Prescription for Progress: 5 ways to scale digital health solutions

While the COVID-19 pandemic has fast-tracked digital health innovation, these tools are prevented from realizing their full potential in low- and middle-income countries by a number of challenges, from a lack of digital infrastructure to funding that is restricted to specific priorities.

“One of my biggest pet peeves about global health at the moment is things that don’t scale up,” said Ernest Darkoh, founding partner at BroadReach Group, a social enterprise that partners with the health industry to use so-called Fourth Industrial Revolution technologies. “If it’s not going to scale up, you may as well not do it.”

This frustration, which he discussed during Prescription for Progress, Devex’s annual event on global health partnerships, is widely shared, and the event homed in on what approaches and partnerships can address this problem.

1. Start with trust

Silicon Valley is known for its engineering mindset — but when companies based in places like San Francisco bring their solutions to low- and middle-income countries, they must tailor their work to those settings.

“We tend to … look at the world’s problems as engineering problems,” said Safa Naraghi, vice president of delivery at Zenysis Technologies, a company headquartered in San Francisco that builds data integration software to help governments — from Mozambique to Pakistan to Brazil — bring together their data in one place.

While in many ways Zenysis identifies with that Silicon Valley mindset, the team has also learned how to contextualize that approach elsewhere.

Governments have reason to be suspicious of outside technology companies, which can sometimes make health systems more siloed, so Zenysis has to build trust with the governments it aims to serve.

“Without trust … you really can't get anything done, no matter how good your technology is,” Naraghi said.

For example, the Zenysis model is built on user-driven product development. The company hires user engagement specialists who serve as a bridge between software engineers and public health practitioners. This increases the likelihood that platforms will be accessible, useful, and scalable.

2. Consider the ‘three I’s’

Organizations working on global health innovations are paying more and more attention to implementation science — or methods to promote the uptake of innovations — to address the problems that prevent them from working outside a laboratory setting.

“Our work is mostly focused in driving innovation to improve access to health care,” said Julian Atim, program lead for primary health care at Global Health Labs, a nonprofit set up in 2020 by Gates Ventures, the private office of Bill Gates, in support of the Bill & Melinda Gates Foundation’s priorities.

The team is guided by what it calls the “three I’s:” improving existing technologies, integrating them to optimize their functionality, and inventing new technologies.

Atim mentioned so-called connected health devices as one example of the work GH Labs is focused on. The ability to monitor technologies with sensors and gather data to inform planning and maintenance is critical to avoid the problem of medical equipment “graveyards,” she said. The term is widely used to describe tools that go unused, either because they are not designed with user constraints in mind or no plans are in place to fix products when they break.

GH Labs has partnered with Nexleaf Analytics, a nonprofit technology company that supports the real-time monitoring of medical equipment, on this work.

3. Listen to governments

Dr. Kesete Admasu has a unique perspective on what’s needed to scale digital health solutions, having worked in government, advocacy, and philanthropy.

Formerly a health minister in Ethiopia, he is now the CEO at Big Win Philanthropy, a foundation that focuses on improving young people’s lives in Africa, and a board member at the END Fund, a private philanthropic initiative dedicated to ending so-called neglected tropical diseases.

Admasu said funders and implementers alike must listen to governments if they want to go from being a part of the problem to a part of the solution in the adoption of digital health.

“Listen to the countries and … listen to the leaders there,” he said. “They know their countries. They know their priorities. They know what works [and] what doesn’t work.”

4. Support integrated solutions

Nithya Ramanathan, CEO and co-founder of Nexleaf Analytics, cautioned that the “need for speed” is “often used as an excuse to bypass government.” Whenever someone says they don't have time to listen to the government, she stops everything.

“That is an immediate red flag,” Ramanathan said. “That is the only thing we have time for.”

Nexleaf Analytics is perhaps best known for sensor-based technologies that protect the low-temperature supply chain for vaccines.

But increasingly, the company is using those same technologies to safeguard other biomedical equipment and to ensure the quality of power in health facilities.

Nexleaf Analytics has found that better data can help governments make the business case for investing in, and sustaining, digital health solutions.

“So it’s not about: ‘Should I send a technician to fix a fridge?’ But rather, ‘Is it worth spending $100 to protect $50,000 of vaccines?’” Ramanathan said.

5. Plan for discovery, development, and delivery

Krista Donaldson, the CEO at Equalize Health, which designs and works with partners to deliver medical devices in low-income settings, shared a story about a pediatrician who approached a member of her team.

Equalize Health, formerly known as D-Rev, had worked on a phototherapy device for neonatal jaundice in a Rwandan hospital without any neonatologists. The pediatrician asked whether the team also could also develop CPAP — or continuous positive airway pressure — machines, which can gently push oxygen into the lungs of premature babies.

The Equalize Health colleague said her team was not focused on that. And when she asked the doctor how he was providing treatment to babies in need of breathing support without any CPAP machines, he said he prayed for them.

CPAP technology has been around for decades, and some efforts have sought to develop the machines for low-resource settings. But CPAP had not made it to this hospital.

Stories like this illustrate the problems that prevent lifesaving medical devices from completing the journey from discovery to development to delivery in low-resource settings, Donaldson said.

The re-brand from D-Rev to Equalize Health is about more than a new name, she added. The organization has an expanded mission to speed up the pace of product development by helping other innovators design products with user and market constraints in mind.

For more from Prescription for Progress 2022, check out the full list of sessions.