speaker: the cost of saving babies from jaundice in developing countries

design that mattersI N N O V A T I O N F O R S O C I A L E N T E R P R I S E

AMERICARESAUGUST 14, 2012

DESIGN THAT MATTERSDESIGN FOR SOCIAL ENTERPRISE

WHO

WHAT

WHERE

HOW

METHODS TO MOVE FROM CONCEPT TO IMPLEMENTATIONIMPROVING THE HEALTH OF MOTHERS AND CHILDREN WITH CONTAINERS TO CLINICS

photo courtesy Containers to Clinics

“One container will feature a pair of examination rooms, where pregnant women can get checkups and children can get vaccinations. The other, will be divided into a lab and pharmacy; it will also have a check-in window for patients, who will wait on chairs outside.”

Architectural Record 11May10

AN AGRIBUSINESS INVESTMENT STRATEGY INCREASING SMALLHOLDER FARMER INCOME AND NUTRITION WITH A USAID CONTRACTOR

“In their feedback, USAID specifically noted our ‘thoroughly developed’ innovation measurement scale as a strength. We did some great work together. I hope we can find another opportunity to collaborate soon.”

Business Development Manager

A TOOLKIT FOR M-HEALTH INNOVATION PLANNING EXPANDING THE HOSPITAL’S REACH WITH LIFESPRING MATERNITY HOSPITAL

photo courtesy Kate Krontiris

“I just wanted to say a huge THANK YOU for a wonderful workshop. I learned a lot and am excited to bring these lessons back to LifeSpring. You have me inspired to learn more about design thinking!”

Tricia MorenteLifeSpring Strategist

KINKAJOU MICROFILM PROJECTOR MAKING ADULT LITERACY PROFOUNDLY MORE COST-EFFECTIVE AND SUSTAINABLE WITH WORLD EDUCATION

“it is better, because without the kinkajou, when the teacher is writing on the board, students wait in the dark in vain, and they do nothing.”

Martine Sogobaliteracy teacher in mali

NEONURTURE CAR PARTS INFANT INCUBATOR CONCEPT INSPIRING THE GLOBAL HEALTH COMMUNITY WITH THE CENTER FOR INTEGRATION OF MEDICINE AND INNOVATIVE TECHNOLOGY (CIMIT)

“Though its production plans remain in flux, the device might eventually prompt medical equipment manufacturers and aid agencies to re-evaluate their approaches to neonatal care in rural, impoverished areas.”

Jonathan SchultzThe New York Times, 23Nov10

TRANSFORMING THE DEVELOPING WORLD NEWBORN HEALTHCARE SYSTEM WITH EAST MEETS WEST FOUNDATION AND MEDICAL TECHNOLOGY TRANSFER AND SERVICES

FIREFLY NEWBORN PHOTOTHERAPY

“I am most impressed with how fast the bilirubin level is reduced. I save Firefly for the most severe cases. We moved this baby from overhead phototherapy to Firefly when his levels spiked to 405. If we hadn’t had Firefly, we would have had to do an exchange blood transfusion.”

Nurse Dan Thi Quynh St Paul Hospital

VIABILITY(IMPACT POTENTIAL)

WE START WITH IMPACT,

IMPACT MAGNITUDE

IMPACT SUSTAINABILITY

RESPIRATORY DISTRESS

NEWBORN JAUNDICE

photo courtesy East Meets West Foundation

INFECTION LEADING TO

SEPSIS

photo courtesy Erwin Karim, flickr.com

HYPOTHERMIA

photo courtesy East Meets West Foundation

Jaundice treatment is only available at 7 hospitals in all of Myanmar, a country with annual birth rate of 900,000. last year, 24% of Mawlamyine General Hospital’s 870 jaundice cases required exchange transfusion, compared to .01% or less in U.S. hospitals.

DESIRABILITY(STAKEHOLDERS AND

CAPABILITIES)

CLINICAL CONFIDENCE

TIME

WE UNDERSTAND THE USERS,

MEETING STAFF WHERE THEY ARE

ADDRESSING THE FULL RANGE OF STAKEHOLDERS

PARENTS

MAINTENANCE

SERVICING

DOCTORS

NURSESINFANTS

ADMINISTRATORS

GOVERNMENT

VIETNAM: MAI CHAU DISTRICT HOSPITAL

CAMBODIA: TONLEBATY HEALTH CENTER

STAKEHOLDER CAPABILITY

(DESIRABILITY)

AND WE THINK IN SYSTEMS.

FEASIBILITY(CONTEXT

APPROPRIATE TECHNOLOGY)

/ EASY TO USE CORRECTLY

/ EFFECTIVE

/ DURABLE

/ LOW COST

ANALYZING TECHNOLOGY ACCESSIBILITY

STAKEHOLDER CAPABILITY

(DESIRABILITY)

AND WE THINK IN SYSTEMS. MOVING FROM PIECES

TO SYSTEMS

CPAP & CONSUMABLES

VENTILATOR & CONSUMABLES

AMBUBAG FEEDING TUBES

IV EQUIPMENT

IV FLUIDS

INFANT FORMULABOTTLES

OVERHEAD WARMER

INCUBATOR

ROOM WARMERBLANKETS

THERMOMETER

PHOTOTHERAPY

BILIRUBIN MSMNT

SUN & BUG PROTECTION

POWER SOURCE

INFANT FOOD

CLEANING SUPPLIES

LIGHT METER

MYANMAR: NORTH OKKALAPA GENERAL HOSPITAL

NEPAL: HOSPITAL IN KATHMANDU

VIETNAM: NAM DINH PROVINCIAL HOSPITAL

WE CONSIDER ALL THREE

DESIRABILITY(STAKEHOLDERS AND

CAPABILITIES)

FEASIBILITY(CONTEXT

APPROPRIATE TECHNOLOGY)

VIABILITY(IMPACT POTENTIAL)

USING THIS PROCESS

IDENTIFY ANALYZE IMPLEMENT EVALUATE

1. COST PER DALY 2. RIPPLE EFFECT

4. DESIRABILITY & CAPABILITY

3. CONTEXT APPROPRIATE TECHNOLOGY

ANALYZING OPPORTUNITIES

DESIRABILITY(STAKEHOLDERS AND

CAPABILITIES)

FEASIBILITY(CONTEXT

APPROPRIATE TECHNOLOGY)

VIABILITY(IMPACT POTENTIAL)

1. IMPACT: COST PER DALY

UTILIT

IES

CONSUMABLESYEARS O

F LIFE

DUTIES

FEES

TAXES

SHIPPIN

G

REPLACEMENT

CLEANING

TRANSPORT

PURCHASE

SERVICE

DISPOSE USE

MAINTAIN

TRAIN

INSTALL

DISPOSAL COST

1. IMPACT: COST PER DALY

TRANSPORT

PURCHASE

SERVICE

DISPOSE USE

MAINTAIN

TRAIN

INSTALL

$0

$5

$10

$15

$20

EQUIPMENT ELECTRICITY CONSUMABLES

$1.16 $1.10 $1.39 $1.50

$4.32$4.72 $4.97 $5.28

$7.11

$8.22

$12.07

$16.32

CO

ST P

ER C

HIL

D (U

S$)

DtM Firefly

Pheonix D-Rev

GE Lullaby 2012

MTTS V3000

Madela BiliBed

NeoBlue Mini

NeoBlue Blanket

NeoBlue Cozy

NeoBlue Overhead

GE Spot PT Lite

GE Bilisoft B

lanket

Draeger 4000

1. IMPACT: COST PER DALY

PURCHASE

DISPOSE

USE

MAINTAIN

INSTALL

PHOTOTHERAPY COMPARISON: COST PER CHILD, 5 YEAR LIFETIME, MAX UTILIZATION

1. IMPACT: COST PER DALY

TRANSPORT

PURCHASE

SERVICE

DISPOSE USE

MAINTAIN

TRAIN

INSTALL

1. IMPACT: COST PER DALYELMINATING MORTALITY DUE TO JAUNDICE IN NIGERIA

ESTIMATED COST PER DALY IS 1.8-7.5**does not include DALY from lifelong disability*does not include DALY from mortality due to jaundice-related conditions such as infection and failure to breastfeed.

overall population median age (2011): 19.2 yrsannual birth rate (2011): 5.5M10% of all infants need to be treated1: 550kannual Infant mortality all causes (2011): 500k6% of mortality is due to jaundice2: 30kDALYs with 100% treatment saturation: 575k yrs

device purchase & running costslow = $825K ($1.50/child), high= $2.2M, ($4/child)

other program costslow = $190K ($500/device), high = $2.1M, ($2000/device)

1 Cline, B.K., Vilms, R., McGraw, K., Lou, H. H., Donaldson, K. M., Bhutani, V. K. “Global Burden and Unmet need for Hyperbilirubinemia Treatment.” Pediatric Academic Societies Meeting, Denver, CO, April 30-May 3, 2011.2 Preliminary findings collected from 42 hospitals across Nigeria. Okolo, A., 2012, “Nigeria Kernicterus Survey,” Pediatric Academic Societies Meeting, Boston, MA, Sheraton Exeter Room.

TRANSPORT

SERVICE

DISPOSE

TRAIN

PURCHASE

USE

MAINTAIN

INSTALL

Sunlight Phototherapy Clinical Trial, NigeriaPhoto from project by Tina Slusher M.D.

1. COST PER DALY

COST EFFECTIVENESS RATIO [US$ PER DALY AVERTED]

0 10 100 1,000 10,000

Disease Control Piorities in Developing Countries 2011

Diarrheal Disease:

Underweight Child 0-4: breastfeeding promotion

Neonatal Mortality: family, community, or clinical neonatal package

Neonatal Mortality from Jaundice:

INTERVENTIONS IN SUB-SAHARAN AFRICA

6 Hours by Motorbike4 Hours by Car178 Miles

7 Hours by Motorbike5 Hours by Car211 Miles

17 Hours by Motorbike14 Hours by Car510 Miles

14 Hours by Motorbike11 Hours by Car404 Miles

Hanoi

Ho Chi Minh City

Hanoi

Mai Chau District Hospital

Nam DinhDistrict Hospital

Dai TuDistrict Hospital

1

2

Scenario 1

Mai Chau District Hospital

Vietnam National Hospital of Pediatrics

Home inRural Village

1.5 Hours by Motorbike.75 Hour by Car

2.25 Hours by Motorbike1.25 Hours by Car

45 Miles 70 Miles

Due to lack of proper tools at the district Hospital level

the infant is referred to a national Hospital

Scenario 2

Dai TuDistrict Hospital

Vietnam National Hospital of Pediatrics

Home inRural Village

1 Hour by Motorbike.5 Hour by Car

2 Hours by Motorbike1 Hour by Car

30 Miles 58 Miles

Due to lack of proper tools at the district Hospital level

the infant is referred to a national Hospital

A DEVICE THAT CAN CHANGE THE NEWBORN HEALTHCARE SYSTEM

2. IMPACT: RIPPLE EFFECT

IN NATIONAL HOSPITALS, UP TO 33% OF NICU PATIENTS ARE ADMITTED FOR SIMPLE JAUNDICE TREATMENT.

2. IMPACT: RIPPLE EFFECT

A DEVICE THAT CAN PROMOTE THE BEST STANDARD OF CARE

THE PHILIPPINES: FABELLA NATIONAL HOSPITAL

“We completely banned use of formula in our hospital. Instead, we encourage all mothers to breast feed and use kangaroo care to keep their infants warm.”

Dr. Jazel Manarang

2. IMPACT: RIPPLE EFFECT

VIETNAM: HA NAM DISTRICT HOSPITAL

2. IMPACT: RIPPLE EFFECT

2. IMPACT: RIPPLE EFFECT

A DEVICE THAT CAN PROMOTE THE BEST STANDARD OF CARE

VIETNAM: DANANG WOMEN AND CHILDREN’S NATIONAL HOSPITAL

2. IMPACT: RIPPLE EFFECT

VIETNAM: NAM DINH PROVINCIAL HOSPITAL

3. CONTEXT APPROPRIATE TECHNOLOGY

$0

$5

$10

$15

$20

AVER

AGE

PR

ICE

PER

UN

IT (U

S$)

20132012201120092008

VIETNAM: NAM DINH PROVINCIAL HOSPITAL

* Carbone, James. “LED market grows as prices decline.” Purchasing Pro Magazine, Thief River Falls, MN. January 18, 2011

3. CONTEXT APPROPRIATE TECHNOLOGY

LED PRICE DECREASE* BETWEEN 2008-2013

3. CONTEXT APPROPRIATE TECHNOLOGY

3. CONTEXT APPROPRIATE TECHNOLOGY

VIETNAM: NATIONAL OBGYN HOSPITAL

3. CONTEXT APPROPRIATE TECHNOLOGY

FIELD RESEARCHTHE PHILIPPINES: FABELLA NATIONAL HOSPITAL

Fabella is one of the few (25%) public hospitals. They currently have 6 phototherapy devices to treat a NICU of 115 infants.

4. DESIREABILITY & CAPABILITY

VIETNAM: ST. PAUL GENERAL HOSPITAL

4. DESIREABILITY & CAPABILITY

VIETNAM: DANANG WOMEN AND CHILDREN’S NATIONAL HOSPITAL

4. DESIREABILITY & CAPABILITY

RECOMMENDED USE ACTUAL USE

VIETNAM: DANANG WOMEN AND CHILDREN’S NATIONAL HOSPITAL

4. DESIREABILITY & CAPABILITY

VIETNAM: HAI DUONG PROVINCIAL HOSPITAL

4. DESIREABILITY & CAPABILITY

“Firefly is very easy to use because you don’t have to adjust the height, anyone can use it--nurses, mothers and midwives.”

Dr. Ngo Min Chuong, Director, Nam Dihn Obstetric Hospital

VIETNAM: ST PAUL GENERAL HOSPITAL

4. DESIREABILITY & CAPABILITY

“If the price of an overhead phototherapy was 20M VND, then I would expect Firefly would be about 30M VND because it is so much more effective and it also prevents cross infection.”

Nurse Dan Thi Quynh, St Paul Hospitalechoed by Moc Chau Hospital staff

IN THE NICU

“We save it for our most severe jaundice cases. We performed approximately 50 exchange blood transfusions last year.”

Nurse Dan Thi QuynhSt Paul General Hospital

“We have been using phototherapy in mom’s room since 2007. Firefly is the best phototherapy we have seen designed for use in mother’s room.”

Dr. Truong Thi Nhu HuyenDanang Women and Children’s Hospital

4. DESIREABILITY & CAPABILITY

IN MOM’S ROOM

55INFANTS TREATED TO DATE*

* December 8 - January 6, 2011April 26 - July 18, 2012

40%REDUCTION IN TREATMENT TIME*

* During the December 2011 Clinical Trial atthe National OBGYN Hospital in Hanoi, Vietnam, compared

to state of the art, new overhead LED phototherapy

*an expensive, high-risk treatment of last resort for patients with severe jaundice, where all the newborn’s blood is removed and replaced by

donor blood

EXCHANGE TRANSFUSIONS* AVERTED BY FIREFLY

3+

design that mattersI N N O V A T I O N F O R S O C I A L E N T E R P R I S E

THANK YOU!