Opinion: New models and innovations drive health access

By Daniel Grossman 21 November 2016

A doctor examines patients in Nigeria. Photo: Curt Carnemark / World Bank / CC BY-NC-ND

I replay it frequently in my mind. I’m sure by now the way I remember it is somewhat different from what really happened, but the outcome was the same. I was practicing and teaching emergency medicine in West Africa, part of a clinical rotation during residency. We were caring for a young boy with respiratory distress who was receiving oxygen from an oxygen-concentrator hooked up to an electrical outlet in the wall. The hospital electricity reset — as it did most mornings for a few minutes — and when the backup generator finally kicked in, the child was dead. I was devastated — I hadn’t been educated or trained to deliver care in an environment where that outcome was even plausible. With this experience, I was confronted with the realities of delivering health care in a system with significant resource limitations.

Today, I am using my experience both as a physician and in business to foster new models for improving health care in emerging geographies. I learned in West Africa that resource-limited environments require distinct approaches to deliver care, and I believe that market-based approaches are the most effective way to improve access to high-quality health care. I am excited that public and private sector organizations are designing programs to address many of the barriers to care and the realities of resource-limited settings through partnerships that deliver new models of care and locally appropriate innovation.

Developing new models of care

New approaches and models of delivering care are essential to improve access in the face of changing burdens of disease, population growth, and gaps in health care infrastructure and delivery capabilities. For example, at Medtronic, a global medical technology, services, and solutions company where I work today, one approach we are investing in is the development of “hub and spoke” models of care.

In this model, complex procedures requiring specialized facilities and specialized physicians and surgeons are concentrated at a single location, the hub facility, while spokes staffed by physician or non-physician health care providers focus on the diagnosis, referral, and follow-up of those complex patients and the management of less-complex patients.

Case study: Boosting ‘cath labs’ in Nigeria

To execute this hub and spoke model, Medtronic has joined a consortium of partners led by The Abraaj Group to build and link entire networks of hospitals, clinics, and specialized facilities. For example, in Nigeria, we are working to increase the number of cardiac catheterization suites, or “cath labs,” where patients having heart attacks undergo a procedure to implant cardiac stents as a form of treatment. The capability to urgently treat heart attacks is particularly important in developing countries, where an estimated 80 percent of the worlds’ heart disease-related deaths take place.

In Nigeria, a country with half the population of the United States, there are only nine functioning cardiac catheterization suites, or “cath labs,” while in the U.S., there are more than 2,000 hospitals with cath labs.

In the U.S., specialized cardiac care is delivered efficiently and at scale through networks built around these 2,000 hospitals. But in emerging geographies, particularly those with resource-limited health care systems, closing this gap through the hub and spoke model will take partnerships and investments focused not just on building infrastructure in which to deliver care, but also on training health care providers, improving diagnostic capabilities, and enhancing referral pathways to deliver high-quality care efficiently and at scale.

Locally appropriate innovation

One of the paths that had most impact for bridging gaps in health care delivery is the use of human-centered design and co-creation with local stakeholders, both to identify market-based needs and to create solutions that address the specific resource-limitations of patients and providers.

Is human-centered design a game changer in global development, or just another buzzword? Devex breaks down exactly what it is and why it matters for the global development community — and delves into some of the ways it could help organizations work more efficiently.

At Medtronic, we have formed Medtronic Labs, a new entity to incubate and to commercialize entrepreneurial business built around locally appropriate products, services and solutions that are designed to address these unmet needs in emerging geographies. Currently, we are piloting new solutions to hypertension care in West Africa and rolling out, Shruti, a model for the identification and treatment of chronic ear disease and hearing loss in India. Medtronic is not alone in these efforts to target innovation to address local unmet needs. Entrepreneurs using human-centered design are developing novel service models and therapies to improve access.

For example, Noora Health identified post-operative home care as an unmet need for patients in India who underwent cardiac surgery. The Noora Health team developed specific training programs for patients and family members to provide specialized care. As a result, patients are able to return home from the hospital earlier and have fewer complications after surgery.

Early-stage medical technologies, such as Sisu Global Health’s Hemafuse device and InPress Technology’s Postpartum Intrauterine Device leverage human-centered design to develop locally appropriate products to treat conditions where significant mortality results from the loss of blood, such as ruptured ectopic pregnancy and postpartum hemorrhage. Both Sisu and InPress seek to address gaps in health care delivery left by rare and expensive blood transfusions and by premium surgical and critical care technology. Those gaps are often the sweet spots for innovation, identified through a commitment to human-centered design and addressed through innovating market-based solutions.

I made a commitment several years ago in West Africa to help transform health care delivery in emerging geographies, and I am encouraged by the growing focus of stakeholders around the globe on innovating market-based solutions to improving access. Through thoughtfully constructed partnerships and by developing different approaches for different segments of the market, I am confident that we can improve access to high-quality health care.

Making Markets Work is an online conversation to explore what’s being done to make global health care markets accessible to people at the base of the pyramid. Over 10 weeks, we will amplify the discussion around effective health financing, analyze key challenges blocking universal market access in the health care supply chain, and explore the key strategies to make markets more effective. Join us as we look at this important issue, and share your thoughts by tagging #MakingMarketsWork and @Devex. 

About the author

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Daniel Grossman

Dr. Daniel Grossman is senior director for global health at Medtronic. He leads Medtronic Labs, Medtronic’s efforts to launch businesses that transform health care for underserved patients in emerging markets. Daniel also advises across the organization on business development, strategy and the changing environment of health care delivery in the U.S. and internationally. He currently maintains his clinical practice in emergency medicine at Mayo Clinic Hospital in Rochester, Minnesota.


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