The role of technology in improving healthcare around the world is well acknowledged: in 2012, the World Health Organization (WHO) adopted several resolutions acknowledging the need for appropriate and affordable medical devices in low-to-middle income countries and recognizing that key public health priorities cannot be achieved without such devices. But in this glorious age of high tech, we sometimes forget that technology is just a tool, not the entire solution.
Technology alone is not enough
Instead of a photo of smiling children and mothers from Rwanda or Bangladesh or Indonesia, here is a photo of a functioning, busy pathology laboratory in a district level hospital in India. This is what “global health” looks like on-the-ground: limited resources serving large populations, and requiring innovation not just in technology, but also in service delivery, personnel management and access to care.Education and awareness matter
A South Africa-based NGO, mothers2mothers, provides counseling and support to pregnant women with HIV in over a dozen sub-Saharan African countries. (Disclosure: I used to work there.) It is brilliant example of the power of talking to people, and educating them about better healthcare outcomes. No fancy gadgets necessary. Technology can serve many purposes, but one cannot negate the power of simple human interaction. (Now you can have some smiling babies.)
Business models will make or break you
While technology innovation is critical, the products with greatest impact require significant business model innovation. How does the device get to the hospital? Who will service it when it breaks down? Does it need electricity? Does it need trained staff to operate it? Is it even necessary? (see KMC example below). How much does it cost?
Answers to these questions and others determine the success or failure of a new global health technology, far more than the actual technical specifications. While the need for affordable technology has been discussed ad nauseam, appropriate business models get much less attention.
There is no substitute for legwork
In a deeply insightful piece for the New Yorker, Atul Gawande talks about how much effort it takes for a health worker to change their practices. He talks about the oral rehydration therapy education program undertaken by the Bangladeshi government in the 1980s. The government trained thousands of community health workers to go to over 12 million households, multiple times, to teach families about ORS and saving their children from diarrhea.
“We’re infatuated with the prospect of technological solutions to these problems — baby warmers, say. You can still find high-tech incubators in rural hospitals that sit mothballed because a replacement part wasn’t available, or because there was no electricity for them.”
Healthcare is a multifactorial problem
Solutions that take entire health systems into account need to be built: those that create sustainable, functioning, people-focused and culture-appropriate processes in developing countries. Solving entrenched healthcare problems requires organizations that successfully employ a multifactorial approach — engaging governments, non-profits and corporations — in order to improve healthcare outcomes in the global South. Technology is necessary, but not sufficient, for this critical task.