Covid-19 pandemic has raised our collective awareness of the importance of effective healthcare systems, we see innovators working hard to design new ways to deliver everything related to healthcare supplies, from vaccines, oxygen, ventilators, and more.
Although speed is an important aspect of the pandemic response, what we have learned during a decade working on public health issues in Africa and Asia is that innovators and health care providers must think carefully when pursuing technological solutions.
They should take into account many factors that could determine whether these solutions will achieve its aspiration.
Among the risks that threatens success, we can cite disrupted energy supply chains, inadequate design, insufficient maintenance, and a mismatch between technology and local needs.
Without taking into account these concerns and others, the best solutions that emerged during the Covid-19 pandemic are in a risk to join unused or broke down medical equipment that remain forgotten in equipment dumps around the world.
As public health stakeholders around the world continue to respond to the pandemic and other similar crises, here are some practices to consider when designing, employing, and expanding technology solutions.
The following guidelines will help ensure that people at risk in developing countries get the help they need.
Understanding the Local Healthcare Needs
Reference should always be made to the accepted notion that those involved in providing solutions need to understand problems and their solutions through the eyes of the people who encounter them.
After several practices, we have learned that engaging key stakeholders at the country level, and doing so early and frequently, is critical to aligning with local communities and designing solutions that can be scaled up with some responsibility.
Given that ministries of health extensively coordinate healthcare work in developing countries, these ministries should in the first place be on the list of institutions to collaborate with.
Additional efforts could be complemented or possibly intensified to find and support local innovators, engineers, and social leaders; Who can provide solutions tailored to local needs.
Nexleaf worked with the Ministry of Health in Kenya and Mozambique to develop monitoring devices that track the temperature of the refrigerators used to store vaccines, which could become useless unless they are kept at a temperature ranging from two to eight degrees Celsius.
Nexleaf contacted the Ministry of Health in Kenya to provide a prototype of the device and worked to install it in a few clinics, taking the time to monitor and learn from how healthcare workers deal with the technology.
Collaboration with the Ministry of Health at an early stage and learning from healthcare workers has helped Nexleaf improve device design and update features to account for limited connectivity and safety issues.
The redesigned device was then distributed to vaccine storage sites across Kenya, and this resulted in a significant reduction in the exposure of the vaccines to heat-damaging levels.
Precautions for Power Supply Fluctuations
Given that many health facilities in developing countries lack access to fixed power grids and often cannot obtain fuel for back-up generators, devices intended to save lives must be able to accommodate power outages and voltage fluctuations.
A study conducted on the performance of refrigerators in 27 health clinics in Mozambique found that power cuts caused 16% of equipment malfunctions.
This is a serious problem, because refrigerators have been used to store a variety of vaccines, all of which are temperature sensitive.
In order to address this challenge, consider equipment design improvements, such as built-in rechargeable backup batteries, and more efficient power circuits.
Solutions can also empower healthcare facilities, including the provision of an uninterrupted power supply (UPS) that allows the device to continue working on battery power when the primary source is lost.
Voltage stabilizers are considered, regulating the incoming supply voltage to protect devices from low or over voltages; Another option.
On a larger scale, public health workers should study access to energy in resource-limited or hard-to-reach areas. This includes options such as miniature solar grid, off-grid solar energy, and other renewable energy sources.
Or, they could simply improve people’s access to fuel to run the generators. In Tanzania, for example, a local health official required health facilities to have additional cylinders of LPG in order to secure backup capacity.
Offering open source or standardized designs
Most of the life-saving equipment needed in more developed countries has been designed and will likely include durable accessories made of consumable parts and spare parts, such as filters, nasal catheters, and other supplies used to operate ventilators, for example.
But many developing countries have for years lacked access to coherent supply chains that could supply such parts, without which supplies this equipment would be useless.
The problem is further complicated by the failure of different manufacturers to standardize the design of consumable parts or replacement parts.
Standardizing the design, or including flexibility in designs based on local supply chains, allows local stakeholders to provide equipment and use it more effectively.
One laboratory, the Jet Propulsion Laboratory, took this approach by designing an experimental prototype ventilator.
In the event that agreement on unified designs appears to be a far-fetched solution, the other option is to borrow the concept of “open source” from the software world and apply it to designs.
This would, at the very least, give organizations and individuals with adequate resources the ability to manufacture practical parts on their own. For example, Italian engineers have used 3D printers to manufacture disposable valves to keep respirators working.
Not only design is concerned, but also the data that devices may generate about their operation, from simple records about power fluctuations to error messages and notifications.
Given the rate of technological change, data should be organized with the help of open source, making it useful for a variety of other devices and software.
Popular services provided by Facebook, Twitter, and Airtable use this concept, called an application programming interface (API), to make the data they obtain useful for applications other than their own.
Nexleaf team used an open-source API to organize data from the refrigerators used to store vaccines in different locations and manufactured by multiple vendors. Then gathered it into a dashboard, called the Intelligent Maintenance and Planning Tool (IMPT), which health officials can use to monitor devices.
Evaluate the Availability of Other Commodities Necessary for the Device
Ventilators are essential equipment that contribute to saving the lives of those infected with the Coronavirus, in addition to their importance for other urgent medical needs, such as surgery and treatment of lung diseases, but ventilators do not work alone.
These devices need oxygen, which is in short supply and difficult to distribute to where it is needed. As more ventilators are produced and shipped worldwide, public health stakeholders also need to evaluate oxygen supply chains.
In this case and most likely other cases, there is more than one way to obtain all the necessary ingredients for the device. If access to oxygen in the cylinders is limited, for example, hospitals can use oxygen concentrators, and what distinguishes them is that they are more economical, prolific and diversified when it comes to providing healthcare.
On the other hand, oxygen concentrators also need energy and regular maintenance. Each piece of equipment has its pros and cons at the same time, and when distributing it to facilities, we should not assume that there is a comprehensive solution for all health needs.
Adding Smart Features to Devices Such as Receiving Alerts and Analyzing Problems
For countries and regions with reliable communications networks, public health stakeholders should consider labeling devices that are able to collect data and signals for assistance.
Nexleaf team has worked with health officials over the past eight years to add such sensors to the refrigerators in which vaccines are stored.
Sensors detect when temperatures are causing damage to vaccines and then send an SMS alert to healthcare workers, who take measures to prevent this from happening, from closing the refrigerator door that was left open by mistake to transporting vaccines from the fridge that has permanently malfunctioned.
Through these measures, healthcare workers can feel confident that the vaccines they provide are safe.
On the other hand, the advantage of receiving alerts is not sufficient on its own, as healthcare workers need to be able to understand what went wrong with a device in order to be able to improve the maintenance process.
Manufacturers can be a part of the solution by programming the devices so that they are able to output data about their condition.
This information may include power on or off status, power availability, error codes, performance metrics, and quite basic information about whether the device is working at all. With such data available, device users can request appropriate assistance, and those charged with maintenance can organize their work to efficiently respond to different and best categorized problems.
In an evaluation conducted in cooperation with the Mozambican Ministry of Health, Nexleaf learned that technical specialists who have access to analytical data for faults can remotely evaluate the refrigerator and talk to healthcare workers to help them over the phone to perform simple maintenance operations, such as adjusting the temperature.
This resulted in significant savings in time and money for technicians who would otherwise have had to travel to remote health facilities.
Remote malfunction analysis in Mozambique has reaped significant benefits in terms of problem avoidance. Between August 2014 and May 2015, the number of times refrigerators reaching dangerous levels of warmth decreased by 78%, and extreme cold problems were reduced by 60%.
Training of Healthcare Professionals
Managing ventilators requires specialized training, including intubation. But few healthcare workers know how to take action given the high demand for them in response to the coronavirus pandemic.
Focus on comprehensive training to maximize the use of available resources. Training could assure keeping any existing or newly designed equipment up and running.
When Nexleaf observed that healthcare workers could not benefit from remote temperature monitoring technology, the team investigated the causes and learned that they were afraid of the technology, despite an initial training program. In response, it provided more hands-on training, which increased usability.
Planning Before Shipping Healthcare Equipment
As this pandemic is still a worldwide crisis, the risk of equipment production and distribution ending up in an ever-increasing number of equipment landfills is very real.
But by asking few questions in advance, the best plans can be made to distribute medical equipment that brings optimal results. And before shipping it, make sure it will work well for those who are aiming to help it.