THEME BRIEF

December 1st, 2017

Dear delegates,

We look forward to welcoming you to the 2018 AMWHO Inter-national Conference on “Global Health Innovation: Novel Ideas, New Horizons.” We hope this theme brief will be beneficial as you begin thinking about how we can develop innovative solu-tions to pressing global health concerns.

Most sincerely,

Pooja Joshi and Nishita ShethExecutive Conference Co-Directors2018 AMWHO International Conference

welcome

“Health innovation is to develop new or improved health policies, systems, products and technol-ogies, and services and delivery methods that improve people’s health, with a special focus on the needs of vulnerable populations.” -- WHO Health Innovation Working Group

Moore’s Law refers to the incredible phenomenon of the annual doubling of data storage capacity one can purchase for a single dollar. Our society is innovating at a faster pace than ever before, especially in the field of healthcare. Some of the most powerful examples of the exponential rate of humanity’s technological growth are in the life sciences, from genomics to organ replacement to nanosurgery.

However, innovation does not only take place in the labs of scientific institutes or the workshops of Silicon Valley companies. It can come from the villager who builds a working toilet for his neighborhood, or the bureaucrat who implements a vitamin distri-bution program for local children. Innovation is found in every corner of the world, and finding ways to catalyze it is an imperative function of the World Health Assembly.

In thinking about innovation, we explore five sub-themes: public-private partnerships, equitable access, health technology, patient experience, and diffusion of innovation. Within this framework, we can begin to develop policies to support novel ideas unto

new horizons.

introduction

“Investing in health is the surest way to find the path to economic development and greater wealth. Public-private partnerships have an important role to play in achieving that worthy and ambitious

goal.”

Raymond V. GilmartinChairman, President, and CEO, Merck & Co., Inc.1

Global health challenges affect millions, if not billions, of people every year, but are often complex, expensive, and in-volve a multitude of moving parts. Part-nerships between the public and private sector can provide workable solutions when neither the markets nor govern-ments can do so on their own. However, such partnerships are also often criticized for bringing distorting public initiatives to favor the financial interests of private companies. The private sector can bring scientific and technical expertise, busi-ness acumen, manufacturing capabilities, and existing distribution channels to the table, while public sector organizations can bring sustainable investments, aggre-gated demand, and clinical expertise2. Together, partnerships between the two can facilitate decreased costs, accelerat-ed innovation, and better health.

1. Widdus, R. (2004, April 16). Combating Diseases Associated with Poverty. Retrieved November 13, 2017, from http://www.who.int/intellectualproperty/topics/ppp/en/CombatingDiseases-Abridged.pdf?ua=12. Reich, M. R. (2002). Public-Private Partnerships for Public Health. Retrieved from https://cdn1.sph.harvard.edu/wp-content/uploads/sites/480/2012/09/Partnerships_book.pdf3. Public-Private Partnerships for global health. (2013, June). Retrieved November 13, 2017, from https://www.path.org/publications/files/ER_app_ppp_policy_br.pdf

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CASE STUDY: GERMANY

“One in three pregnancy- and childbirth-related deaths could be avoided if all women had access to contraceptive services, according to the latest United Nations Population Fund estimates. Yet women, espe-cially those in developing countries, continually suffer infections, injuries, and deaths related to unintended pregnancies. To better meet the need for a wom-an-initiated, nonhormonal, discreet contraceptive, PATH began to design and develop the SILCS dia-phragm in 1994 with funding from the US Agency for International Development. The resulting product—unlike typical diaphragms—is a single-size device that fits most women, and should be easy to supply and use. In 2010, PATH licensed the technology to Kessel Marketing & Vertriebs GmbH of Germany, a manu-facturer with more than 24 years of reproductive and sexual health product development expertise. Kessel brought manufacturing capabilities to produce a sus-tainable supply, marketing expertise and distribution channels to generate demand and ensure the avail-ability of SILCS. Kessel is launching the product in five European countries. PATH is working with partners in multiple countries to evaluate opportunities and strat-egies for future introduction in low-resource settings.”

- PATH3

“Let us be frank about it: essential and life-saving drugs exist while millions and millions of people cannot afford them. That amounts to a moral problem, a political problem and a problem of credibili-

ty for the global market system...”

Dr Gro Harlem BrundtlandFormer Director-General, WHO1.

While innovations and technologies are being discovered and invented every day, oftentimes they are unaccessible to the peo-ple that most need them, especially those in developing countries. The most commonly cited example of inaccessible innovation is that of drugs. According to the WHO Medi-cines Strategy, equitable access to drugs de-pends on four factors: rational selection and use, affordable prices, sustainable financing, and reliable supply2. Both public and private sector organizations can contribute to strate-gies that address each of these four factors to increase accessibility of lifesaving drugs. Fi-nancing in particular is regarded by the WHO as the greatest concern--public spending on drugs in over 30 countries is less than $2 USD per year3. In order to decrease costs while encouraging research and development, pol-icymakers must develop sustainable solutions with all stakeholders.

1. WHO Medicines Strategy. (2000). Retrieved November 13, 2017, from http://apps.who.int/medicinedocs/en/d/Jwhozip16e/2. Ibid.3. Ibid. 4. Hessou, C. P., & Fargier, M. P. (1994). Central Purchasing Office for Essential Drugs: A New Experiment. Essential Drugs Monitor. Retrieved November 13, 2017, from http://apps.who.int/medicined-ocs/documents/s21256en/s21256en.pdf

2equitableaccess

CASE STUDY: BENIN

“Benin is a small West African country of almost five million inhabitants. Making drugs accessible to the whole population was one of the main objectives of its health strategy for 1989-1993. To achieve this, plans were made, in collabo-ration with development partners, to set up a national supply structure using a central purchas-ing system for the public and non-profit private sectors. Certain features of the structure break new ground for drug supply in Africa. Previously accountable to the Ministry of Health, the Cen-tral Purchasing Office is now an independent structure with financial autonomy, mandated by statute and governed by civil law. Its private style management allows for a high degree of flexi-bility, and its function as an integral part of the Health Services Development Project, financed by the World Bank, exempts it from customs du-ties and direct taxes. The new structure, operat-ing and responding to the needs of health facili-ties since October 1991, has genuinely improved Benin’s drug situation. This experience suggests a potentially suitable model for tackling some of the drug supply problems of small developing countries.” -- Action Programme on Essential Drugs and Medicines4

“Innovation is what helps us flourish. To slow down on innovation now by missing the chance to boost research is to turn our back on our greatest strength.”

Bill GatesCo-Founder, Microsoft; Co-Chairman, Bill and Melinda Gates Foundation1

Health technology is not simply limited to robotic surgery equipment and virtual real-ity exposure therapy platforms, but includes even SMS capabilities on a mobile phone. Medical devices and technologies have only recently entered the global health are-na--only in 2007 did the WHO issue its first directive on medical devices2. Every country has specific uses for medical devices, and conducting thorough needs assessments is imperative before implementing a certain technology. Today, medical devices range from paper-based “labs” on a chip that dramatically reduce the need for diagnostic testing to telemedicine kiosks that can accelerate movement of patients through the primary care system. However, health technologies do have their limitations: they are often expensive, require significant resource investments, and can sometimes only be implemented in settings with adequate infrastructure.

1. Gates, B. (2016, October 20). Science is the Great Giver. Retrieved November 13, 2017, from https://www.gatesnotes.com/Health/European-Innovation2. Sinha, S. R., & Barry, M. (2011). Health Technologies and Innovation in the Global Health Arena. New England Journal of Medicine, 365, 779-782. doi:10.1056/NEJMp11080403. The Data Revolution for Global Health. (2017). Retrieved November 13, 2017, from http://www.cghd.org/index.php/global-health-partnerships-and-solutions/technology/61-the-data-revolu-tion-for-global-health

3health

technology

CASE STUDY: UNITED ARAB EMIRATES

“In Abu Dhabi, health data for every resident is processed in real-time through a secure, online clearing house called Shafafiya (Arabic for “transparency”). Copies of the data are stored on a secure, universal da-tabase, which serves as a central ‘source of truth’ for facilities, professionals, insurers and the regulator (this hub is called KEH, “Knowledge Engine for Health”). The Abu Dhabi system is far more than simply a record; it is now processing ePrescribing, eAuthorisations, and eEligibility Checks. From late 2012 the system will be fully integrated into user-accessible disease management programs through a secure cloud computing interface. In addition, the Health Authority for Abu Dhabi is now building a unique, population-wide, secure health cloud based on KEH through a scalable NCD programme called “Weqaya” (Arabic for “prevention”). The Abu Dhabi solution is adaptable and scalable, and eHealth transaction costs are near zero. HAAD has recently made its basic architecture and source code public (through the Shafafiya website), and has been approached by a number of countries for support in implementing the Abu Dhabi model.” -- The Center for Global Health and Diplomacy3

“Too often, we ask the patient, “What is the matter with you?”, instead of asking, “What matters to you?” That’s what we need to change.”

Ram RajuSVP and Community Investment Officer, Northwell Health1

Patient-centered care (PCC), or the process of developing care models that understand and respond to patient needs, values, and preferences, is increasingly at the forefront of the conversation in the healthcare space. The six core elements of patient-centered care are: education and shared knowledge; involvement of family and friends; collabora-tion and team management; sensitivity to non-medical and spiritual dimensions of care; respect for patient needs and preferences; and free flow and accessibility of information2. For innovations to succeed, the patient’s experience must be accounted for.

1. Larsen, E. (2017, September 20). From India to Urban America: How Ram Raju’s experience serving underserved communities is redefining patient-centered care at Northwell Health. Retrieved No-vember 13, 2017, from https://www.advisory.com/research/health-care-advisory-board/blogs/at-the-helm/2017/09/ram-raju-india-to-america 2. Cronin, C. Patient-Centered care: an overview of definitions and concepts. Prepared for the NationalHealth Council; Feb. 10, 2004.3. Jha, S. (2016, July 11). Fortis Healthcare improves patient engagement with mobile app. The Economic Times. Retrieved November 13, 2017, from https://cio.economictimes.indiatimes.com/news/enterprise-services-and-applications/fortis-healthcare-improves-patient-engagement-with-mobile-app/53153727

CASE STUDY: INDIA

“New Delhi- headquartered healthcare service provider Fortis Healthcare has conceptualized an innovative idea to change the way patients engage with its hospitals across India.

The healthcare firm has come up with its ‘My Fortis’ mobile healthcare app that provides patients with a one-stop mobile information hub for navigating Fortis Healthcare’s patient care services. The customer app was rolled out across Fortis hospitals in May and is presently available on the Android andiOS platforms.

On selecting the city, hospital, and specialty, the patient gets to see the credentials of our doctors and their available time slots, when they can be consulted. They can also fix an appointment for a convenient time and proceed to either make the payment online or pay on arrival. Based on the payment mode chosen, the patient gets a confirmatory SMS giving them the time at which they are expected to reach the hospital. This is usually 10 or 20 minutes ahead of the scheduled appointment.

Customers can fix an appointment by recording their Unique Hospital ID or even as a guest for which no previous ID is need-ed. In the latter case, the patient has to come to the hospital and complete the registration formalities. The app can also be conve-niently used to set appointments for other family members.” -- The Economic Times3

4the patientexperience

“Around the world, more of the same simply will not do. Innovations are badly needed, but just as important are their wider adoption and use.”

Professor the Lord Ara DarziImperial College London1

For innovations to maximize impact, they must diffuse through existing healthcare infrastructure as quickly and safely as possible. According to the Institute of Glob-al Health Innovation at Imperial College London, four critical enablers are necessary when considering the diffusion of innovation: vision, strategy, and leadership; a specif-ic organization or initiative in charge of diffusion; funding for research, development, and diffusion; and communication channels across healthcare, other relevant indus-tries, and the public2. In order for innovations to reach the vulnerable populations that need them, all of the involved groups must conduct coordinated efforts to disseminate them.

1. From Innovation to Transformation. (2013, June). Retrieved November 13, 2017, from https://workspace.imperial.ac.uk/global-health-innovation/Public/From_Innovation_to_Transformation.pdf2. Darzi, A., Parston, G., & McQueen, J. (2015). Global Diffusion of Healthcare Innovation. Retrieved from http://www.wish-qatar.org/app/media/17443. Ibid.

CASE STUDY: ARGENTINA

“Argentina’s Ministry of Health (MOH) launched a targeted immunization program to prevent cervical cancer, a disease that kills about 1,800 Argentine women a year. The HPV vaccine became available in Argentina in 2006, but only through the private sector and at a very high cost. In February 2011, the Argentine Presi-dent announced that the HPV vaccine would be included in the national immunization schedule, making it available free of charge to the target population as of October 2011. Guided by a clear vision and strategy, which was overseen by a dedicated agency within the MOH, the National Program for the Control of Im-munopreventable Diseases (ProNaCEI), the vaccine dissemination program is fully funded by the Argentine Government, with the vaccine purchased at a reduced rate through the revolving fund of the Pan Ameri-can Health Organization. A major focus of the diffusion effort was to raise awareness of the vaccine and its benefits among the public and healthcare providers. Each province developed its own strategy for how best to reach the target population in the local context, including through health centers, schools, and commu-nity health workers visiting houses personally. More than 500,000 girls received the full three-dose vaccine series between the start of the program and February 2014. For this cohort alone, the campaign is expected to help prevent more than 9,000 cases of cervical cancer and avert 4,000 deaths. National coverage rates, which were negligible, have increased to 88 percent of 11-year-old girls receiving at least one dose of the vaccine and 52 percent receiving the recommended three doses.” - World Innovation Summit for Health3

5diffusion ofinnovation

Written byPooja Joshi & Nishita Sheth

Designed byNishita Sheth & Pooja Joshi & Llana Abella

Edited bySanjay Gadi, Nupur Jain, and Neha Acharya

(c) AMWHO National, Inc.theme@amwho.org

www.amwho.org

acknowledgements