ideas and discoveries from research, it may cross many sectors and disciplines involved in the development and applicaƟon of a novel product or process.
The Global Forum for Health Research focuses on promoƟng an environment that fosters innovaƟve soluƟons for the health of poor populaƟons. In doing so, it places parƟcular emphasis on health equity as the central goal, i.e. reducing health dispariƟes within and between populaƟons.
Global Forum Update on Research for Health Volume 5
InnovaƟon for health is a vital driver of development. Drawing new
The fiŌh volume of the Global Forum Update on Research for Health provides insights into the newest thinking on innovaƟon for global health. Some 30 leading insƟtuƟons and professionals from around the world reflect on how policy, social, technological and corporate innovaƟons can be fostered for global health.
Fostering innovaƟon for global health Global Forum Update on Research for Health Volume 5
This volume is produced to coincide with the Global Ministerial Forum on Research for Health, Bamako, which is co-organized by the Global Forum for Health Research.
Editors Monika Gehner, Susan Jupp and Stephen A Matlin, Global Forum for Health Research
Editorial Advisory Board Pan American Health OrganizaƟon
Andrés de Francisco
The Partnership for Maternal, Newborn and Child Health
Nirmal Kumar Ganguly
NaƟonal InsƟtute of Immunology, India
Stuart Gillespie
Plaƞorm on Agriculture and Health Research
Odile Leroy
European Malaria Vaccine IniƟaƟve
Judith Sutz
Universidad de la República, Uruguay
Alfred Watkins
World Bank
Derek Yach
PepsiCo, Inc.
ISBN: 978-2-940401-12-3 Cover - Final_layout.indd 1
Pro-Brook
Luis Gabriel Cuervo
www.globalforumhealth.org 22/10/08 16:30:41
00-08 Contents GF5:GF5
23/10/08
09:37
Page 1
Fostering innovaĆ&#x;on for global health Global Forum Update on Research for Health Volume 5
www.globalforumhealth.org
Pro-Brook 23/10/08 09:34:53
00-08 Contents GF5:GF5
23/10/08
09:15
Page 3
Contents
Editorial Advisory Board: Luis Gabriel Cuervo Pan American Health Organization Andrés de Francisco The Partnership for Maternal, Newborn and Child Health Nirmal Kumar Ganguly National Institute of Immunology, India Stuart Gillespie Platform on Agriculture and Health Research Odile Leroy European Malaria Vaccine Initiative Judith Sutz Universidad de la República, Uruguay Alfred Watkins World Bank Derek Yach PepsiCo, Inc. Editorial Team: Monika Gehner, Global Forum for Health Research Susan Jupp, Global Forum for Health Research Stephen A Matlin, Global Forum for Health Research Production Team: Julia Federico, Global Forum for Health Research Monika Gehner, Global Forum for Health Research Oana Penea, Global Forum for Health Research Pro-Brook Publishing Team: Trevor Brooker, Pro-Brook Publishing Tim Probart, Pro-Brook Publishing Stephen Kemp-King, Pro-Brook Publishing Simon Marriott, Art Direction Jude Ledger, Copy Editor Pr Photo credits: WHO/PAHO/Carlos Gaggero WHO/TDR/Andy CraggsWyndeham Grang The Global Forum Update on Research for Health Volume 5 is published for the Global Forum for Health Research by Pro-Brook Publishing Limited Pro-Brook Publishing, 13 Church Street, Woodbridge, IP12 1DS, United Kingdom Copyright Text © the Global Forum for Health Research 2008 Volume © Pro-Brook Publishing Limited 2008 All rights are reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photo-copying, recording or otherwise without the permission of the Publisher. The information contained in this publication is believed to be accurate at the time of manufacture. Whilst every care has been taken to ensure that the information is accurate, the Publisher and Global Forum for Health Research can accept no responsibility, legal or otherwise, for any errors or omissions or for changes to details given to the text or sponsored material. The views expressed in this publication are not necessarily those of the Publisher or of the Global Forum for Health Research. Application for reproduction should be made in writing to the Publisher. ISBN 978-2-940401-12-3 First published 2008 Acknowledgements: The Publishers hereby acknowledge the assistance of all the contributors who have helped in the production of the publication and the advertisers who have made the publication possible. e, Southwick, UK Global Forum Update on Research for Health Volume 5
3
00-08 Contents GF5:GF5
22/10/08
14:06
Page 5
Contents
Contents 009 Foreword/Préface Gill Samuels 013 The scope and potential of innovation for health and health equity Stephen A Matlin innovating for health and development 024 Research and innovation in Brazil: the institutional role of the Ministry of Health Suzanne Jacob Serruya with Reinaldo Guimarães, Itajai Oliveira de Albuquerque and Carlos Medicis Morel 030 Health markets and future health systems: innovation for equity Gerald Bloom with Claire Champion, Henry Lucas, M Hafizur Rahman, Abbas Bhuiya, Oladimeji Oladepo and David Peters 036 Strengthening the base: innovation and convergence in climate change and public health Saqib Shahab with Abdul Ghaffar 041 Global health diplomacy – a bridge to innovative collaborative action Thomas E Novotny and Ilona Kickbusch with Hannah Leslie and Vincanne Adams 048 Hideyo Noguchi Africa Prize Kiyoshi Kurokawa with Tamaki Tsukada and Eri Maeda 054 Health research and innovation: recent Spanish policies Flora de Pablo with Isabel Noguer moting healt 059 The changing landscape of research for health Kirsten Havemann with introduction by Ulla Tørnæs 066 Global health and the foreign policy agenda Jonas Gahr Støre 072 “Policies for innovation”: evidence-based policy innovation – transforming constraints into opportunities Miguel Angel González Block Social innovations 076 Interactions between populations, health workers and health programmes for prevention of malaria: teachings of an analysis “from below” Yannick Jaffré 082 Ethical aspects of innovation in health José Geraldo de Freitas Drumond 088 Ethics, evidence and innovation Kenneth W Goodman 091 Seeding a global movement on neglected diseases Sandeep P Kishore with Pius Mulamira 096 Supporting implementation research partnerships for health systems strengthening: one foundation’s approach in sub-Saharan Africa Elaine K Gallin 099 The practical impact of research in South-East Asia funded by the Wellcome Trust Jimmy Whitworth with Ruth Branston and Michael Chew
Global Forum Update on Research for Health Volume 5
5
00-08 Contents GF5:GF5
22/10/08
14:06
Page 7
Contents
104 Independence and innovation: looking beyond the magic of words Xavier Crombéddressing global challenges 107 Creating incentives to induce behavioural change and improve health: success and limitations of conditional cash transfer programmes Mylene Lagarde with Andy Haines and Natasha Palmer Technological innovations 114 Innovation and access: medicines for the poor – the IGWG strategy and plan of action Bart Wijnberg and Marleen Monster 120 The Noordwijk Medicines Agenda: a model for changing innovation for neglected and emerging infectious diseases Bénédicte Callan with Susanne L Huttner, Iain Gillespie and Barbara Slater 124 Health dynamics, innovation and the slow race to make technology work for the poor Melissa Leach with Ian Scoones H ealth research institutions and g 130 Leapfrog technologies for health and development Harry McConnell with Prita Chathoth, Ashley Pardy, Camille Boostrom, Eugene Boostrom, Koos Louw, Luis Gabriel Cuervo and Sumiko Ogawa 138 The IVI’s innovative approach to closing the gap between vaccines for industrialized and developing countries Denise DeRoeck with Anna Lena Lopez, Rodney Carbis and John D Clemens 143 Commercializing African health research: building life science convergence platforms Peter A Singer and Abdallah S Daar with Sara Al-Bader, Ronak Shah, Ken Simiyu, Ryan E Wiley, Pamela Kanellis, Menaka Pulandiran and Marilyn Heymann Corporate sector-related innovations 152 Making drugs accessible to poor populations: a funding model Paul L Herrling 157 Public-private partnerships drive innovation to improve the health of poor populations Christopher J Elias with Yvette Gerrans and F Marc LaForce 161 Innovations and incentives: why pharmaceutical companies are becoming interested in neglected tropical diseases Arianne Matlin 166 Vision for a venturing ecosystem to generate global health innovation William Rosenzweig 171 Beyond product: the private sector drive to perform with the purpose of alleviating global under-nutrition Dondeena Bradley 174 Innovating against hunger and under-nutrition Josette Sheeran 177 Riders for Health: an award-winning social enterprise ensuring health care delivery across Africa Ngwarati Mashonga 182 UNITAID: innovative financing to scale up access to medicines Jorge Bermudez 186 Threshold of evidence needed for health claims on functional foods Peter J Jones with Stephanie Jew 190 The Lilly MDR-TB Partnership: innovation to fight a disease Patrizia Carlevaro
Global Forum Update on Research for Health Volume 5
10/9/08 9:40:12 PM
7
Foreword
Foreword Gill Samuels, Chair of the Foundation Council, Global Forum for Health Research, Switzerland
nnovation is a vital driver of development. It involves the creation of novel ideas, processes and products and their application to deliver practical solutions. In the health field, it encompasses not only technological inventions of products such as drugs, vaccines and diagnostics, but also innovations in the environmental, economic, political and social fields that can impact on the capacity to deliver health products and services and health protection and promotion messages and that can influence the broader determinants of health. The Global Forum for Health Research especially focuses on promoting an environment that fosters innovative solutions to health problems that are relevant to resource-poor settings or adapted to different social and cultural contexts in low- and middle-income countries (LMICs). In doing do, it places particular emphasis on health equity as the central goal and on the importance of bringing innovation to bear on the health problems of the poorest and most disadvantaged people. While increasing attention is now being given to the role of high-income countries in contributing to research and innovation for global health or the health of populations in LMICs, these countries need their own capacity to conduct and utilize research to solve their immediate health problems. They too need to strengthen their systems of innovation as important drivers of development. The global agenda must encompass how to (a) strengthen health research systems and innovation systems in LMICs; (b) strengthen systems incentives to create relevant products accessible to poor populations; and (c) enhance coherence
I
between policies and actions of global players and national forces shaping country research and innovation systems. Some LMICs are now showing greater commitment to investing in research for health and to developing systematic and equitable approaches to the creation and use of knowledge and innovation. These “innovative developing countries� have the potential to contribute significantly to the production of health-related products, services and processes for low-income countries and to south-south capacity building. To do so, they will require policy and legal frameworks that need to be set nationally and globally, as well as significant levels of public sector investment to ensure that the system delivers products that are accessible and affordable to the poor and contribute to a reduction in health disparities. The Global Ministerial Forum on Research for Health (Bamako, 17-19 November 2008) brings together a wide range of stakeholders in research and innovation for health. It affords a unique opportunity for a multi-sectoral dialogue to give impetus to this global agenda, to address the environment for innovation to accelerate achievement of the Millennium Development Goals and tackle some of the world’s major health challenges. As a contribution to this dialogue, the Global Forum for Health Research has commissioned this collection of writings by a range of experts and leaders in the fields of development, innovation and research. We are extremely grateful to the writers for providing cogent summaries, fresh insights and challenging messages to inform the dialogue. J
Global Forum Update on Research for Health Volume 5
09
Préface
Préface Gill Samuels, Présidente du Conseil de Fondation, Global Forum for Health Research, Suisse
'innovation est un moteur essentiel du développement. Cela comprend la création d’idées, de procédés et de produits nouveaux et leur application pour fournir des solutions pratiques. Dans le domaine de la santé, cela englobe non seulement les inventions technologiques de produits, tels que médicaments, vaccins et diagnostics, mais aussi l’innovation dans tous les domaines environnemental, économique, politique et social qui peuvent avoir un impact sur la capacité d'offrir des produits et des services de santé et sur les messages de protection et de promotion de la santé qui peuvent influencer les déterminants de la santé. Le Forum mondial pour la recherche en santé a pour objet, en particulier, de promouvoir un environnement qui favorise des solutions novatrices aux problèmes de santé spécifiques aux milieux défavorisés ou adaptés aux contextes sociaux et culturels variés des pays à faibles et moyens revenus. Pour ce faire, il se donne tout particulièrement comme objet d’atteindre l'équité en santé et de faire porter l'innovation sur les problèmes de santé des plus pauvres et des plus défavorisés. Alors que l’on accorde une attention accrue à la contribution des pays à revenu élevé à la recherche et à l'innovation pour la santé globale ou la santé des populations des pays à faibles et moyens revenus, ces pays ont besoin de leur propre capacité d’effectuer et d'utiliser la recherche pour résoudre leurs problèmes de santé immédiats. Ils doivent aussi renforcer leurs systèmes d'innovation, en tant que facteurs importants du développement. L'ordre du jour global doit inclure les moyens de (a) renforcer les systèmes de recherche en santé et les systèmes d'innovation dans les pays à faibles et moyens revenus ; (b) renforcer les systèmes d'incitation pour créer des produits adaptés accessibles aux populations pauvres, et (c) améliorer
L
10
Global Forum Update on Research for Health Volume 5
la cohérence entre les politiques et les actions des acteurs globaux et des forces nationales qui configurent les systèmes de recherche et d'innovation des pays. Certains pays à faibles et moyens revenus s’engagent maintenant à investir dans la recherche pour la santé et à développer des approches systématiques et équitables pour susciter et utiliser la connaissance et l’innovation. Ces 'pays en développement innovants' ont le pouvoir de contribuer significativement à la production de services, de processus et de produits pour la santé à destination des pays à faible revenu, et de renforcer les capacités entre pays du Sud. Pour ce faire, ils auront besoin d’un cadre politique et juridique qu'il faudra établir à différents niveaux, nationaux et mondial, ainsi que d'investissements conséquents du secteur public pour s'assurer que le système fournit des produits accessibles et abordables pour les pauvres, contribuant à une réduction des disparités en santé. Le Forum ministériel mondial sur la recherche pour la santé (Bamako, 17-19 novembre 2008) rassemble un large éventail de personnes concernées par la recherche et l'innovation pour la santé. Il offre une occasion unique de dialogue multi-sectoriel en vue de dynamiser cet ordre du jour mondial, de s'intéresser à l'environnement pour l'innovation pour accélérer la réalisation des objectifs du Millénaire pour le développement et s'atteler à certains des plus grands défis en matière de santé dans le monde. En tant que contribution à ce dialogue, le Forum mondial pour la recherche en santé a commandé ces contributions de nombreux experts et chefs de file dans les domaines du développement, de l'innovation et de la recherche. Nous sommes extrêmement reconnaissants aux auteurs d’avoir fourni des récapitulations pertinentes, des éclairages nouveaux et des messages stimulants pour contribuer au dialogue. J
113 Title page:GF5
23/10/08
10:18
Page 113
Technological innovations 114 Innovation and access: medicines for the poor – the IGWG strategy and plan of action Bart Wijnberg and Marleen Monster 120 The Noordwijk Medicines Agenda: a model for changing innovation for neglected and emerging infectious diseases Bénédicte Callan with Susanne L Huttner, Iain Gillespie and Barbara Slater 124 Health dynamics, innovation and the slow race to make technology work for the poor Melissa Leach with Ian Scoones 130 Leapfrog technologies for health and development Harry McConnell with Prita Chathoth, Ashley Pardy, Camille Boostrom, Eugene Boostrom, Koos Louw, Luis Gabriel Cuervo and Sumiko Ogawa 138 The IVI’s innovative approach to closing the gap between vaccines for industrialized and developing countries Denise DeRoeck with Anna Lena Lopez, Rodney Carbis and John D Clemens 143 Commercializing African health research: building life science convergence platforms Peter A Singer and Abdallah S Daar with Sara Al-Bader, Ronak Shah, Ken Simiyu, Ryan E Wiley, Pamela Kanellis, Menaka Pulandiran and Marilyn Heymann
Global Forum Update on Research for Health Volume 5
113
130-135 McConnell:GF5
22/10/08
09:33
Page 130
Technological innovations
Leapfrog technologies for health and development Article by Harry McConnell (pictured), Professor of Neuropsychiatry, Griffith University, Australia with Prita Chathoth, Ashley Pardy, Camille Boostrom, Eugene Boostrom, Koos Louw, Luis Gabriel Cuervo and Sumiko Ogawa
as a potential tool to address the inequalities in health care nformation and communication technologies (ICTs) are between the low- and middle-income countries (LMICs) and increasingly being recognized as essential health high-income countries. We focus here on two current technology, giving individuals at all levels of the health examples of leapfrogging which are already being workforce and other stakeholders access to information that successfully implemented in many developing countries: helps them protect and improve health and save lives. Radio ePublishing and mobile phones. Other leapfrog technologies and television are ever-present in many parts of the world, and potential benefits and risks of their use for health in and their uses in health care, health education, and health information dissemination and access continue to be invaluable. At the clinical and laboratory level, ICTs are Barrier Comment used to track and provide patient information, to Absorptive capacity Inadequate ability to recognize, place value upon, facilitate research, diagnosis and testing, and to deliver internalize and apply new knowledge (e.g., among IT support workers and system managers in services through telemedicine despite distance and LMICs) time barriers. Attitudes and Acceptability, perceived needs based on a needs analysis, Debate continues as to the roles and relative perception attitudes towards technology, concepts of development and importance of ICTs in socioeconomic development1 aid, and focus on the problems to be solved (i.e. being peopledriven and problem-oriented not kit-driven) including health development. Many people believe that ICTs are a necessary component of every facet of Cultural and Language, cultural views towards technology, sharing of community issues resources within the community, appropriateness of a specific development, ranging from infrastructure projects and technology within a given culture or community, literacy general economic development to community requirements, gender issues and access issues development, health care provision and education. On Legal and ethical Privacy, confidentiality, security, malpractice potential, the other hand, there are many barriers to Issues insurance, jurisdiction, copyright, patents for new technologies and treatments, other intellectual property issues implementing ICTs and health technologies in developing countries (see Table 1) and many argue Technical issues Access to electricity grid and alternative power supplies, power schedules and reliability, UPS back-ups, ongoing maintenance that clear precedence must be given to clean water, of computers. Inappropriate access devices and inappropriate sanitation and jobs. There have been many efforts to Internet technologies including low bandwidth. Insufficient language and cultural adaptation of content and the digital divide use older ICTs for health and development in developing countries. Radio and television networks Environmental Effects of weather, temperature, humidity and dust on equipment. issues Security and accessibility of equipment. Isolation, transport can be powerful tools for widespread health education. issues There have been many efforts to donate legacy systems Sustainability Ongoing upgrades of technology, ongoing costs, and older computers to developing countries, issues cost-effectiveness although some argue that this is more a means of Practical issues of Corruption, borders and customs in equipment transport, dumping eWaste than a philanthropic effort. MIT working internationally nationally-imposed barriers to information access or has recently announced it is developing a US $ 10 dissemination or to information privacy, donor-imposed barriers, time zones and communication issues of working in computer using the older Apple II hardware and remote geographical areas software in parallel with the One Laptop per Child Health care In health, insufficient means to implement health care and take (OLPC) initiative. infrastructure full advantage of leapfrog ICT technologies, e.g. lack of The concept of leapfrogging implies that developing treatment facilities, drug delivery systems, inadequate cold chain facilities for vaccines countries should be able to benefit from the most current technologies and bypass older legacy systems Table 1: Potential barriers to implementing leapfrog technologies in as a more efficient means of achieving technology developing countries transfer. This paper looks at leapfrogging technologies
I
130
Global Forum Update on Research for Health Volume 5
130-135 McConnell:GF5
22/10/08
09:33
Page 131
Technological innovations
Technology
Examples of potential applications in developing countries
Examples of potential risks and implementation problems in developing countries
Telemedicine technologies
eRadiology, ePathology, teleSurgery, Store and Forward Telemedicine can enable access to necessary expertise and help in overcoming the “brain drain� of medical personnel in developing countries
Differing cultural understandings of illness; medico-legal implications; bandwidth issues
Open access technologies
Technologies such as Web Bibliometrics, Web 2.0 and wiki are Poor quality controls for information; making it possible to realize the principles of The Budapest Open misinformation becomes published as fact Access Initiative, The Berlin Declaration, the Open Source Initiative and Gnu License, as well as The Copy Left Movement. Projects such as The Public Knowledge Project, HINARE, The Open Archives Initiative and online journals such as the Public Library of Science, Biomedcentral are revolutionizing medical publishing with Open Peer Review and Commentary and free access to publications. This has resulted in a paradigm shift in why and how we publish scientific research
Collaborative technologies and social networking
Advances such as Web 2.0 and wiki will mean that health professionals and Poor quality controls for information; patients in developing countries can effectively network with each other misinformation becomes published as fact and with the industrialized world and actively participate in knowledge development through projects such as medical wikis. This will also lead to patient empowerment and to better informed health care particularly for those suffering from chronic illness and disabilities
GRID technologies
May deliver greater power at less cost by harnessing the capacity of many computers and increasing collaboration efforts
Internet2
Internet2 allows advanced centres of medicine to provide health education Risk of increasing digital divide as currently to hospitals and universities in developing countries through increased limited availability in developing countries bandwidth, improved security and collaboration potential
eLearning technologies and virtual patient simulation
The creation of these new resources is both exciting and precarious as Lack of acceptance; technology transfer they can offer limitless possibilities to advance in areas like distance issues learning and interdisciplinary development. Facilitates capacity building and collaboration with other institutions through both real time and asynchronous delivery methods
Bioinformatics
Identification of drug targets and understanding pathogen-host interactions
High development costs
Alternative network technology
3G, 4G mobile phone networks and digital satellite radio offer the potential for access in remote areas
High establishment costs
Eco-technologies
Environmental sustainability, sanitation, clean water, bioremediation
High development costs
Solar technology
Power for computers, phones. A lesser known health sector application for solar technology is the application of solar ovens to dispose of hazardous medical waste
Reliability
Genomics and recombinant technologies
Sequencing pathogen genomes to assist in development of antimicrobials; Intellectual property and patent issues decreased costs of vaccine development; development of less expensive and more field-useable vaccines Reduced costs of drug development; development of more effective and appropriate and less expensive drugs for priority problems in LMICs
Nanotechnology
Nanomedicine offers new methods of diagnostics and could completely Concerns over health effects of nanoparticles, displace certain classes of drugs and change the ways diseases like HIV, including potential for asbestos-like effects malaria and TB are treated
Genetically modified crops
Increased nutrients to counter specific deficiencies
Cross-contamination with other crops, international regulation issues
Combinatorial chemistry
New drug discovery
High development costs
Molecular technologies
Affordable diagnosis of infectious disease
High development costs
Cost and limited bandwidth access limit utility
Table 2: Examples of leapfrog technologies
Global Forum Update on Research for Health Volume 5
131
130-135 McConnell:GF5
22/10/08
09:33
Page 132
Technological innovations
developing/LMIC countries are outlined in Table 2. Case studies have recently been published outlining eHealth activities and results in Peru, South Africa, Turkey, Vietnam and Rwanda2. The South African case study3 confirmed that the needs of developing countries differ from those of the developed world in some areas. Issues of interoperability, human resource development, broadband penetration and high cost of bandwidth are worth noting. Although several e-Governance projects have been implemented in South Africa and a draft e-Health White Paper Discussion Document has been developed, the implementation of eHealth policy remains a concern. The training of the workforce needed for successful eHealth implementation is globally a common focus. Apart from residential degree courses, online training opportunities are now also offered, such as Drexel University’s Certificate in Healthcare Informatics4 and Certificate in Medical Billing and Coding5. An important part of eHealth, albeit sometimes viewed as on the periphery, is consumer health sites. Such sites should preferably be accredited by the Health On the Net Foundation (HON), whose mission is to guide Internet users to reliable understandable accessible and trustworthy sources of medical and health information6. However, the apparent success of consumer health sites can result in – or unveil – another problem for health-care consumers and providers. A recent survey in the USA commissioned by Envision Solutions found that more than 85 million adults in the USA – almost 40% – have doubted their health-care providers’ opinions when the information did not match what they found online7. A good example of technology leapfrogging is mobile phones, which have enabled low- and middle-income countries to overcome the barriers of poor or insufficient telecom infrastructure and leapfrog into 21st century mobile technology. ICT leapfrogging also applies to digital technologies whereby many low- and middle-income countries have been able to leapfrog to the digital age without going through the analogue era technologies. This possibility to leapfrog extends to eLearning and eHealth as well. Currently, most of the popular eLearning and eHealth programs and applications require sophisticated hardware and software, and in many cases access to high-speed Internet. As a result, countries that need eLearning and eHealth services the most are also the ones least able to access and use them. With the introduction of mobile technologies and devices, it is possible to provide eLearning and eCapacity building programmes to public health providers, even in remote and isolated areas. By 2010, the total number of mobile phone users is expected to grow to 3.3 billion globally, or approximately half the world’s population. Although the more affordable mobile phones in developing countries may not yet have sophisticated features found in Smart Phones, mobile phones are becoming ubiquitous in Asia, Africa and Latin America. This is expected to result in an increase in mobile-enabled health systems and services throughout the world. The recent development of “mobile web” is already turning web browsing into an “any time, any place” phenomenon. The mobile web will essentially function as “personal computers”. If at least one
132
Global Forum Update on Research for Health Volume 5
The UN hopes that if the very poor in Africa have mobile phones they will be able to use them effectively in medical emergencies and also to access appropriate and useful health information
doctor and one nurse in every hospital in developing countries, especially those in rural and peripheral areas, were to have access to (and effectively use) a mobile “smart” phone with web capability, it could have a major impact on provision of health care. The UN Millennium Villages Program has initiated a plan in which some of the world’s poorest people in several African countries will be connected to cellular networks and be able to use mobile phones. This is expected to have a significant impact on health care and education. They will not have access to mobile web browsing yet, but that could be available to them within a few years. The UN hopes that if the very poor in Africa have mobile phones they will be able to use them effectively in medical emergencies and also to access appropriate and useful health information. A rural hospital would be able to make a call to the nearest specialty hospital or specialist and thus help save lives during emergencies. Mobile web browsing, at the very least, could provide instant access to the most relevant and up-to-date health information to health practitioners, especially if the most relevant and appropriate information were available in easily accessible forms, and it would offer a private and personal form of learning experience. The mobile web can be a “knowledge repository” for both providers and consumers of health care. Other mobile devices such as patient monitoring devices, PDAs and wireless radios can all be used in public health education, training and capacity enhancement. For example, they can be used in real-time monitoring of patient vital signs and in accessing important and useful health information. One of the main constraints that prevents developing countries from being fully part of the emerging global ICT infrastructure is the lack of resources, both financial and human, to acquire and apply the technologies. The latter is true, especially in public health. Even if the government or donor agencies are prepared to invest in the required infrastructure, at present there are not enough skilled people within the health sector, especially in the rural areas, who are able or willing to use most ICTs effectively. Mobile phones and some other hand-held wireless devices, however, do not seem to pose too much of a challenge to the users. Medical record-keeping is an area which begs for leapfrogging. In the tsunami-hit hospitals in Sri Lanka and other countries, for example, paper-based health records and patient records were washed away or destroyed. Having one’s medical records available on a mobile phone would also help doctors, nurses and pharmacists make the right decisions,
130-135 McConnell:GF5
22/10/08
09:33
Page 133
Technological innovations
developments in public health research. In many parts of the developing world, unlimited Internet access is now available on a monthly rate basis. Health personnel with such access can easily have individualized professional development by just going through these online Initiative/organization Comment journals. Many medical schools and colleges have AED SatelLife Uses ICTs, especially PDAs, in health and development. computer centres that allow students free time on the http://www.healthnet.org/whatwedo.php Internet. Many journals are available on a fully openDevelopment Gateway World Bank Initiative. Portal for development partners and access basis, e.g. BioMedCentral and PLOS Medicine, member countries. www.developmentgateway.org and in developing countries many journals are available through HINARI and even some evidenceFirst Voice International Uses WorldSpace Digital Satellite Radio for broadcast of health information. www.firstvoiceint.org/ based medicine websites such as dynamicmedical.com are available free of charge to Health InterNetwork Biomedical publishers, working closely with the World health professionals in many developing countries. for Developing Nations Health Organization (WHO), allowing free or very low priced (HINARI) online access to more than 2000 key biomedical research and Electronic journals also offer the convenience of taking healthcare journals. part in blogs, debates, webchats, and other forms of http://cat.inist.fr/?aModele=afficheN&cpsidt=14647338 eLearning and electronic participation. This has the Health on the Net Sets code of practice for health Internet sites to guide added advantage of peer learning and of being part of Foundation (HON) Internet users to reliable, understandable, accessible and communities of practice on a global scale. ePublishing trustworthy sources of medical and health information. www.hon.ch also stands to make major changes in the way we InfoDev World Bank Initiative. Sponsors ICT and development disseminate information. Success will be measured by programmes and framework documents. www.infodev.org web bibliometrics analysing one’s contribution to making a real impact, rather than merely by Interactive Health Nonprofit organizations dedicated to using online Network and Academy technologies to combat health inequities through stimulating counting peer review publications and citations. These for Health Equity and discussion regarding effective policies for public and private bibliometrics have the potential to replace the current Disability health programmes and practices affecting those most system of publish or perish merit system measured by marginalized in society. Works in Africa and Asia-Pacific predominantly on eLearning and ePolicy initiatives. Uses ICTs citations. The new system will allow an for eCapacity Building of health-care workers and for effective unprecedented transparency in research, making national and international policy development. www.ihn.info fraudulent research very difficult. Open access, open International Network Promotes access, use, dissemination and communication archives, open editorial review and open peer review for the Availability of of research information in developing countries will make possible access to original data and Scientific Publications http://www.inasp.info/file/434/inasp-health.html collaboration in ways not yet envisioned. An open (INASP) source approach to research dissemination will ensure International Sets standards in telecommunications and monitors eHealth true advancement in scientific acknowledge through Telecommunication programmes; Sponsor of the World Summit on the real paradigm shifts and important innovative Union Information Society (WSIS). http://www.itu.int advances8. IRDC Acacia Initiative Works in Africa with a focus on appropriate applications and This year’s Global Economic Prospects9 focuses on technologies, infrastructure, policy and governance. technology diffusion in developing countries and www.idrc.ca/acacia states that even the introduction of relatively simple PATH Nonprofit organization using health technologies designed for technologies can have far-reaching development low-resource settings, by the people who will use them; impacts. “Technological advances do not need to be promoting health equity for women, among the world’s most vulnerable – and influential – populations and vaccine extraordinarily complex or reliant on the most programmes. www.path.org sophisticated technology to have important development impacts”. This holds true for health ICTs. Rockefeller Foundation Sponsors think tank meetings on E-health aimed at improving and the global coalition health systems in the developing world. Includes BIREME/PAHO/ With the convergence of mobile phones and the web, for eHealth in WHO Latin American and Caribbean Center on Health Sciences we expect major impacts on the way health developing countries Information, the American Medical Informatics Association information is used and processed. More and more (AMIA), International Medical Informatics Association (IMIA), Health Level Seven (HL7), Health Metrics Network (HMN), health workers will be able to access web-based Partners in Health (PIH), Regenstrief Institute, Telemedicine health and hospital information using their mobile Society of India, United Nations Foundation (UNF) and Vodafone phones than their desk top or laptop computers, Group Foundation Technology Partnership, University of Washington’s Center for Public Health Informatics, and the which usually do not exist in many health care World Health Organization (WHO). http://www.rockfound.org; facilities. Ubiquitous, portable and personal http://www.ehealth-connection.org/ computing via affordable mobile phones will lead the WHO Essential Has eHealth branch focusing on applications in developing way in leapfrogging ICTs in many parts of the Technologies countries; collaborates with NGOs on programmes; sponsors developing world. ePublishing and Open Access make Programme many conferences on technology and health. www.who.int it possible to access essential health information at the Table 3: Examples of international initiatives promoting ICTs for health and point of care on these devices, and this is already development (modified from McConnell 2004, 2006) occurring in many areas.
based on a patient’s health history. Electronic public health journals offer a very inexpensive form of eLearning. They keep readers up-to-date on new
Global Forum Update on Research for Health Volume 5
133
130-135 McConnell:GF5
22/10/08
09:33
Page 134
Technological innovations
Table 3 shows some examples of international efforts toimplement Leapfrog technologies in developing countries for health care.
Conclusion In public health practice, ICTs enable the identification of disease and risk factor trends, analysis of social and demographic data, and increase access to publications and databases. As free and open source software continues to evolve, the uses of ICTs for health will expand exponentially. ICTs can be used by medical professionals and community health workers to improve not only health services but also entire health-care systems, while beneficiaries can use ICTs to access health information and make well-informed decisions regarding their own health. However, not all members of the health workforce or the public have equal access to ICTs. The digital divide – the gap between those with effective access to ICTs and those without it – contributes directly to the persistent health inequality both between and within countries. In health, lacking or limited access to ICTs impedes the provision of health care and the effectiveness of public health work. Efforts to bridge the gap in access to ICTs have varied dramatically in their effectiveness and their usefulness. Beyond the creation of systems for cell phone and Internet use, we need to ensure that access to ICTs for health will link individuals to the health information and modes of communication that are most useful to them, and that the most necessary, valid and useful information is available in the most acceptable and useable forms. Thomas Kuhn in The Structure of Scientific Revolutions in 1962 put forward that true scientific knowledge does not advance as a linear increase in understanding based on logical models. He proposed that true advances occur naturally as a series of revolutions, replacing the old paradigms and resulting in a “paradigm shift”: a new way of thinking about a problem. Thus, to advance development, the use of leapfrog technologies must extend this process to include ecologically, financially and socially sustainable means of tackling poverty and heath inequalities. Examples of such paradigm shifts include very recently the effect of the Internet on information retrieval, and earlier the discovery of penicillin and vaccines for combating infectious diseases. ICTs are already having an impact in health in developing countries through the rapidly growing use of mobiles and through Open Access initiatives for ePublishing10. There is a unique opportunity for developing countries to harness eHealth technologies in a way that will ensure a paradigm shift in how we “deliver” or “support” development and how health is progressed in these regions. It offers the potential of greater transparency, improved governance and access to essential tools and expertise, irrespective of geography or of financial or resource implications. J Harry McConnell is a neuropsychiatrist specializing in disability with more than 20 years’ experience in both the clinical and public health aspects of health and disability. He has published five textbooks and worked as a Clinical Editor at BMJ Clinical Evidence.
134
Global Forum Update on Research for Health Volume 5
He has a keen interest in Open Access and innovative use of IT to make scientific publishing more available in developing countries. Professor McConnell has worked extensively with the WHO, World Bank and other international agencies on the implementation of eHealth programmes in developing countries. He trained in the USA, Canada, New Zealand and the UK. Professor McConnell also has a keen interest in evidence-based policies for disability services and in health and disability in developing countries. He is a Consultant Psychiatrist and Professor of Neuropsychiatry at Griffith University School of Medicine. Prita Chathoth PhD has more than 20 years of international experience in eLearning, eHealth and ICTs for development. She worked at the World Bank in Washington, DC, from 1993 to 2007. During this time, for more than seven years, she served as senior operations officer in the Global Development Learning Network (GDLN). As Task Manager of the GDLN Global Dialogues Program, Dr Chathoth worked extensively with all regions of the world. From July 2005 to December 2006, Dr Chathoth was on assignment at the WHO Office in Sri Lanka as eCapacity Building Coordinator and Project Manager of the Sri Lanka eHealth Project. Prior to joining the World Bank, she worked at INTELSAT, in Washington, DC, as a training specialist. In 2007, Dr Chathoth worked as a consultant at the Pan American Health Organization (PAHO). She has researched, written and produced more than 15 broadcast quality documentaries. Dr. Chathoth currently works as an independent eLearning/eHealth Consultant. Ashley Pardy is the co-director of the Interactive Health Network (IHN) and project manager of the Academy for Sustainable Health Equity and Development (AHEAD). Both are nongovernmental organizations dedicated to improving health and disability services in developing countries through the use of information communication technologies. Now a full-time PhD student at Griffith University in Australia, Ashley started her university education at Queens University in Canada, where she completed her BA and then continued on to Australia to do her masters in International Relations. She is currently focusing her dissertation on mental health research in Ethiopia and is actively involved in development projects in the Asia pacific region. Ashley has worked as a volunteer in Asia, Africa and South America. Camille Boostrom is a PhD candidate in public health at Griffith University, Australia. Her research analyses the sector-wide approach in Mozambique’s health sector and its impacts on the country’s HIV/AIDS prevention efforts, specifically on the negotiation and dissemination of HIV/AIDS communications. Camille is also a Research Associate with the Georgetown University Medical Center. Eugene Boostrom MD, DrPH is a public health specialist with more than 30 years’ experience in the development of health systems and health personnel. He has worked in Africa, Latin America and the Caribbean, the Middle East and South Asia with bilateral and multilateral agencies, universities, foundations and the private sector. He retired from the World Bank as Senior Public Health Specialist in 2002 and now lives in Okinawa, Japan, where he is a Visiting Researcher at Meio University Research Institute. He also teaches public health, epidemiology, health project and human
130-135 McConnell:GF5
22/10/08
09:33
Page 135
Technological innovations
resources planning and management, and sustainable development related topics for the Japan International Cooperation Agency (JICA), Japan’s National Institute of Public Health, and Hokkaido University Medical School. Koos Louw is an eHealth consultant living in Cape Town, South Africa. He served for many years in the top management of the South African Medical Research Council as Executive Director: Informatics and Knowledge Management. He is an acclaimed role player in the area of health informatics and knowledge management, nationally and internationally, and has a track record of various successful large multi-institutional eHealth projects. He holds a PhD from Stellenbosch University, South Africa. This university appointed him in the honorary position of Visiting Professor: Information Science (Knowledge Management) and as an Associate of its Centre for Knowledge Dynamics and Decision Making. Luis Gabriel Cuervo is a Medical Doctor with an MSc in Clinical Epidemiology & Biostatistics from the Universidad Javeriana, and qualified as a Specialist in Family Medicine at the Universidad del Valle, Colombia. He brings first hand experience as producer and user of evidence for health care in the clinical, academic, and research fields working in various communities in rural and urban environments in Colombia. He has developed a career around
knowledge management including summarizing evidence and developing strategies to systematically inform policy and practice with research evidence. From his position as Clinical Editor at BMJ Clinical Evidence he emphasized evidence-based programmes and access to developing countries and worked closely with the World Health Organization and International NGOs including the Cochrane Collaboration and INCLEN. More recently he has coordinated the response of the Pan American Health Organization (PAHO/WHO) to the 2004 Mexico Declaration on Health Research. Sumiko Ogawa, MS in Medical Sciences, MPH, PhD, is Associate Professor at Meio University, Okinawa, Japan, where she teaches Public Health. Her successful work with WHO and JICA in developing Primary Health Care and Village Drug Revolving Funds and improving water supplies in the Lao PDR’s remote Khammouane Province from 1992 to 1996 led the Government of Laos to award her its Labor Medal, and the Japan Chamber of Commerce named her Japan’s Outstanding Young Person of 1997. With support from Japan’s Ministry of Education and JICA, she documented the postWorld War Two recovery and development of health systems and human resources for health in war-ravaged Okinawa. She is President of Okinawa’s Association of Former Overseas JICA Experts and a member of the board of Japan’s Association for Overseas Volunteer Studies. She continues her work with the Lao PDR MOH and also teaches and consults for JICA.
References 1
Dzenowagis J. Bridging the digital divide in health: the role of free and open source software. World Health Organization Expert Meeting on Free & Open Source Software UNCTAD, Geneva, 2004. Available at: http://r0.unctad.org/ecommerce/event_docs/fossem/dzenowagis.pdf 2 Refer: www.ehealth-connection.org/content/country-case-studies 3 Refer: www.ehealthconnection.org/files/resources/County%20Case%20Study%20for%20eHeal th%20South%20Africa.pdf 4 Refer: www.drexel.com/online-degrees/information-sciences-degrees/certhci/index.aspx 5 Refer: www.drexel.com/online-degrees/nursing-degrees/medical-billingcoding/index.aspx 6 Refer: www.hon.ch/ 7 Monegain B (ed). Online info has patients doubting doctors, survey founds. In: Healthcare IT News, 30 July 2008 http://www.healthcareitnews.com/story.cms?id=9654 8 McConell H. Pardy Medical Publishing in Snyder et al. Medicine and the media (in press), 2008. 9 http://econ.worldbank.org/WBSITE/EXTERNAL/EXTDEC/ EXTDECPROSPECTS/GEPEXT/EXTGEP2008/0,,menuPK:4503385~page PK:64167702~piPK:64167676~theSitePK:4503324,00.html 10 McConell H. Pardy Medical Publishing in Snyder et al. Medicine and the media (in press), 2008. Furthur reading Berger M. Nanotechnology patents and the future of the pharma industry. Nanowerk LLC, 2007. http://www.nanowerk.com/spotlight/spotid=2912.php Bernhardt JM. Health education and the digital divide: building bridges and filling chasms. Health Education Research, 2000, 15(5):527-531. Brodie A et al. Health information, the internet, and the digital
divide. Health Affairs, 2000, 19(6):255. Dzenowagis J. Bridging the digital divide in health: the role of free and open source software. World Health Organization Expert Meeting on Free & Open Source Software UNCTAD, Geneva, 2004. Available at: http://r0.unctad.org/ecommerce/event_docs/fossem/dzenowagis.pdf Improving health, connecting people: the role of ICTs in the health sector of developing countries. A Framework Paper, InfoDev, 2008. http://www.infodev.org/en/Project.38.html McConell H. Pardy Medical Publishing in Snyder et al. Medicine and the media (in press), 2008. McConnell H, Shields T and Drury P. Leadership in Global Health Technology Update. World Hospitals and Health Services, 2006. McConnell H and Marchibroda J. Leadership in Global Health Technology (LIGHT): an international dialogue towards cooperation in medical education, clinical, and research initiatives in healthcare. World Hospitals and Health Services, March, 2004. Salamanca-Buentello F et al. Nanotechnology and the developing world. PLoS Medicine, 2005, 2(5): e97 doi:10.1371/journal.pmed.0020097. Singh JP. Leapfrogging development? The political economy of telecommunications restructuring. SUNY Press, NY, 1999. Steinmueller E. ICTs and the possibilities for leapfrogging by developing countries. International Labour Review, 2001, 140(2):193-210. Tan-Torres Edejer T. Disseminating health information in developing countries: the role of the internet. British Medical Journal, 2000, 321(7264):797-800. Warschauer M. Reconceptualizing the digital divide. First Monday, 2002, 7(7). Available at: http://firstmonday.org/issues/issue7_7/warschauer/index.html Global Economic Prospects 2008: Technology Diffusion in the Developing World. World Bank, 2008.
Global Forum Update on Research for Health Volume 5
135
ideas and discoveries from research, it may cross many sectors and disciplines involved in the development and applicaƟon of a novel product or process.
The Global Forum for Health Research focuses on promoƟng an environment that fosters innovaƟve soluƟons for the health of poor populaƟons. In doing so, it places parƟcular emphasis on health equity as the central goal, i.e. reducing health dispariƟes within and between populaƟons.
Global Forum Update on Research for Health Volume 5
InnovaƟon for health is a vital driver of development. Drawing new
The fiŌh volume of the Global Forum Update on Research for Health provides insights into the newest thinking on innovaƟon for global health. Some 30 leading insƟtuƟons and professionals from around the world reflect on how policy, social, technological and corporate innovaƟons can be fostered for global health.
Fostering innovaƟon for global health Global Forum Update on Research for Health Volume 5
This volume is produced to coincide with the Global Ministerial Forum on Research for Health, Bamako, which is co-organized by the Global Forum for Health Research.
Editors Monika Gehner, Susan Jupp and Stephen A Matlin, Global Forum for Health Research
Editorial Advisory Board Pan American Health OrganizaƟon
Andrés de Francisco
The Partnership for Maternal, Newborn and Child Health
Nirmal Kumar Ganguly
NaƟonal InsƟtute of Immunology, India
Stuart Gillespie
Plaƞorm on Agriculture and Health Research
Odile Leroy
European Malaria Vaccine IniƟaƟve
Judith Sutz
Universidad de la República, Uruguay
Alfred Watkins
World Bank
Derek Yach
PepsiCo, Inc.
ISBN: 978-2-940401-12-3 Cover - Final_layout.indd 1
Pro-Brook
Luis Gabriel Cuervo
www.globalforumhealth.org 22/10/08 16:30:41