BERLIN — For Dr. Twalib Ngoma, innovation emerged from simplicity at this year’s World Health Summit in Berlin. At an event showcasing everything from medical record technology to artificial intelligence, it was a mere speculum, acetic acid, and "good eyesight” that struck him as a game-changing combination.
With those widely available tools, a health worker can conduct a simple cervical cancer screening. Ngoma is the executive director of the Ocean Road Cancer Institute in Tanzania, where cervical cancer is the most common form of female cancer. Outside of major cities, Ngoma said, the country's health system is not equipped to provide Pap smears, the more common method of testing for the cancer.
"We have now created a test that is practical," he said. "And we should, in all the innovations that we do, look at something that is going to be accessible, something that is going to be affordable and feasible."
Ngoma’s enthusiasm reveals a growing quandary for medical professionals in the developing world. Doctors there are faced with many of the same diseases and conditions as their peers here in Germany. Yet high-tech, infrastructure-dependent innovations often don’t translate into contexts where medical professionals and facilities are in short supply. Low- and middle-income countries are struggling to balance attempts to adopt the latest medical techniques from the West, while also spurring context-specific research into more accessible methods that could be used outside specialist facilities.
With exceptions, that balance has not yet worked in their favor. Private investors are loath to put money into low-cost solutions unlikely to drive profit. Donors that try to support specialized tools often fail to include provisions for upkeep and maintenance, leaving devices run down or even offline.
"Most of the innovation has gone straight into mainly using it for diagnosis and treatment in specialized care or in health facilities," said Dr. Hassan Mshinda, former director general of Tanzania's Commission for Science and Technology. "The reality in our country is different."
Many here see local innovation as the best way forward. Entrepreneurs and officials told Devex that educated and committed people in their countries are ready to deliver groundbreaking new approaches, but they need the support of donors and governments. They also require institutions that will allow them the flexibility to explore, while offering incentives and financial backing.
Innovating in context
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Mshinda is among the public health experts now looking for innovations that recognize shortages of infrastructure and health care workers. He praised low-tech efforts like the visual cervical cancer test, for example.
Another category of innovation, however, could be even more powerful, he said: New technologies tailored to a low-income context.
One example is a battery-powered microscope presented during the summit that can read blood smears or transmit biopsy images to specialists sitting thousands of miles away.
Satya Tapas, an entrepreneur from India who created the prototype, said rural patients in his home country often have to wait for biopsies to travel from all parts of the country to Mumbai — a process that can take up to 10 days.
"The primary health care centers in rural areas, those are the places where we are lacking the pathologists," he said. "We can resolve that problem using high-end technology."
Tapas said his primary constraint now is investment. He received about $77,000 in startup money in 2015 to support his microscope development through a grant funded by the Indian government. He has secured another round of funding from the same source, but he is currently looking for investors to help take it to scale — a common refrain for innovators from the developing world who attended the summit.
Innovators and analysts told Devex that better innovation would also require stronger local research centers and more tailored interventions. One such project is the Africa Centers for Disease Control and Prevention, which launched at the start of the year. Arnaud Bernaert, the head of global health and health care industries at the World Economic Forum, hopes the Africa CDC take on projects such as developing precision medicines that are tailored to African populations.
Mshinda also underscored the importance of building innovation hubs, both to give entrepreneurs a physical space to experiment, but also to help connect them to potential funders. Hubs, such as Buni in Dar es Salaam, Tanzania, connect entrepreneurs to mentors who help them develop their projects, but also to communities of users that can provide feedback and help refine an idea. The World Bank reports that there are similar tech hubs in more than 25 African countries.
At the same time, Mshinda said donors should be working with governments to think about how they can "leapfrog" anticipated development steps, like the training and distribution of more health workers. The current pace of education means it will be decades before health centers are staffed at internationally recommended levels in some countries, he said. Better to begin thinking about how to centralize services and then use affordable technology to connect specialists to patients.
"We don't want to train doctors to be programmers," he said. "But the question of how services will be offered will depend a lot on the technology."
Integrating the top line
When developing countries do adopt technology built for resource-intensive settings, donors, companies, and governments still need to consider the context. Unadjusted, the products can come with too many features, overwhelming an overstretched and undertrained health center staff. Or, in other cases, the technology might quickly be rendered useless if it breaks and the donor did not include funding for repairs.
Bernaert urged companies to think about creating models that will be appropriate in different settings. "The innovation will be about de-featuring what's not critical," he said. "Don't put more technology on a device when it's not going to be used."
He also called for donors to be more strategic when they agree to provide a product and include financing for training, routine maintenance, and repairs. The most durable solutions, experts agreed, are likely to be those that are homegrown.
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