next to a trail.

Hopefully there’s a toilet for more than one tourist at this sign’s destination. Photo: Christopher Duggan.

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A novel contraceptive makes life easier in Uganda and beyond

Woman on bench in empty clinic space.

A woman waits for health care at a clinic in Uganda’s Mubende District. Photo: PATH/Will Boase.

If you had to walk 14 miles and cross a river to get contraception, you might think twice about how to use your time.

Do I really need family planning? What are my chances of actually getting pregnant anytime soon? And will it be a long wait at the clinic?

Add children to the equation. Children who need your attention, now. And the meals that need to be made. After a while, the long walk gets pushed into the background as your day-to-day priorities take over.

So let’s change the equation

What if contraception could be accessed in your village in a simple dose that only required minimal training to administer? And as a bonus, the needle was smaller than the usual shot in the arm.

All of a sudden, making time gets a whole lot easier.

Woman looks on as Sayana Press shot is prepared.

Sayana Press brings long-acting injectable contraception closer to where many Ugandan women live. Photo: PATH/Will Boase.

A breakthrough for women

Fiona Walugembe.

Fiona Walugembe, PATH’s Sayana Press project coordinator in Uganda. Photo: PATH.

In the PATH office in Kampala, project coordinator Fiona Walugembe works closely with the ministry of health and country partners to implement a project designed to bring family planning choices closer to where women live.

Fiona coordinates Uganda’s pilot introduction of the long-acting, reversible contraceptive called Sayana® Press, a new formulation and presentation of the widely used Depo-Provera®. Sayana Press eliminates the need to prepare a needle and syringe. Instead, the contraceptive is delivered through the single-use Uniject™ injection system (originally developed by PATH). It’s a streamlined design that makes it easier for trained community health workers to safely provide injections in clinics, community locations, or villages.

Due to its design, Sayana Press presents an ideal opportunity to strengthen the capacity and expand the role of community-based health workers called Village Health Teams (VHTs) throughout Uganda.

“This is a breakthrough for women in Uganda. Sayana Press will go a long way in reaching out to women in the most remote areas, especially since injectables are already the most preferred method of family planning choice in Uganda. The fact that it is delivered in the all-in-one Uniject system with a shorter needle will be highly acceptable to the women,” says Fiona.

To date, the PATH team has trained about 260 VHTs in Uganda’s Mubende District, and Pathfinder Uganda has collaborated with PATH to train 100 more in Amuria District. PATH and Pathfinder are training these VHTs on a variety of family planning methods, including Sayana Press. Fiona has seen firsthand that the VHTs take this new opportunity and their responsibilities to their communities very seriously.

Hand holding Sayana Press single shot contraceptive.

A health worker holds a Sayana Press injectable contraceptive, which is being offered as a new family planning option in Uganda. Photo: PATH/Will Boase.

“Community health workers have welcomed this new option for women. They appreciate the ease of injection,” says Fiona. “One health worker in Uganda predicted that Sayana Press will expand access (to family planning) for busy young mothers who will now be able to visit a health worker in the community for an injection rather than waiting a long time at a clinic.”

Contraception that’s easy and inexpensive

Injectable contraceptives are a widely used family planning method for women, and have been used around the world for several decades. They are especially popular in developing countries, where the risk for maternal death during childbirth can be as high as 1 in 15. Each injection provides a woman with protection for roughly thirteen weeks (about three months). The downside is that, in many settings, the same woman must often travel to a clinic about every three months to receive each injection.

A woman holds her baby while receiving an injection.

A woman holds her baby while receiving the Sayana Press contraceptive. Photo: PATH/Will Boase.

However, Sayana Press may be more easily administered to women in remote, hard-to-reach areas by health workers like VHTs who have basic training—and potentially for women to administer themselves through self-injection. It’s contraception that’s easy to transport, easy to use, and designed to reach women wherever they live.

A health worker throws away a used injectable.

A health worker throws away a used Sayana Press injectable. Photo: PATH/Will Boase.

What lies ahead

This year Sayana Press was introduced in Uganda, Burkina Faso, and Niger, and Senegal is now following suit. PATH works closely with ministries of health (MOH) and local partners to coordinate these country-led introductions.

Since the program launched in Burkina Faso, approximately 75,000 Sayana Press units have been distributed to health facilities, and approximately 2,500 health care providers have been trained to administer Sayana Press. In Burkina Faso alone, preliminary data shows that more than 5,700 women are using Sayana Press, and over 1,600 of these women are new users of family planning. Data in Uganda are only just starting to come in, but a full report will be available early in 2015.

“By the end of the first quarter of 2015, PATH and Pathfinder together will have trained about 1,200 VHTs in 10 districts of Uganda,” says Fiona. “In the coming year or so, other partners in Uganda, including FHI 360, WellShare, and Marie Stopes Uganda, will train an additional 1,360 community health workers in 19 more districts. It is energizing to see these partners working collaboratively to increase contraceptive options for so many women in Uganda.”

PATH is starting to train VHTs in Gulu District, with a particular focus on ensuring young women can access Sayana Press. Youth-friendly, rights-based family planning is emphasized in all the VHT trainings throughout Uganda. In addition, in Gulu, PATH is supporting the Ugandan affiliate of International Planned Parenthood Federation, Reproductive Health Uganda (RHU), to integrate Sayana Press in their youth-friendly outreach and services.

In early 2015, PATH and the Ugandan MOH will also begin studies to explore how a self-injection program might work, including what support women would need to inject Sayana Press safely and effectively at home.

The potential for Sayana Press is becoming a reality—for the first time

The Bill & Melinda Gates Foundation, the Children’s Investment Fund Foundation (CIFF), and Pfizer just announced an agreement that will expand access to Sayana® Press even further, at a new per-dose price of US$1 to qualified purchasers such as procurement agencies like the United Nations Population Fund (UNFPA) or the United States Agency for International Development (USAID). The agreement will help ensure that women in the world’s 69 poorest countries have access to this new contraceptive option at reduced or no cost.

Tweet about Sayana Press NYT article from Melinda GatesThe consortium of public- and private-sector donors and aid organizations supporting this collaboration includes the United Kingdom’s Department for International Development (DfID), UNFPA, and USAID. These partners are playing an important role in ensuring that even more women can access Sayana Press. In addition to assisting with procurement, DFID, UNFPA, and USAID will support country introductions and the delivery of Sayana Press to health facilities.

“It is exciting,” said Fiona. “It is really a big thing.”

As access to Sayana Press increases due to the new product price, the pilot introductions are now even more important. PATH anticipates that this program will provide valuable information to more countries that choose to add Sayana Press to their family planning options under the new initiative. The lessons learned will help take this innovation to scale faster, offering millions more women access to family planning that meets their needs no matter where they live.

More information

Sayana® Press and Depo-Provera® are registered trademarks of Pfizer Inc. and/or its affiliates. Uniject is a trademark of BD.

Friday Think: you can bank on this breast milk app

Friday Think logoEach week, we scour the news for the hottest stories on innovation. Our weekly feature, The Friday Think, highlights one we’ve found particularly fascinating.

This week, we’re sharing a National Public Radio story about breast milk banks.

Each year, millions of children under the age of five die because as infants they lacked access to breast milk. Breast milk is better than formula for supporting a baby’s immune system and ability to thrive, especially if they’re premature or underweight. In countries with ample resources, access isn’t a problem, thanks to high-tech breast milk banks stocked by donors. The problem is greatest in rural, low-resource areas where 99 percent of infant deaths occur. And that’s because these places often lack or can’t afford expensive pasteurization technology.

What if there was a low-cost device that could safeguard donated milk so babies, whose mothers are unable to breast feed, could still get the nutrition they need?

Newborn in an incubator at a hospital.

A technology to pasteurize breast milk is helping those who are unable to breastfeed their babies. Photo: PATH/Wendy Stone.

Here’s an excerpt from NPR:

Now there’s a simple device called FoneAstra that, when combined with a smartphone, can pasteurize milk so a bank can be set up almost anywhere. The cost is only about $1,000.

But a commercial device to pasteurize breast milk can cost from $10,000 to $45,000—out of reach for rural clinics. …And that’s the part of the world where breast-milk banks are especially crucial. Each year, 800,000 children under the age of 5 die because they didn’t have access to breast milk—close to 1 out of every 8 infant deaths, most of which occur in developing regions.

Read the full story on the NPR website.

(Full disclosure: PATH and the University of Washington were instrumental in the development of this device and app.)

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What is “frugal science?” A visit to the home of the $1 folding paper microscope

Two men look at a hand-sized microscope made from folded paper in a lab.

PATH’s president and CEO Steve Davis and Dr. Manu Prakash discuss the $1 folding paper microscope developed in Prakash Lab at Stanford. Photo: PATH/Tom Furtwangler.

What innovations or economic opportunities would be unleashed if powerful microscopes only cost $1 each, and fit in a pocket?

What health improvements could result from bringing point-of-care diagnostics to the most remote outposts, in a simple wind-up device that does not need electricity or external chemical reagents?

Imagining—and then building—global health solutions at the visionary edge of possibility are part of the mission of Dr. Manu Prakash’s Stanford University bioengineering lab.

Their “frugal science” philosophy has already led to the development of the $1 folding paper microscope popularized by this TED talk, which has caught the imagination of more than 1.2 million viewers.

Two students talking in a lab full of devices.

Students are imagining—and then building—global health solutions at the visionary edge of possibility in Dr. Manu Prakash’s Stanford University bioengineering lab. Photo: PATH/Tom Furtwangler.

What does “frugal science” mean?

“Your lab thinks about many of the same problems we focus on at PATH, and in very similar ways,” said Steve Davis, PATH’s president and CEO, meeting with Manu and his students recently on campus at Stanford, where Steve is a visiting faculty member this quarter.

The students, a diverse group whose disciplines range from physics to mechanical engineering to music, and who represent countries from around the globe, work in a lab where frugal science is one of several areas of focus. Pressed by Steve to define the term, members of the group described how the frugal science concept frames their solutions-oriented work.

“Innovators in low-resource settings are really good at this,” said Elizabeth Marshman, a graduate student in the lab. “So it’s bringing that spirit of creativity to an environment like Stanford where there are so many people who are creative and capable and primed to innovate.”

Indian man and girl sit behind the wheel of a rickety truck.

This jugaad truck, like many in India, was built with a diesel engine originally intended to power an agricultural irrigation pump. Photo: Wikipedia.

“But it does not mean that you compromise, in terms of the solution,” added Manu.

“There is a word that gets tossed around, ‘jugaad,’ which happens to have Indian origins, and there are people in the management world who use jugaad as an analogy for problem-solving in business. By jugaad they really mean a hack, a quick way of getting to a one-time solution, but then you leave it there, and it’s often not sustainable or scalable or optimal in any way. Frugal science is not that.”

“Sometimes people are confused about this,” added graduate student Deepak Krishnamurthy, chiming in with enthusiasm. “But it’s about using cost as a parameter; it does not mean that you are going for a solution that is anything less than the optimal.”

Poster showing magnified images, with hand gesturing towards it.

Manu shows a poster describing how the pocket-sized microscope offers magnification over 2000X, at a cost under $1 per unit. Photo: PATH/Tom Furtwangler.

The impact of 10,000 free microscopes

While other lab innovations are moving from concept to prototype, the “Foldscope” origami microscope remains the lab’s most famous creation. For under $1, the microscope provides 2000X magnification, in a form that fits in a pocket or can be sent in the mail.

Recently the lab began distributing more than 10,000 of the devices for free, after collecting applications from more than 130 countries worldwide. “The only thing we asked in return is that they use a simple online form to submit how the microscope is being used,” said Manu.

As the submissions come in, user feedback shows the diverse and unexpected ways the Foldscope is being used, which was the whole point of sending out so many free kits.

A scrap metal recycler who earns a few dollars a day wrote that he can now tell more accurately which metal he is handling and whether he is getting a fair price for it. A beekeeper uses the Foldscope to diagnose parasites that are attacking her bees; healthier hives have the potential to increase her family’s financial security.

Three men hold and look at a small device in their hands.

Steve, Manu, and Kenyan graduate student George Korir discuss one of the lab’s innovative devices: a simple wind-up mechanism from a toy, reconfigured to run disease diagnostics using a paper strip carrying punch-card programming and embedded chemical reagents. Photo: PATH/Tom Furtwangler.

Bridging from the lab to the field

The lab’s intersection of cross-disciplinary experts who come together to solve complex problems mirrors the approach PATH often takes, a similarity noted by Steve in the discussion.

Promising to connect the lab’s students and projects with several PATH groups, he wrapped up the conversation with an encouragement to keep “moving development thinking to the left” as much as possible, explaining that he meant “taking considerations that often come much later in the product development process, like user testing, and manufacturing costs, and regulatory hurdles, and moving them to the left, meaning earlier, in the development cycle.”

“Your group’s emphasis on ‘frugal science’—a term that I love—is remarkable in its emphasis on integrating these cost and manufacturing considerations into your design thinking from the beginning,” said Steve.

Coverage plan: mobile phone app fights tuberculosis

Man and woman with their belongings at a local tuberculosis hospital.

It’s not uncommon for tuberculosis patients to experience long wait times at local hospitals in Vietnam. Photo: PATH/Nguyen Ba Quang.

What do the following facts have in common?

  • Vietnam has 90 million people and roughly 120 million mobile subscriptions (a 130 percent saturation rate).
  • Cases of multidrug-resistant tuberculosis are rising in Vietnam, 23 percent of which are retreatment cases.

Here’s the answer: The former is battling the latter in an innovative pilot program that’s shown promise in treating tuberculosis (TB). And a good portion of the work is literally in the hands of health workers and their patients.

Tuberculosis remains one of the world’s deadliest communicable diseases

The World Health Organization’s Global Tuberculosis Report 2014 affirms that globally, TB is the second-leading infectious disease, infecting over nine million people in the past year. Although Vietnam has achieved a high TB treatment success rate (over 90 percent), there’s still a great deal of work to be done.

PATH, working alongside the National TB Program, supports patients by helping them stick with their TB care plans through a project currently funded by The Global Fund for AIDS, Tuberculosis and Malaria. The objective? To improve adherence of TB care plans without further burdening public health resources.

Patients on cots at TB hospital.

PATH hopes to improve patient care and reduce the administrative costs associated with tuberculosis. Photo: PATH/Nguyen Ba Quang.

A novel coverage plan

Patients who do not closely follow their TB care plans are less likely to be cured or complete their full course of treatment. As a result of this behavior, the treatment success rate can drop and the multidrug-resistant tuberculosis (MDR-TB) rate can rise.

PATH’s TB team capitalized on the high level of mobile phone coverage in Vietnam by implementing a pilot mobile health application (mHealth app) that could access patient phone records through the national TB treatment management database. The app uses this information to send text messages (SMS) to patients, reminding them to take their medication and to show up for scheduled health checks and follow-up tests.

Commune health worker uses mobile phone application to enter data.

Commune health worker uses the mobile phone application to enter and upload TB patient information to the system. Photo: PATH/Dao Dinh Sang.

The application aims to support TB patient treatment adherence, which is especially important in a country where MDR-TB in both new and relapse TB cases is on the rise.

Two women sit in a waiting room

Two women sit in a TB hospital waiting room in Vietnam. Photo: PATH/Nguyen Ba Quang.

Piloted in 17 communes of Vung Tau City in Vietnam, preliminary findings show that the app increased the percentage of on-time visits for scheduled health checks (from 72.3 to 82 percent for the third visit), as well as overall treatment success rates (from 91 to 98 percent) in TB patients. PATH’s app allows TB patients to better manage their treatment, empowering them to take control over the disease. One of the most exciting aspects of this app is that Vung Tau City has expanded its use within the province post-pilot, which shows great promise for the cost-effectiveness and sustainability of this tool.

Incorporating mHealth solutions is new territory for tuberculosis efforts in Vietnam, but based on the positive results so far, the team is looking to expand the reach of this app and other potential mHealth solutions. An evaluation of the pilot, planned for mid-2015, will contribute to a set of recommendations for the National TB Program.

The team’s success with the pilot mHealth app was accepted for oral presentation at the 45th Annual TB Union Conference in Barcelona, Spain.

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Guest contributor Claire Topalian is a freelance writer for PATH.

Friday Think: the $150 Ebola technology challenge

Friday Think logo

Each week, our media team scours the news for the hottest stories on innovation and shares them with us. Our weekly feature, The Friday Think, highlights one story we’ve found particularly fascinating.

This week, we’ll focus on Dr. Ian Lipkin, a professor at Columbia and one of the world’s leading infectious diseases investigators. Lipkin appeared on the radio program Here & Now (NPR and WBUR Boston) after he challenged college students at Columbia’s School of Engineering and Applied Science to come up with low-cost technology solutions($150 or less) to problems encountered during Ebola treatment. Oh, and he wanted these solutions within two weeks’ time.

Never underestimate the ingenuity of thrifty college students

Dr. Lipkin received submissions as varied as using a colored bleach foam so health workers could see if sanitation measures were effective, to hazmat suits outfitted for long work days with hydration systems. Here’s the story:

Listen to the story on the WBUR website.

The future of field-appropriate diagnostics

Adolescent holding an infant.

Eliminating neglected tropical diseases are the focus of diagnostic tools and innovations. Photo: PATH/Gabe Bienczycki.

Editor’s note: This week PATH is announcing the launch of a new diagnostic test for river blindness with manufacturing partner Standard Diagnostics, Inc. This is the third day of a blog series exploring how river blindness affects communities, how the diagnostic test works, and why diagnostic tools are the next wave in global health innovation.

Part 3: The future is quick, nimble, and surprisingly simple

Yesterday we talked about a new diagnostic test for river blindness, one of 17 neglected tropical diseases (NTDs) the World Health Organization (WHO) has targeted for control, elimination, or eradication by 2020. The new rapid test is a bold first step by PATH to support reaching these targets.

Children play in the river.

Women and children from a community in Togo exposed to river blindness gather at the river during a 2014 PATH field study of the SD BIOLINE Onchocerciasis IgG4 rapid test. Photo: PATH/Dunia Faulx.

“What’s needed now is quick action to add this simple test to control and elimination programs.” said David C. Kaslow, vice president for Product Development at PATH.

Over the next several years, PATH will leverage its expertise, innovation, and global partnerships to speed the development of a suite of diagnostic tools to help eliminate other NTDs. Together, these collaborative efforts will reduce suffering, improve health equity, and help communities thrive worldwide.

“The lack of sensitive, effective, and field-ready diagnostic tests for NTDs is a critical gap in the global health community’s ability to direct control and elimination efforts and track progress in the fight against NTDs,” says Tala de los Santos, group leader of Diagnostics at PATH.

A battle against the scourges

Neglected tropical diseases are a set of infectious diseases that affect more than one billion people worldwide, mainly in sub-Saharan Africa, Asia, and Central and South America. They cause significant illness, disability, pain, and suffering, and their effects are especially hard on women and children. Women often have to care for sick family members, limiting their opportunities as well as making them vulnerable to infection; children are also at high risk of infection, and their physical and cognitive growth are negatively impacted by these diseases. The effects of NTDs on health and development contribute to keeping the world’s most vulnerable communities trapped in a cycle of illness and poverty.

Gloved hands applying a blood sample to a malaria diagnostic next to a test log and pill packet nearby.

A health worker applies a blood sample to a malaria diagnostic test as part of the Malaria Control and Evaluation Partnership in Lusaka, Zambia. Photo: PATH/Gena Morgan.

It’s not all about the apps; they must be appropriate tools

Diagnostic tools play a crucial role in the entire surveillance process. Their impact can be felt from initial mapping of an endemic area to confirming elimination. And in many cases, confirming an area has eliminated a disease can be challenging.

Anurag Mairal, Technology Solutions leader at PATH, agrees: “Vaccines and drugs typically take priority in the fight against neglected diseases. But without diagnostics, it’s hard to know whether a program is having an impact.”

Add to the fact that many current diagnostic tests require a person travel to a clinic, often miles away from their rural community, before they can receive the correct treatment. It’s just one more argument for the development of field-based tests that are rapid, simple, and accurate.

Additional resources will be needed to ensure that tests are produced and made available to national NTD control and elimination programs. Once these are applied in the field, the new tests can help to guide policy and further political and financial support for NTD programs. To that end, PATH will work with partners to identify opportunities to bring these products to market.

At PATH, we call these opportunities to improve the health and livelihoods of people game-changing technologies. And we believe the outcomes result in an extraordinary return on investment.

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