To deliver tech solutions in delivery rooms, donors look to distribution

SAN FRANCISCO — One million newborns die every year in Africa, and 80% of these deaths are preventable with technologies that have been available for 50 years in the U.S., according to Dr. Queen Dube, a pediatrician at Queen Elizabeth Central Hospital in Blantyre, Malawi.

Across Africa, newborns die in the hands of nurses and doctors — not because they don’t know how to save them, but because health workers don’t have the tools to do so, she said during a TED Talk.

She worked together with partners to introduce and scale up a low-cost CPAP — or continuous positive airway pressure — machine, which can gently push oxygen into the lungs of premature babies.

“My country now saves thousands of newborn lives every year — babies who would have died,” Dube said. “We save them using these low-cost technologies, which keep on working in environments where high-tech Western solutions fail.”

Now, Dube is a principal investigator for NEST360°, which is focused on introducing “newborn essential solutions and technologies” to reduce the neonatal mortality rate in Africa. In both projects, the key to success has been not just low-cost technology, but also high-quality distribution.

Across the global health landscape, new medical technologies developed without distribution in mind fail to achieve their intended impact. A number of funders and practitioners are narrowing in on some of the supply chain bottlenecks that prevent maternal and newborn health products from reaching mothers and babies during moments of life and death, and they are starting to discover ways to address the market failures that prevent these products from saving lives.

Getting products to the last mile

When health facilities place their orders for the medicines and other health products they need, they rely on wholesalers and distributors, which tend to be highly fragmented in low- and middle-income countries.

By working with the private sector, health facilities can avoid “the long, arduous supply chain that government-run central medical store systems often entail,” said Prashant Yadav, a fellow at the Center for Global Development, who previously worked on supply chain issues at the Bill & Melinda Gates Foundation.

But without the right market incentives and regulations in place, wholesalers and distributors may supply poor-quality medicines, add unreasonable markups, or fail to get these products to health facilities on time.

Donors can help in a couple of ways: first, by improving the quality and maturity of wholesalers through capital and technical know-how; and second, by equipping country governments with the tools and technical capacity to contract with high-quality wholesalers, Yadav said.

For example, the World Bank is working with the Democratic Republic of the Congo’s Ministry of Health to improve access to maternal, newborn, and child health, or MNCH, through regulation and quality assurance for medicines and other health products distributed through the private sector, said Dominique Baabo, national coordinator for the health systems strengthening project, at a recent CGD event.

“It is hard to implement projects without strengthening systems that exist,” he said.

Ann Allen, program officer for systems innovation at the Gates Foundation, said her colleagues working on new medical devices for MNCH and other areas of global health are trying to better understand the market for distributors.

At the CGD event, Allen said the question is whether distributors have the capabilities to bring some of her colleagues’ innovations to scale.

Allen highlighted access to affordable finance, policy reforms that lower barriers to entry, and quality assurance mechanisms as three critical factors for private sector wholesalers and distributors to improve the efficiency and effectiveness of MNCH and other global health supply chains.

Finding end-to-end solutions for distribution

Last year, the Gates Foundation put out a request for proposals focused on local distribution channels for MNCH technologies.

“In maternal and newborn health, there are different devices and different techniques and different standards of care,” said Noah Perin, CEO of VIA Global Health, a global health purchasing platform that aims to streamline the medical supply chain in emerging markets. “So you get this fragmentation that creates frictions and inefficiencies.”

The Gates Foundation awarded VIA Global Health with a two-year grant, as part of an RFP seeking ideas to better inform buyers of available technologies, improve offerings across product categories, and expand the availability of service, warranties, and spare parts.

With hundreds of these products in MNCH — many of which can be substituted for one another — it can be a challenge to get the large volumes that are generally associated with lower prices and higher efficiency, said Jessica Jones, program officer at the Gates Foundation.

The market has not traditionally rewarded distribution partners to provide additional services for MNCH devices and diagnostics, including installation, technology selection, and maintenance, she said.

This led Jones and her colleagues on the global delivery programs team to ask whether there is a role for distributors and wholesalers to be agents for market-shaping.

So far, the Gates Foundation has supported initiatives such as NEST360° and VIA Global Health as part of its strategy to invest in the distribution for MNCH products.

Dube worked to scale the CPAP device in Malawi with support from Saving Lives at Birth, a program supported by the Gates Foundation and a range of bilateral donors. Now, she is working with the global NEST360° team on a bundle of affordable technologies that go beyond helping babies breathe by also keeping babies warm, treating jaundice, and controlling infections in Malawi, Kenya, Tanzania, and Nigeria.

For technologies to play a role in addressing maternal and newborn health, they have to be effective, affordable, and sustainable, Dube said.

The NEST360° team is working to tackle these challenges on all fronts, said Rebecca Richards-Kortum, co-founder and co-director of NEST360°.

“Distribution is at the heart of sustainability,” she told Devex. “We need an end-to-end solution for distribution.”

With support from a collaborative of funders that includes the Gates Foundation, she and her team are working to develop business models and financing options to ensure that lifesaving medical equipment reaches babies on time.

Update, Feb. 13, 2020: This article has been updated to clarify the name of the team at the Gates Foundation working on distribution.