Innovative programs offer new perspectives on the road to the Last Mile - Reflections from IPIHD Members Forum 2015

On March 23-24, the International Partnership for Innovative Healthcare Delivery (IPIHD) held its 4th Annual Forum in Washington, D.C. The forum, which brought together a diverse group of LMIC healthcare innovators (part of the IPIHD innovator network), impact investors, foundation and government donors, and NGOs, explored challenges, lessons learned, and opportunities for achieving quality, access and affordability of healthcare delivery through innovation. Select highlights from the event were captured by the Hub team.

Building Systems for Health-- A Keynote with Victor Dzau, IOM

The forum began with a keynote address by Victor Dzau at the Institute of Medicine, who spoke of the future of global healthcare delivery. He argued that the global development community should shift to building systems for health, instead of health systems, pointing to the need for more partnerships, capacity building, and country and community ownership. Key to this approach are innovators themselves, who are well poised to build up systems of health in their own communities and countries, including developing new technologies, novel ideas, innovative delivery models and the ability to “reach people where they are” through last mile delivery and care. 

Innovator Presentations

The new IPIHD innovator cohort includes twelve entrepreneurs operating in low- and middle-income countries. Common themes from the 2015 cohort presentations included:

Low-cost productsAyzh (India) has developed low-cost clean birth kits to promote safe delivery in both home and hospital birth settings. Zana Africa has developed locally produced sanitary pads which are being sold to girls through existing delivery channels.

Low cost, high quality delivery through chains and network models: Dr. Consulta (Brazil) has developed a network of low cost outpatient clinics for uninsured patients. Bive (Colombia) is connecting doctors and patients through an annual membership model.

ICT platforms for healthcare managementMicroClinic Technologiesdeveloped ZiDi, an IT management system for clinics that integrates electronic medical records with drug and supply chain management software

Training and health education/promotion: Bodhi Health (India) has developed on-demand health worker training courses to support medical education. Noora Health (India) is training family members waiting on patients to be discharged in proper aftercare and health promotion. PACE MD (Mexico) runs tele mentoring and training programs for emergency workers.

Last mile delivery of products and servicesSevamob (India) has developed a mobile clinic model paid for by an annual subscription fee. SWAP (Kenya) employs local women as health promoters to provide health products and teach healthy behaviors in rural Kenya.

Funders Perspectives on Accelerating Global Health Innovation

On Day Two of the event, IPHID convened a session of funder representatives who shared their approaches on financing global health innovation. Participants included Beth Bafford of the Calvert Foundation (moderator), Ben Midberry of Deutsche Bank, Jonathan Hera of Grand Challenges Canada, Nadia Sood of Impact Investment Partners, and Wendy Taylor of USAID. Panelists spoke about how their respective organizations approach investments in global health innovation and shared challenges in impact investment today. Challenges include:

•an opaque market, where it is hard to establish key players
•social enterprises do not always negotiate good deals for themselves (i.e. licensing agreements), which doesn't set up them up for growth and scale
•a difficulty by all partners in balancing the business side of a social enterprise with public health impact
•foreign currency risks in investing across borders
•a need for more transparency and partnership mentality by both the investor and investee

Replication and Adaptation of Innovation

The forum’s last session was focused on the replication and adaption of innovation to new geographies. Moderated by Deborah Bae of the Robert Wood Johnson Foundation (RJWF), the panel featured Chandy Abraham of Health City Cayman Islands, Luke Disney of North Star Alliance, and Amanda Folsom of the Center for Health Market Innovations (CHMI).

Leading off the session, Amanda Folsom introduced CHMI’s new Adaptation Framework for Global Exchange of Innovation. Developed in collaboration with RJWF, the framework is designed as a flexible set of tools to support users interested in innovation translation to new contexts identifying potentially relevant practices - or active ingredients - and develop a plan for adaptation. 

After exploring CHMI’s conceptual framework, Chandy Abraham shared experiences of adapting Narayana Health, one of India’s largest hospital providers, to the Cayman Islands, arguing for the universality of the Narayana model in improving quality and access to care. For Narayana, he explained, the process of adaptation always starts with the decision to replicate itself. In this example, Narayana wanted to expand its model, and the Cayman government was looking to diversify its economy and expand access to healthcare. Nayarana was successful in adapting its active ingredients—including control of clinical processes, integrated care, audit feedback and interdepartmental collaboration—but had to adapt its overall model to new challenges in the Cayman Islands, including establishing new supply chains, embedding the work culture in a new team, and overcoming logistical and environmental challenges of an island environment. 

Luke Disney elaborated on North Star Alliance’s replication across Africa. North Star, which operates a network of shipping container based clinics that provide primary care and other basic health services across common transportation routes, developed its model with scalability at the forefront. Disney argued that although healthcare is sensitive to local conditions, flexible models with constant iteration and monitoring can both continually improve and adapt to different contexts, while still remaining true to core organizational principles. 

Lessons Learned and Questions for Further Discussion

Broad lessons and questions emerged out of the multi-day discussions facilitated by IPIHD. There is no shortage of interest in healthcare innovation, particularly last mile services and models, a focus on mobile technology, patient centered care, and low cost products. But obstacles remain—innovators struggle with how to scale and challenges around human resources, marketing and recruitment remain key barriers to growth. Both the public and private sectors are increasingly interested in developing new public-private partnerships, but fragmentation of the overall market eco-system remains a constraint. Finally, there is a plethora of information about innovative models, but true evidence on “what works” is still lacking.

Photo: MicroClinics Technologies' ZiDi cloud-based EMR system in use.

This post originally appeared on the HANSHEP Hub. Cross-posted with permssion.