Can a new effort end 'equipment graveyards' at neonatal ICUs?

Just outside of San Francisco, product engineers at a manufacturer and supplier of health technologies are hard at work on devices to save newborn lives in settings far different from this bayside facility.

The 3rd Stone Design warehouse features a display of lifesaving technologies for newborns, including a continuous positive airway pressure — or CPAP — machine that the team helped develop.

The company is part of a global coalition of organizations working to get such devices to babies in low-income countries, where they confront inequity from the moment they’re born. The coalition is called Newborn Essential Solutions and Technologies, or NEST360, and it targets neonatal intensive care units.

Infants born in sub-Saharan Africa or Southern Asia are 10 times more likely to die during the first month of life compared with those born in high-income countries, due in part to a lack of access to medical devices. About 75% of babies born prematurely can be saved with the right medical care.

But when health facilities end up with devices that are not designed with their constraints in mind — or when staffers lack training in using these tools and there are no plans to fix products when they break — potentially lifesaving technologies can end up in what are often called medical equipment graveyards.

NEST360, which aims to reduce newborn mortality in sub-Saharan African hospitals by 50%, is trying to change that. It’s taking what it describes as a “holistic approach” to neonatal care — distributing newborn health technologies, educating clinicians and technicians on how to maintain these tools, and supporting local innovators to build the technologies that work best for their contexts.

The coalition launched in 2019, with an initial focus on Malawi, Kenya, Tanzania, and Nigeria. From the beginning, NEST360 has said there is a need for not just low-cost technology but high-quality distribution. With assistance from 3rd Stone Design, which helped develop a new nonprofit called Hatch Technologies, NEST360 may have found the end-to-end solution for distribution that it sought.

Hatch provides distribution and support services for devices designed for newborn care units in sub-Saharan Africa. And partners involved in NEST360 say they hope it can serve as a model for ensuring medical equipment reaches low birth weight and premature babies in time to save their lives.

Steve Adudans, Kenya country director at the Rice360 Institute for Global Health Technologies — which is also part of the NEST360 partnership — has seen many examples of donated medical devices piling up instead of being used in neonatal ICUs.

“We need to bury the medical equipment graveyards,” he said during an online webinar on innovations in newborn health in Africa organized by The Elma Philanthropies, one of NEST360’s funders. “That’s what NEST is about.”

The NEST360 bundle of technologies includes 18 medical devices focused on areas including temperature stability, respiratory support, and neonatal jaundice treatment. Each of them meets target product profiles for newborn care in low-resource settings developed by NEST360 in partnership with UNICEF.

Many of the NEST360 technologies that meet these operational and performance characteristics were developed by innovators focused on low-resource settings, where it is often impossible to repair products made by corporations that impose restrictive warranties, lock their software, and limit access to spare parts.

But these devices cannot fulfill their vital potential when they are introduced into a broken system, Adudans said.

NEST360 needed a solution to get products from manufacturers to distributors to facilities in the countries where it works. That’s where Hatch Technologies comes in.

Often, nations with the highest rates of neonatal mortality receive donated equipment that fails when placed in environments with unreliable electricity, temperature variation, and too much dust and dirt.

But even when countries can procure medical supplies, they often don’t know which devices would work best for their settings. So they end up with cheap devices that break because they are poor quality or high-end ones that never get fixed because maintenance is too expensive, said Dick Oranja, CEO at Hatch Technologies.

Based in Nairobi, Kenya, Hatch Technologies launched in March 2020 with a mission to transform the way newborn care devices are distributed, supported, and used in Africa. To date, Hatch has helped NEST360 distribute almost 2,000 pieces of equipment reporting over 95% functionality, meaning they are working as they should. It is starting with support from the same backers as NEST360 but is an independent nonprofit that could continue to seek support elsewhere.

Hatch uses asset tracking — with a bar code-type sticker on each of its products — to follow each shipment from the initial logistics and warehousing to shipment and ultimately the use of the device.

“Distributors will mention they provide a level of service. They have to assure their customers. But the truth of the matter is distributors do not offer targeted service,” Oranja said. “We measure customer service parameters a routine medical equipment manufacturer will not measure.”

Beyond delivering medical devices, Hatch installs the equipment, trains staffers, and stops by to see how the technology is working, based in part on its measure of the functional status of the equipment — meaning whether it is being used as intended or at all.

A number of supply chain bottlenecks prevent newborn health products from reaching babies in low-income countries during critical moments of life and death.

“People who come up with product ideas are not the same people who figure out how to sell something, and the people who figure out how to sell it are not the same people who figure out how to service it and support it,” Robert Miros, CEO at 3rd Stone Design, told Devex.

That reality is part of what led 3rd Stone Design to work with partners to develop Hatch Technologies.

NEST360’s expanded model, which includes Hatch, reflects a growing understanding that no matter how innovative medical devices are, they are only one part of the solution to saving newborn lives. The other crucial piece is distribution.

Hatch Technologies began after Miros and his colleagues formed a task team to brainstorm the effort together with other NEST360 partners and funders. They drew on the expertise of 3rd Stone Design’s Danica Kumara, a director of product management who formerly worked on medical device efforts in Southeast Asia, and Vikas Meka, a senior product manager who was formerly a senior adviser on global health innovation at the U.S. Agency for International Development.

Now that NEST360 has launched in four African countries, it intends to demonstrate a path to scale across the continent, said Rebecca Richards-Kortum, director at the Rice360 Institute for Global Health Technologies, during the webinar.

But what turned the tide on newborn survival in the United States and the United Kingdom was a network of neonatal ICUs — “a regional system with people and products that are ready to help babies,” she said.

So as NEST360 partners with Hatch Technologies to bridge the gap from manufacturers to distributors and ensure that lifesaving medical devices can reach health care facilities, it is also calling for stronger hospital systems for newborn care.

This coverage, presented by the Bay Area Global Health Alliance, explores the intersection between technology, innovation, and health. How are tech, innovation, and cross-sector partnerships being leveraged to accelerate equitable access to health care?