Appropriate Technology For Global

Health

Nicholas Comninellis, MD, MPH Institute for International Medicine

Presentation Objectives

At the completion of this presentation, participants will be able in the context of a low-resource community to:

• Identify the controversies connected with use of technology

• Select technology most appropriate for given settings

Healthcare In Crisis • Health is chronically in crisis, especially in low resource communities. • Wise leadership is essential by those who understand the causes of ill health, recognize effective interventions, and possess the necessary diplomatic skills to implement them.

Learn To Think Like A Leader • Few are taught to think like leaders in health. Traditional medical training addresses only individual patient care. • Health leadership requires skill. But more importantly, it requires motivation and perseverance. Armed with these virtues, many health professionals can become effective leaders.

Learn To Think About Health Systems

What Is A Health System?

A Health System:

• The way we go about organizing for better health • “The combination of resources, organization, financing and management that culminate in health services for people”

Why Consider Health Systems?

Why Consider Health Systems?

A wide variety of interventions may promote health, but may also not be appropriate or efficient for a given community.

What Basic Ethical

Principles Should Apply

To Health Systems?

Ethical Principles For Health Systems

• Sanctity of human life • Alleviation of suffering • Common good and social justice (benefits everyone) • Effective use of limited resources (cost effectiveness)

Calculating Cost-Effectiveness

Average cost of the intervention Average number of Years of Life Saved

= Cost-effectiveness

Calculating Cost-Effectiveness

Cost-effectiveness of measles vaccine in West Africa:

$2 (vaccination cost per person)

5 Years of Life Saved

= $0.40 per Year of Life Saved

Calculating Cost-Effectiveness

Cost-effectiveness of hypertension control in West Africa:

$450 (HTN control cost per person)

5 Years of Life Saved

= $9 per Year of Life Saved

Effective use of limited resources

includes appropriate

application of technology –

especially in low-resource settings

2008 Health Indicators

Nation Life Expect @ Birth Under 5 Mortality

Per Capita Health Expenditure

All Low Income 59 years (M 58/F 60) 11% $16

All Africa 51 (M 50/F 52) 16% $33 Angola 41 26% $16 Liberia 44 23% $6 Niger 42 25% $6 Sierra Leone 40 27% $6 Zambia 43 18% $18 Afghanistan 42 25% $3 Iraq 56 (M 48/F 67) 5%? $14

All High Income 80 (M 77/F 82) 0.7% $2,672

What tests can be used to determine whether a technology

is appropriate or not?

Reliability

Sustainability

Acceptability

What are some inappropriate uses of technology in low-resource health systems?

Inappropriate Uses Of Technology

Diagnostic imaging that is financially unsustainable

Inappropriate Uses Of Technology

Diagnostics & therapeutics that require personnel with skills that are unavailable

Inappropriate Uses Of Technology

Prescription of medications that are unavailable or unfamiliar

Inappropriate Medications

“Our healthcare team saw a Honduran lady who was treated by an American physician for her chronic neuropathic pain with a newly marketed and expensive medication. After the physician left, the lady developed severe adverse effects, with no one to care for her, let alone anyone who was familiar with the drug…”

Nancy Crigger

Inappropriate Medications

“While well intended, the physician's care was neither sustainable nor safe. Even if the drug had been effective, she would never be able to obtain it in Honduras. Using prudence in prescribing (limiting medications to those on the WHO Essential Drug List) and making sure that a local follow-up was in place may have helped the physician avoid this precarious situation."

What are some appropriate uses of technology in low-resource health systems?

Appropriate Uses Of Technology

Rapid diagnostic tests

Appropriate Uses Of Technology

Mobile health information and medical record keeping

Appropriate Uses Of Technology

Ultrasound imaging

Appropriate Uses Of Technology

Adherence to use of WHO & National Essential Drugs

How Can We Keep

Technology Appropriate?

Keeping Technology Appropriate:

Partnerships With Local Hosts

The guidance of local partners greatly increases the likelihood that

technology will be used appropriately.

Partnership With Whom? • Local healthcare

professionals • Local healthcare

institutions • Local educational

institutions • Local government

agencies • Local civic groups

Appropriate Technology For Global

Health

Reliability

Sustainability

Acceptability

Commit Yourself To

Thinking Like A Leader

“I don't know what your destiny will be, but one thing I do

know: the only ones among you who will be really happy are

those who have sought and found

how to serve.” Albert Schweitzer

(1875 – 1965)

Institute for International Medicine

- Equipping healthcare professionals to serve the forgotten -

6400 Prospect Ave Suite 338A Kansas City MO 64132 816-444-6400 office@inmed.us www.inmed.us

Nicholas Comninellis, MD, MPH