NEJM: Collaboration necessary to meet global medical device needs

Despite growing interest in global health, addressing the inaccessibility of health technologies will require a multidisciplinary needs assessment, as well as innovation, in countries where device delays and capacity restraints linger, according to the authors of a New England Journal of Medicine (NEJM) perspective published Sept. 1.

Low-cost infant warmers, point-of-use water purifiers, portable low-cost ventilators and self-contained parasite-detection systems are among the noted World Health Organization examples of technologies needed in low-resource settings, according to Sidhartha R. Sanha, MD, and Michele Barry, MD, both of Stanford University School of Medicine in Stanford, Calif.

“Creating appropriate products for low-resource settings requires not only a rethinking of what is considered a health technology, but also cross-disciplinary innovation and in-depth understanding of the particular needs of each country,” wrote Sanha and Barry.

The authors noted that approximately 70 percent of complex medical devices in developing countries sit inoperable, and most basic devices aren’t available in adequate numbers. While cost is a factor, more critical to the gap is capacity. “The capacity issues include a lack of spare parts and needed consumables and a lack of the basic infrastructure, distribution channels, trained personnel, and engineered systems required for utilizing devices appropriately.”

Notably, new technologies create many opportunities.

“Just as many developing countries used cell phones to leapfrog conventional copper-wire landlines, innovation in medical technology offers similar promise. For example, ‘lab-on-a-chip’ technology, which may cost less than a penny per paper-based chip, can replace many expensive diagnostic tests and be used at rural locations.”

The authors suggested needs-findings research, financial and design modeling, and business implementation plans to develop solutions for developing countries. Both “leapfrog” technologies and incremental innovations may be useful, and collaboration should extend into public-private partnerships, they opined.

“Finally, we must not embrace technology for its own sake. Billions of dollars are spent on technologies that don’t clearly improve outcomes. Medical devices must meet real needs and provide clear value,” the authors wrote. “Assessing medical needs, building capacity and promoting cost-effective innovation will help in realizing technology’s potential for achieving better health in low-resource settings.”

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