he state of global health today is a study in contrasts. Developed countries are enjoying a wave of progress in science and medicine that includes such marvels as personalized genomic therapies, minimally invasive robotic surgery and targeted nanoparticles that improve drug delivery. But in the developing world there remains an acute crisis of disease and poverty, with enormous gaps in maternal and infant care in particular. Nearly 9 million children aged five and younger die each year, almost three-quarters of them from pneumonia, diarrhea, malnutrition and other preventable causes. And about 1,000 women, predominantly in poor rural communities, die each day from complications of pregnancy and childbirth, according to the World Health Organization.
The root causes of this disparity range from government corruption to a lack of access to clean water and electricity to shortages of medical equipment and clinical acumen. Addressing these myriad issues is daunting. Yet, since 2004, Developing Health Globally™, an initiative from GE , has been combining product resources, engineering expertise and best practices drawn from business to create holistic “enterprise solutions” for health facilities in Africa, Latin America and Southeast Asia. Through DHG, GE has invested $40 million in more than 100 hospitals and clinics in 13 countries, an effort that has affected an estimated 4.8 million lives. In the process, the company has also created a model for addressing the global health crisis — a model that’s driven by innovations in planning, implementation and sustainability.
What’s the problem?
The first step in this approach is to define the needs of each country by working with local ministries of health. Tim Reynolds, project and infrastructure consultant for Assist International, has been involved in DHG projects in Cambodia, Ghana, Honduras, Rwanda and other countries. “GE starts with a countrywide assessment of selected hospitals to determine the specific equipment needs of each facility,” says Reynolds. “How many beds and patients does it have? How many surgeries and deliveries per month? What are the mortality rates? Is it lacking power, water or communications infrastructure?”
A typical blueprint for improving a hospital may include an ultrasound machine, patient monitors, incubators, an X-ray machine and sterilization equipment, though gauging the needs of a particular facility requires a holistic understanding of local conditions. Air-conditioning units, for instance, a creature comfort in the developed world, might be essential to keep an operating theater sterile in a hot, buggy, humid area. And water filtration systems that can be cleaned manually are better than those depending on expensive, difficultto- replace cartridges.
Once needs have been established, GE teams create appropriate equipment configurations for local conditions. Assist International, a nonprofit humanitarian organization with more than two decades’ experience in the developing world, gets the gear to the hospital, where GE engineers and specialists install the units and train local clinicians. This approach has already had an impact, with infant mortality rates dropping by about 40% at six DHG sites in Honduras. And in Rwanda, referral rates from outlying hospitals to the hospital in the capital, Kigali, plunged from 42% to 3% with no spike in mortality, a sign that the
remote facilities were better able to handle cases on their own.
Learning to think outside the box
But this delivery model isn’t only about getting up-to-date equipment and basic user training where it’s needed. The model also aims to bring medical expertise to the countries in which DHG operates. Rachel Moresky, an emergency physician and assistant professor at Columbia University’s Mailman School of Public Health, directs the Systems Improvement at District Hospitals and Regional Training of Emergency Care (sidHART e) program, another GE partner. Since 2009, sidHART e has run training programs for doctors and nurses at district hospitals in Ghana. Using GE - donated equipment, sidHART e trainers teach medical providers to use available resources to treat cases locally rather than automatically referring patients to more advanced facilities in distant cities.
For example, a district hospital may have an ultrasound machine but not a CT scanner. Though ultrasound is used most often in obstetrics cases, physicians working with sidHART e trainers learn how to employ that technology to see whether traffic accident victims, for example, have internal lacerations. Those who don’t have complicated injuries can be treated on-site, slashing costs and making care more immediate. Integrating equipment donations with training in clinical acumen, Moresky says, is essential to creating sustainable improvements in care.
Of course, modern medical machines are of little use if they’re not working, and according to the WHO, at least half of the laboratory and medical equipment in “resource poor” settings is partially or completely out of service at any given time. To improve on that dismal statistic, GE has partnered with Engineering World Health, a nongovernmental organization based in the United States, to implement a threeyear training program for biomedical equipment technicians in Cambodia, Ghana, Honduras and Rwanda. Local technicians are taught more than 100 basic technical assistance and troubleshooting skills, and they learn to make creative use of whatever resources are available. They might take the bulb from a car’s headlight to fix a lamp in an operating theater, for example, or use the plastic liner from the inside of a bottle cap and a standard sewing fastener to fashion a reusable pad for an electrocardiograph machine. Equipment that’s beyond repair can be cannibalized to keep other machines in working order.
To gauge the impact of such training, the Duke University Department of Biomedical Engineering, which partners with EWH, recently conducted a study of the biomedical engineering technician training program in Rwanda that involved 10 hospitals and more than 500 pieces of essential medical equipment. On average, the study found, equipment in hospitals in which technicians had been trained by EWH was 54% more likely to be in service than was equipment in hospitals whose technicians had not yet undergone the training. In addition, trained technicians were 27% more likely to be able to resolve problems with the medical equipment. The ultimate goal is to make the training sustainable, allowing the current generation of technicians to teach the next.
“As in most developing countries, our needs are many in terms of human resources, equipment and financial resources,” says Agnès Binagwaho, minister of health in Rwanda. “The GE program has been very helpful in terms of medical equipment maintenance and the training of local personnel to keep that equipment operating. The program has provided crucial support for our district hospital initiative, which focuses on delivering high-quality medical care as close as possible to where people live. Ensuring that medical equipment in these district hospitals is available and operating is very important to the success of this program, and the GE training initiative has dramatically improved equipment availability.”
Such gains could be duplicated in many other regions with similar needs, suggests Robert Malkin, a co-founder of EWH, who believes the broader engineering mind-set that drives the seemingly simple techniques put to use in the Developing Health Globally program could have a far-reaching impact. “Situations in the developing world look very different to an engineer than to the average person,” Malkin says. “We’ve seen the kinds of solutions engineering has brought to the developed world, and now that kind of innovative thinking is being translated into advances for the developing world as well.”
(A model of health promotion in Rwanda and other developing countries, the GE-sponsored program is attacking the scourge of preventable maternal and infant deaths.)