Friday Think: a “clinic on wheels” packs a punch at poverty

Map showing Medicaid birth rates in Gainesville by ZIP code.”

After a Gainesville doctor tracked birth rates to ZIP codes, she started noticing some disturbing health trends. Map: Census Block Group and University of Southern Florida.

When Gainesville, Florida, doctor Nancy Hardt and Alachua County Sheriff Sadie Darnell first met, they had an unusual “aha” moment. Both had been mapping out the same area in Gainesville, only for different reasons: high crime rates and poverty birth rates.

A colleague suggested they meet and compare maps. What they saw was an area or “hotspot” that both maps shared. It was enough to launch them into action.

“We kind of blinked at each other,” Hardt says. “And — simultaneously — we said, ‘We’ve got to do something.'”

Here’s an excerpt from Laura Starecheski’s story that aired on NPR‘s public health blog Shots.

"Clinic on wheels" bus parked at an apartment complex.

Dr. Nancy Hardt’s free “clinic on wheels,” gets about 5,000 visits from patients each year. Photo: Bryan Thomas for NPR.

The hotspot is dotted with isolated, crowded apartment complexes with names like Majestic Oaks and Holly Heights. The first time she visited, on a ride-along with Sheriff Darnell’s deputies, Hardt tallied up all things that make it hard for kids here to grow up healthy.

And there were quite a few things Dr. Hardt noticed: substandard housing, hunger, and a lack of medical care services for the uninsured. The story continues:

She mapped it out and determined that the closest place to get routine medical care if you’re uninsured — which many people here are — is the county health department. It’s almost a two-hour trip away by bus. Each way.

The “clinic on wheels” first made it out to the hotspot in 2010, parking right inside one apartment complex there. Patients could walk in without an appointment and get treatment free of charge, approximating the experience of a house call. Today, the mobile clinic gets an average of 5,000 visits from patients per year, in under-served areas all over Gainesville.

Friday Think logo You can listen to this story or read the transcript in its entirety at NPR.org.

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.

Cleaner water, higher quality goods, better lives, by design

Mother stands with two young daughters next to household water filter.

PATH’s user-centered design process resulted in standardized home water filters that fit multiple water systems. We then worked with manufacturers and partners to make these water systems affordable through a microfinance program. Photo: PATH/Gabe Bienczycki.

How do you get a new product to people who are in an underserved market, who may live on just a few dollars a day, have little access to credit, and are hard to reach via conventional distribution channels?

This is the story of how a user-centered design process in India positively impacted the health of communities, benefited manufacturers, strengthened the marketplace, and empowered lives.

Developing products that can impact individual, family, and community health at multiple levels, by design

At PATH, we practice user-centered design as we develop new technologies for people who live in low-resource settings around the world. Our process extends far beyond our lab and product development workshop—to the field, people’s homes, and sometimes manufacturing facilities, to name a few. It incorporates input from multiple stakeholders and includes partnerships that shift depending on which stage of innovation we’re in.

“Imagine a map with very little detail. By defining a need and anticipating who will use it, you develop a better map. Successive approximation and iterative work makes the journey route clearer and clearer. The navigation to innovation is rarely linear.” —Glenn Austin, senior advisor of Product Development at PATH.

Designing for cleaner water and for better lives: bringing field tests into homes

In India, we started with the people and their need for safer water. To better understand how low-income people might use water treatment and safe storage products, we enlisted the help of 20 households to “road test” five existing models to share what they liked and didn’t like. Up until then, water filters among participants were novel products, and few people had seen, let alone used them.

“There’s a difference between designing a functional water filter and designing a water filter that people will use.” —Jesse Schubert, senior program associate in Devices and Tools at PATH.

Woman in her home standing proudly between a blue water storage barrel and a water filter.

In Vavilala, India, Taramma got a water filter during a PATH pilot project. Photo: PATH/Gabe Bienczycki.

Over a period of months, each household weighed in on what might influence their adoption and use of water filters. For instance, a bigger water system was initially perceived as better. Hard-to-reach surfaces were seen as problematic to clean. Steel containers were considered aesthetically pleasing. And price made a big difference on whether they would buy replacement filters. All these observations informed our own prototype design.

Through multiple cycles of feedback, PATH’s water filter prototype evolved and improved until we landed on a design that met the needs of our household testers while providing safe water and making a positive impact on their health. The testers essentially became codesigners with PATH and their input helped inform design guidelines for more effective devices.

The design becomes a blueprint for a new user: the manufacturer

When developing solutions, we design for sustainability to ensure manufacturers can keep costs as low as possible while still making a fair profit. In this case, we found our initial prototype was too costly to build.

PATH worked with manufacturers to remain true to our user guidelines, modifying materials to ensure high quality at sustainable production costs. Together, we were able to develop affordable water filters for underserved populations in low-resource settings. The end result: a product that people found attractive, beneficial, and useable.

Getting the product to the people: a new distribution model

Our involvement didn’t end at the physical product; getting the water systems to these areas was another story. Traditional methods of distribution were too expensive for manufacturers to support.

PATH helped develop a new distribution channel. We linked microfinance organizations to the manufacturers so local groups of consumers could purchase these products through affordable loans that were easier to repay.

A woman standing next to a water filtration device holds a child.

Creating a distribution network to villages is costly for water filtration manufacturers and drives the price up. This slideshow shows how microfinance loans helped get filters into rural homes. Photo: PATH/Gabe Bienczycki.

What we really do is user-centered “development”

The Journey of Innovation: learn moreIt’s a longer game that’s played well when all the stakeholders and steps are included along the way.

From the start, PATH enlists a team that covers technology, public health, commercialization, and, depending on where we’re at in the development process, experts who help us customize solutions for the local environment.

Refining technologies by leveraging partnerships and resources can help define new industry standards. The result: lower costs, higher quality, and expanded health access. And that’s really the end game.

This post is part of a multi-part series, Mapping the Journey, which explores how PATH turns ideas into solutions that bring equity, dignity, and health to women, children, and families worldwide. This is the third installment of the series.

Other posts in this series

Strength in numbers: the power behind peer learning networks

A group of participants from the Joint Learning Network (JLN) members share ideas.

We’re finding that one of the best ways to problem solve and distill information is to share experiences with your peers. Photo: PATH.

Around the world, a large percentage of the global health community still records data and tracks medical inventories by hand using paper forms. Yet by studying India and Thailand’s health insurance information systems, Ghana and Kenya were able to develop their own e-claims standard and automate their payment processes.

As technological advances make accessing and sharing data a practical activity, it’s easy to lose sight of how effective it is to simply ask someone to share their lessons and what’s worked for them.

Two African men look at a cell phone that one is holding, while standing in a conference setting with devices around them.

When people cross borders to collaborate with their peers in other countries, the result can be new and novel approaches, models, and examples of implementation. Photo: Flickr/Maker Faire Africa.

Today, this type of sharing reflects a paradigm shift in global health programs as we see the development of national experts who can connect emergent experiences.

Sometimes, the best solutions have a deceptively simple approach

It’s called peer-to-peer learning. And through this model, a fresh set of voices and views are creating effective solutions to global health challenges from the ground up.

Peer-to-peer working groups are made up of those leading the way at the national level. Medical practitioners, health officials, service engineers, purchasing decision-makers, and others—all of whom come together across borders to share their knowledge and find common solutions, together.

Joint Learning Network: a global health network for sharing knowledge

The Joint Learning Network (JLN) is one example of how an innovative country-led program can achieve success through the power of knowledge exchange among peers.

In this video, JLN Information Technology (IT) track members work together to determine and document common requirements for IT systems that support national health insurance information scenarios. Video: JLN.

By removing the silos that policy makers and practitioners often operate in and offering opportunities to share their successes, even failures, JLN members are finding innovative solutions that can be put to work more quickly than those developed through more traditional channels.

Sam Adjei, executive director at the Centre for Health and Social Services Ltd in Ghana, gives this example:

“We had to do things on our own, learning by doing. But when we start connecting with people and we start diving into details of how to do things—enrollment, registration, IT, provider payment—then it’s critical to have this exchange with other people and get to know how did they do it.”

This is how Ghana and Kenya were able to take their new e-claims systems a step further and make them available for other countries to use.

PATH’s role as a trusted matchmaker

PATH helps to match participants across countries who can share knowledge, analyze user needs and requirements, and use this new information as a tool to develop and iterate solutions in their own countries.

By learning from the successes and failures in other countries, and building new solutions together, countries can make faster progress than they can alone.

One of the greatest challenges in forming peer networks is making sure participants receive executive support for their work. This covers everything from supporting volunteer participants as they take time away to attend learning groups, to the investment they’ll need to implement new programs and systems.

“We ask countries to support these collaborative cross-country teams,” says Kate Wilson, director of Digital Health Services at PATH and one of the founding members of the JLN IT group. “People are busy. And the participants who are most driven to make change need permission to invest the time it takes to learn what made other projects successful and apply that knowledge at home.”

Wilson highlights another example of bringing efficiencies to country-wide health systems: the Better Immunization Data (BID) Initiative. Supported by a grant from the Bill & Melinda Gates Foundation, the BID Initiative was developed to help countries strengthen their immunization programs through improved data quality, collection, and use by identifying practical, country-owned, country-led digital health solutions.

“There’s power in bringing countries together to design solutions, see them implemented in a few places, and then take it and adapt it to their own situation,” says Wilson. “Like the new e-claims systems in Ghana and Kenya, we expect that members of the BID Learning Network will design the standards and solutions that will be used for generations to deliver lifesaving impact.”

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Friday Think: the innovative catch of the day is a fish bandage

A tilapia fish.

Proteins from the skin of the tilapia fish are said to help speed up wound healing. Photo: Peter Griffin.

What does a little collagen, some electrospun fibers, and fish skin get you? Apparently a bandage made from fish that researchers claim will speed up the healing time in skin wounds. And they say it has commercial possibilities.

In China, a group of researchers and scientists were able to extract collagen from tilapia to make a flexible weave that could cover wounds with the added benefit of faster healing times. We’ll resist throwing in the fishing metaphors, and let this article by Andrew Turley in Chemistry World speak for itself.

It might not sound terribly appealing, but the best way to heal skin wounds could be to apply some fish skin protein. That, at least, is the claim of a group of researchers in China who were able to speed up skin wound healing on mice using collagen obtained from the skin of tilapia fish.

To investigate further, a team led by Jiao Sun at Shanghai Jiaotong University School of Medicine, extracted collagen chemically from tilapia to create a sponge, which they spun into nanofibres.

There are many applications for this bandage, one of which may be a good low-cost solution for people with chronic wound care.

Tests showed that the nanofibres had the right physical characteristics for use in wound healing, including a high tensile strength, which suggested they would retain structural integrity as the skin moved around. They were also hydrophilic and thermally stable – the constituent fish collagen was found to have a high denaturation temperature of 45°C, meaning it will not lose its form at body temperature (38°C). Friday Think logo

You can read this article in its entirety at Chemistry World.

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.

Designing a device to save newborn lives: thinking big while thinking small

Group holds a tubing device and discusses it in the PATH shop.

Clinicians confer with PATH product development engineer Gene Saxon on the 3D-printed prototype of a low-cost oxygen blender. Left to right: Drs. Anna Hedstrom and Ryan McAdams of University of Washington/Seattle Children’s Hospital, Dr. James Nyonyintono of Kiwoko Hospital/Adara Development in Uganda, and PATH’s Gene Saxon. Photo: PATH/Tom Furtwangler.

When experts gather around the prototypes of lifesaving devices in the PATH shop, it never takes long for questions, opinions, and stories to start flowing.

This week, the devices in question were a low-cost bubble continuous positive airway pressure (CPAP) kit and an oxygen blender. We have been collaboratively developing these technologies with partners from University of Washington Department of Pediatrics, Seattle Children’s HospitalAdara Group, and Kiwoko Hospital for use in health facilities with limited resources. And the experts who gathered from PATH and those partners represented diverse fields: neonatal medicine, medical product engineering, commercialization, and public health.

There is a clear need for these devices: respiratory infections are a leading cause of infant mortality in many of the world’s poorest places and claim millions of newborn lives each year. A bubble CPAP device can provide an infant with the air pressure needed to support their breathing, and when combined with an oxygen blender, it can deliver critically needed oxygen at appropriate concentrations. These interventions can mean the difference between life and death, and between healthy infant development and lifelong neurological damage or blindness.

Newborn baby in blankets

How can we ensure that every baby, no matter where he or she is born, has an equal shot at a healthy, productive life? Photo: PATH/Gabe Bienczynski.

While bubble CPAP devices and oxygen blenders are standard in American neonatal wards, their high cost puts them beyond the reach of many hospitals, as does their requirement for pressurized oxygen and air, steady power, and access to trained technicians and replacement parts.

PATH and our partners have been working to refine the design for an oxygen blender and an ingenious, low-cost bubble CPAP that is made primarily from common medical supplies kept in stock by most medical equipment vendors in the developing world.

Tubing and 3D-printed device held in hands.

PATH is developing an inexpensive oxygen blender that mixes air and oxygen in specific concentrations, and can be used when administration of 100% oxygen is not appropriate. Photo: PATH/Tom Furtwangler.

The inspiration for these devices came, as it often does, from stories of newborn lives that had been saved with improvised, cobbled-together bubble CPAP solutions built by clinicians who were short on resources and long on ingenuity. Those handmade devices worked in some settings and situations, but they had not been rigorously tested, were difficult to scale up, and sometimes relied on the presence of their designer for effective use.

Group in PATH shop engaged in discussion.

In the PATH shop, experts from a variety of disciplines contributed to a wide-ranging discussion about how to develop a device that is inexpensive, easily maintained, and meets the needs of clinicians caring for newborns in respiratory distress. Photo: PATH/Tom Furtwangler.

Funding from the Saving Lives At Birth Grand Challenge and other supporters is allowing refinement of these concepts into manufacturer-ready designs suitable for widespread distribution.

But there are many hurdles to getting inexpensive, high-quality devices designed, manufactured, and commercially available in the settings that need them. So in the shop, as experts from each discipline contributed to the conversation, the design decisions and trade-offs became sharper, while the list of issues and considerations grew longer.

Can hospital staff be trained to disinfect and reassemble, or should some parts be single-use and disposable? Is there a manufacturer in Africa who can make precision parts at low cost, or will they need to be imported? Is it more important to make a simple device that is effective in the most critical situations, or a more complex, adjustable device that is effective in a wider range of situations and environments?

Shop staff member demonstrates equipment for a group.

Part of the product design process includes running low-cost parts through highly sensitive tests designed to mimic real world conditions. PATH shop technician Alec Wollen shows how it’s done. Photo: PATH/Tom Furtwangler.

Passing around a variety of tube-and-bottle bubbler combinations as they worked through the lunch hour, the group nailed down dates for an upcoming round of user input at a Ugandan hospital and planned site visits to African device manufacturers. And then after breaking for just a few minutes, the group began considering the next design perspective, as a commercialization expert presented a comprehensive overview of the market for bubble CPAP devices in India.

Designing for very small infants and for the very big picture

This cross-disciplinary process embodies many of PATH’s unique and distinctive competencies. Focusing a broad group of experts on the challenge of saving the largest number of newborn lives possible, the project asks them to consider the design of neonatal respiratory devices from every angle, to learn from each other, to try hands-on experimentation, and to think holistically. Having advanced hundreds of projects over four decades, PATH brings our own experience to the table as a convening partner.

Hands hold tubing designed to be inserted into infant nostrils.

In order to design an effective and sustainable solution, a wide range of factors are considered: from the width of premature newborns’ nostrils to the World Health Organization’s policies. Photo: PATH/Tom Furtwangler.

The design thinking encompasses the whole system in which the device will be manufactured, approved, marketed, used, and maintained. The conversation ranges with equal emphasis from the shape of tubes that will fit comfortably into a premature baby’s nose, to the complexities of manufacturing, assembly, and supply chains, to the relevant World Health Organization policies.

Detailed charts and graphs are presented. Stories are told. The group names other experts they should consult, lists manufacturing partners to consider, and brainstorms questions to ask in Africa when gathering additional stakeholder feedback on the prototypes.

But no matter how technical the discussion gets, nobody forgets why they are here. “When you follow up, and a baby has passed away,” says Ugandan colleague Dr. James Nyonyintono, who traveled to Seattle for this work, “you ask yourself: what could I have done differently?”joi-bug_blog-link

This post is part of a multi-part series, Mapping the Journey, which explores how PATH turns ideas into solutions that bring equity, dignity, and health to women, children, and families worldwide.

Other posts in this series

PATH’s partners on this project include Adara Group, Kiwoko Hospital Uganda, the University of Washington Department of Pediatrics, and Seattle Children’s Hospital. This project is made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of PATH and do not necessarily reflect the views of USAID or the United States Government.

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True story: how truckers introduced Tarun Vij to global health

Meet Tarun Vij, our India country program leader at PATH. Tarun joined our organization in 2011 after 18 years in the private sector and leadership roles in several Indian development projects.

Tarun Vij at the Taj Mahal.

Tarun Vij at the Taj Mahal in November 2014. Photo: Adarsh Minocha.

Q: Your work in health came after 18 years as an automotive entrepreneur. How did that change come about—and how has your background informed your current role?

A: I transitioned from being an entrepreneur who built and ran an automotive company with a national footprint to leading a national HIV prevention project for India’s truckers, whom my past experience in the automotive sector positioned me to understand well.

I was able to apply an understanding of the “buying” behavior of the community in a commercial setting to preventive practices and health-seeking behavior in their personal lives. It was immensely satisfying to be able to apply business metrics to scaling up a national HIV prevention program among a high-risk group.

I moved from business without a clear idea of transitioning to heath—the truckers became the connection! As a trained engineer and businessman, I could relate to the need for structure, scale, analytics, and accountability to deliver impact.

Q: What brought you to this work—and keeps you motivated?

A: Initially it was the thrill of applying business skills and experience to a new setting and scaling services using the same variables—cost, quality, and reach—to sustain service uptake and generate measurable impact. Apart from being deeply satisfying at a personal level, I engaged with India in many ways that I would not have as an urban businessman. So there is deep personal enrichment and transformation in the work.

Through our work, I have learned that no matter how underserved or economically deprived communities may be, people will come forward and take charge to improve their lives and the lives of those around them, once they become aware and come together as community groups. There is great satisfaction in catalyzing that latent self-esteem in every individual and helping to translate it into personal and community wellness.

Q: Can you tell us about the history of PATH’s work in India and some of the program’s unique strengths and challenges?

A: PATH has been in India for over three decades, with a country office since 2001. Our India portfolio is diverse, representing most of PATH’s global focus areas and collaborations with national and state governments, research and academic institutions, and the private sector. I’d say diversity across the value chain is a key strength. India presents a unique opportunity to connect our products and technologies with the health delivery system and communities to deploy innovations at scale.

Tarun Vij, PATH's India country leader.

Tarun Vij, PATH’s country leader in India. Photo: PATH.

A changing donor landscape consequent to India’s recent economic growth will challenge international development organizations such as PATH to rethink their evolving role in India. PATH is well-poised to accelerate our product development work and support Indian efforts to grapple with emerging health challenges in a rapidly urbanizing population.

Update: Tarun Vij left his role as PATH’s India Country Leader on April 30, 2015.

Tarun Vij, country program leader for India at PATH, holds a degree in electrical engineering from Panjab University, India, and a master’s of business administration from the University of Michigan. This profile originally ran in Spotlight, PATH’s internal newsletter.

Friday Think: could a $2 billion contest accelerate new antibiotics?

Lab worker Patrick Kakembo looks into a microscope in the lab.

We need to encourage the development of new antibiotics that will fight the growing number of drug-resistant strains of bacteria. Photo: PATH/Will Boase.

The battle against super bugs—that growing class of virulent bacteria resistant to antibiotics that the US Centers for Disease Control and Prevention estimates sickens 2 million people annually—results in tens of thousands of deaths each year. It also delivers a $20 billion toll in associated health care costs.

There aren’t many antibiotics in development to battle these super bugs right now. It takes money—lots of money—and often decades to shepherd a promising new drug through R&D to scale. Some pharmaceutical companies are no longer developing new antibiotics because the return on investment is greater in other areas of product development.

Maybe what we need is a new system, and some prize money

In a New York Times op-ed, Ezekiel J. Emanuel, an oncologist and vice provost at the University of Pennsylvania, says the development of antibiotics has “been glacial,” and that we need a new approach.

Here’s an excerpt from Emanuel’s op-ed suggesting governments come together to pool the money needed to develop more antibiotics, and then award the kitty to worthy contenders:

Let’s use prize money. What if the United States government — maybe in cooperation with the European Union and Japan — offered a $2 billion prize to the first five companies or academic centers that develop and get regulatory approval for a new class of antibiotics?

Awarding prize monies for innovation isn’t a novel idea; it’s already successfully spurring advances in everything from space travel to ocean health.

As the XPrize — a foundation that runs competitions to spur innovations for difficult problems that often aren’t being addressed — and others have demonstrated, prizes for lofty goals can catalyze the creation of hundreds of unexpected research teams with novel approaches to old challenges. The prestige, bragging rights and renewed sense of mission created by such a prize would alone make an investment in research worthwhile.

Because it costs at least $1 billion to develop a new drug, the prize money could provide a 100 percent return — even before sales. From the government perspective, such a prize would be highly efficient: no payment for research that fizzles. Researchers win only with an approved product. Even if they generated just one new antibiotic class per year, the $2-billion-per-year payment would be a reasonable investment for a problem that costs the health care system $20 billion per year. Friday Think logo

Read this op-ed in its entirety in the New York Times.

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.

Mapping the Journey: how we turn good ideas into large-scale solutions

Today we’re launching a multi-part series, Mapping the Journey, that explores how PATH turns ideas into solutions that bring equity, dignity, and health to women, children, and families worldwide. This is the first installment of the series.

Child receives oral vaccine while others look on.

In 2014, children in Laos were vaccinated against Japanese encephalitis for the first time. The vaccine’s journey took more than a decade of effort from PATH and our partners, finally receiving World Health Organization approval earlier that year. Photo: PATH/Aaron Joel Santos.

In a world that’s always innovating, there’s no shortage of great ideas that can help people live healthier lives. New technologies. Strategies that accelerate the slow development of drugs and vaccines. Novel partnerships that cross continents and sectors. Yet many ideas never get the chance to make an impact—at great human cost.

The journey from idea to real, large-scale solution is complex

Barriers and pitfalls, from regulatory hurdles to deep-seated cultural beliefs, can prevent even the most promising ideas from succeeding. But the odds of success can be greatly increased when those ideas have a creative guide who knows how to navigate the journey—a guide like PATH.

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Ideas move through a long and complicated journey before they can have widespread impact.

We call the process of moving from idea to impact the “journey of innovation.” And at every stage, there’s work to be done:

  • Adapting a design for low-resource settings.
  • Shepherding a new medication through approval.
  • Working alongside communities with the will, but not the tools, to protect their children.
  • Expanding access to vital care where it’s needed around the world.

It takes tenacity, know-how, and commitment to see the journey through. And that’s where PATH comes in.

A closeup of Sayana Press being injected into an arm.

In 2012, multiple partners, including PATH, committed to delivering Sayana® Press, a long-acting injectable contraceptive to four countries in Africa in order to increase contraceptive choice and access. Administered in the simple, single-use Uniject™ injection system that PATH developed, Sayana® Press has cleared multiple hurdles on its journey to scale. Photo: PATH/Will Boase.

Nothing should stand in the way of solutions reaching the people who need them most

We believe it’s unacceptable that people around the world continue to be devastated by preventable disease, when we know that innovation can change it. So we identify and cultivate promising ideas that can transform health—and make sure nothing stands in their way. We collaborate with a wide variety of partners, from researchers to manufacturers to local governments as we keep solutions moving toward impact. And we’ve earned a track record of constantly innovating to get those solutions to the people who need them most.

Graphic showing time to grow the plant versus the time to synthesize artemesinin.

Our partnership with researchers and industry led to a key malaria treatment innovation. Artemisinin, an essential plant-derived ingredient in key malaria medications (ACTs), can now be manufactured with a semisynthetic ingredient in three months, ensuring a more reliable supply. Infographic: PATH.

We transform the way health solutions are developed and delivered

We’re not afraid of complicated work. And we’re inspired by the partners who travel the journey with us—whether in the laboratory or the factory, in a government hall or the village square. joi-bug_blog-link

Behind every innovation, and at every stage in the journey, there are stories to share. Stories of ingenuity, commitment, and compassion. Stories of scientific discovery and of heroes who are changing their families and communities.

We look forward to sharing a few of these stories with you over the next eight weeks.

Other posts in this series

Sayana® Press is a registered trademark of Pfizer Inc. and/or its affiliates. Uniject™ is a trademark of BD.

5 lessons learned to achieve impact with global innovations

Young man receiving a vaccine at the MenAfriVac launch.

To be successful, we need to think about launch and scale-up at every stage of a project. Photo: PATH/Gabe Bienczycki.

By Steve Brooke, commercialization advisor at PATH, and David Milestone, senior market access advisor at USAID’s Center for Accelerating Innovation and Impact.

What separates impactful global health innovations from the rest? We have spent the better part of our careers thinking about questions just like that. And yet, we have not found a short or simple answer. But, we have uncovered many useful lessons.

IDEA to IMPACT: A Guide to Introduction and Scale of Global Health Innovations booklet cover.

Read “IDEA to IMPACT: A Guide to Introduction and Scale of Global Health Innovations.” Photo: PATH/Patrick McKern.

Some of these lessons are featured in a new resource we developed together. “IDEA to IMPACT: A Guide to Introduction and Scale of Global Health Innovations” by USAID’s Center for Accelerating Innovation and Impact (CII), highlights the challenges of achieving scale and impact, and uses case studies to draw out best practices and practical tips.

Drawing from our individual experiences, the guide, and reflections from panelists at a launch event that USAID and PATH co-hosted with The Aspen Institute, we sat down and challenged ourselves to summarize our five top takeaways on what it takes to achieve scale and impact with global health innovations.

Two women in colorful saris stand holding materials.

Health care workers are an integral part to the success of a mother’s group project in India. Photo: PATH/Gabe Bienczycki.

1. Start with the people

This maxim lies at the heart of good product development. It is important to listen to and observe users to better understand their needs. PATH learned this firsthand on our work on various water filtration systems. Everything from preferred color to size of a standard drinking cup needed to be considered for each different context.

woman drinking from a cup of water she poured from a water filter she owns as part of the Safe Water Project.

Observing how people use a product is just as important as surveys and focus groups. Photo: PATH/Gabe Bienczycki.

We’ve also found that while surveys and focus groups are incredibly useful, sometimes user observation is necessary. With our C1 water filter project we handed users a box of parts and didn’t call ourselves successful until they could assemble it without instructions.

A case study from Design that Matters (featured in the guide) also illustrates the importance of incorporating the needs of manufacturers and distributors into product design. It is important to consider all the users—not just end-users—in the ecosystem that will take a solution to impact.

Three vaccine coolers on tables covered with white cloths, white-clad health workers sit behind them.

Health workers in Burkina Faso wait to open their vaccine carriers at the launch of a meningitis A vaccination campaign. PATH/Gabe Bienczycki.

2. Plan for impact and scale at every step in the process

Core to IDEA to IMPACT is that launch and scale-up are not things you can start thinking about after you’ve developed a product and completed clinical trials—all aspects of delivery need to be incorporated throughout the project. But how can you keep your eye on this goal the entire time?

The Meningitis Vaccine Project faced this challenge when it embarked on an effort to create an affordable, effective vaccine to protect the more than 400 million people at risk in Africa’s Meningitis Belt. PATH and the World Health Organization (WHO) had to simultaneously focus on developing a scientifically sound vaccine and putting it through rigorous clinical trials and regulatory processes, while at the same time working to improve the ability of countries in the region to conduct studies and prepare to administer the vaccine.

The guide includes practical companion tools for outlining the steps required and how and when to plan for impact and scale. The tools provided can serve as examples and inspiration for global health practitioners to start thinking through delivery considerations early on in the design process.

3. Need is not enough

Just because a product fills a need, or has the potential to save many lives, does not mean people will line up out the door to buy it.

This lesson is highlighted in the guide through a case study of CycleBeads®, a family planning tool created by Georgetown University’s Institute for Reproductive Health and Cycle Technologies. Looking at a high unmet need for family planning in Mali and backed by the Ministry of Health, the partners overestimated demand and ended up scaling back. Pilot studies are often useful to test market acceptance and determine demand generation needs.

Godrej and Boyce’s low-cost chotuKool refrigerator. Photo: Godrej and Boyce.

Godrej and Boyce’s low-cost chotuKool refrigerator. Photo: chotuKool.

4. Don’t be afraid to fail (or pivot)

Taking a cue from Silicon Valley, the global health community should not be afraid to fail. The good news is that doesn’t always mean scrapping a project. Often it just takes a “pivot.” For example, Godrej and Boyce’s case study describes how they originally wanted to scale down an existing refrigerator model for lower-income users, but when research made it clear this plan would not work, they shifted their approach and designed a completely new product from the ground up.

5. Don’t forget the regulatory and policy environment

Another vital piece is the policy and regulatory environment in your target market. Of course there will be mandated processes, but don’t forget about other policies needed to support your product. An endorsement from WHO or inclusion in a national policy may be key to unlocking many opportunities for scaling up, as is highlighted in the case study about WHO’s guideline on community use of misoprostol to prevent postpartum hemorrhage.

We use these steps to test, introduce, and scale a product and measure impact, but the good news is they are concrete and achievable. And now you have another great tool to help: the full IDEA to IMPACT guide and companion materials also includes a toolkit.

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Steve Brooke is a commercialization advisor at PATH, where he plays a lead role in public-private product development collaborations, product commercialization strategies, and intellectual property management. David Milestone is a senior market access advisor at USAID, Center for Accelerating Innovation and Impact (CII), where he focuses on the development and implementation of market-based strategies to accelerate the adoption of priority health products.

Friday Think: why syringes should self-destruct

SoloShot syringe is inserted into a vial.

A PATH designed SoloShot™ syringe can only be used once, reducing reuse and possible disease transmission. Photo: PATH/Will Boase.

A brief history of vaccines takes us back over a thousand years ago—when it’s said the Chinese learned to remove matter from smallpox scabs to build immunities of the disease in healthy people via a scratch in their arm.

We live in better days since those rudimentary inoculations. Fast forward to the advent of syringes, and the process for delivering vaccines was made even safer with more predictable results.

So why did the World Health Organization (WHO) put out a call for the world to adopt self-destructing syringes?

A 2014 WHO-sponsored study (using data as recent as 2010) found that the improper use of injections caused an estimated 1.7 million people to be infected with the hepatitis B virus, 315 000 with the hepatitis C virus, and potentially 33 800 with HIV.

Reporter Todd Frankel goes into more detail in a recent Washington Post Wonkblog post about why syringes should self-destruct:

The WHO’s quest began in 1987–just as the spread of a disease called HIV was beginning to cause alarm. At the same time, the widespread switch from glass syringe tubes to plastic ones made reuse even more risky, since glass containers could be disinfected with heat, while plastic melted and warped.

Close up of syringe and cap

The SoloShot™ syringe. Photo: PATH/Glenn Austin.

One place that took up the challenge was Path, [at the time] a small international health technology nonprofit in Seattle. Staff already had begun playing around with different designs two years earlier. They knew they had to make their invention work with existing plastic syringes to keep costs down, said Steve Brooke, the company’s commercialization adviser. …

Path came up with a plastic syringe with a metal clip inside it that locked into place after the plunger was depressed. A syringe manufacturer licensed the product. In 1990, the Soloshot hit the market. Since then, it has been used to deliver more than 6 billion vaccine shots.Friday Think logo

Read this piece in its entirety on the Washington Post Wonkblog.

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.

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