2nd WHO Global Forum on Medical Devices

Innovation in Medical Devices for Maternal and Child Health

The potential impact of disruptive technology using a taskshifting model in rural Africa “PRIORITY MEDICAL DEVICES FOR UNIVERSAL HEALTH COVERAGE” NOVEMBER 22-24, 2013 GENEVA, CH.

4 Newborn

Death

5 Maternal Mortality Denver Phiri, London, UK

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The Challenge

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Poor infrastructure

Few healthcare professionals

Limited health facilities

Financial challenge

Women still deliver at home

Maternal morbidity and mortality still very high

Nurse midwives do not have the proper technology at hand

MDG targets likely to be missed

520

578

454

133

1990 1996 2005 2010 2015

MMR Trend in Tanzania

Global Challenge Africa’s Challenge

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The Environment

• No power • No water • No roads

But we have Vscans!

The Innovation

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Task-shifting in health systems

Local incentives to retain staff in rural areas

Increase in healthcare staff and community health facilities.

External funding resources

The “Big push”

Low-cost disruptive technologies

Portable, intuitive to use, rechargeable

Training for nurses & midwives

Research studies across the globe to collect data from integrated health system network

Global Healthcare Reform Innovation Reform

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The Implementation

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• Brunette, Waylon, et al. "Portable antenatal ultrasound platform for village

midwives." Proceedings of the First ACM Symposium on Computing for Development. ACM, 2010.

• Adler, D., Mgalula, K., Price, D., and Taylor, O. Introduction of a portable ultrasound unit into the health services of the Lugufu refugee camp, Kigoma District, Tanzania. Int. Journal of Emergency Medicine, 1(4):261-266, Dec 2008.

• Harris RD, Marks WM. Compact ultrasound for improving maternal and perinatal care in low-resource settings: Review of the potential benefits, implementation challenges, and public health issues. J Ultrasound Med 2009;28:1067-1076.

• Sippel S, Muruganandan K, Levine A, Shah S. Use of ultrasound in the developing world. Int J Emerg Med 2011; 7;4:72.

• LaGrone LN, Sadasivam V, Kushner AL, Groen RS. A review of training opportunities for ultrasonography in low and middle income countries. Trop Med Int Health 2012; 17(7):808-19.

Increasing literature from Africa (and beyond)

• Kimberley HH, Murray A, Mennicke M, Liteplo A, Lew J, Bohan JS, Tyer-Viola L, Ahn R, Burke T, Noble VE. Focused maternal ultrasound by midwives in rural Zambia. Ultrasound Med Biol 2010; 36(8):1267-72 .

• Landis SH, Ananth CV, Lokomba V, Hartmann KE, Thorp JM Jr, Horton A, Atibu J, Ryder RW, Tshefu A, Meshnick SR. Ultrasound-derived fetal size nomogram for a sub-Saharan African population: a longitudinal study. Ultrasound Obstet Gynecol 2009; 52(2):250-5.

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The Impact

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Increased access to U/S to identify high risk pregnancies

Increased uptake of antenatal services

Enhanced diagnostic capabilities of midwives

Improved clinical management of patients

Allow the shift of some U/S responsibilities from physicians

Potential impact on society Lower-mid tier health care providers can learn to perform sonographic procedures following a short training period

More mothers can be referred to EmONC centres where SBAs can attend and facilitate safer delivery

Properly equipping midwives with the appropriate technologies to deliver quality care is critical

Key takeaways