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Moving Global Health Technologies to Impact: Examples from MNH, HIV, and Ebola USAID Mini-University Brinnon Garrett Mandel, MPH, MBA Tigistu Adamu, MD,

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Presentation on theme: "Moving Global Health Technologies to Impact: Examples from MNH, HIV, and Ebola USAID Mini-University Brinnon Garrett Mandel, MPH, MBA Tigistu Adamu, MD,"— Presentation transcript:

1 Moving Global Health Technologies to Impact: Examples from MNH, HIV, and Ebola USAID Mini-University Brinnon Garrett Mandel, MPH, MBA Tigistu Adamu, MD, MPH Deepti Tanuku, MA, MBA March 2, 2015

2 2 JHPIEGO- AFFILIATE OF JOHNS HOPKINS UNIVERSITY  Founded in 1973  Working in over 35 countries, 2000 people globally  Jhpiego Innovations:  Programmatic and service delivery innovations  Small portfolio of technologies we are developing  Collaborating and partnering to advance technologies developed by others

3  To understand the pathway to impact for global health technology innovations- emerging or existing  To learn the value of critical success factors through select case studies LEARNING OBJECTIVES

4  Brinnon Mandel, MPH, MBA  Director of Innovations Program, Jhpiego  Tigistu Adamu, MD, MPH,  Associate Medical Director, Jhpiego  Deepti Tanuku, MA, MPH  Program Director, Accelovate Program (USAID) PANEL INTRODUCTIONS

5  Devices  Drugs  Diagnostics  Vaccines  Consumer Products  mHealth or eHealth Solutions  Training Solutions WHAT ARE GLOBAL HEALTH TECHNOLOGIES?

6 Ten Years Ago Past Five Years Some Barriers to Entry Have Lowered Open Innovation platforms and funding opportunities that draw wider and more diverse participation Developments in science and technology Broader interest in global health with new actors Some Barriers to Entry Have Lowered Open Innovation platforms and funding opportunities that draw wider and more diverse participation Developments in science and technology Broader interest in global health with new actors Others Have Not Messiness of Sustainability and Scale-Up Sustained financing through the pathway Complexity of regulatory and research requirements Market dynamics: viable commercial product aligned with global health need Others Have Not Messiness of Sustainability and Scale-Up Sustained financing through the pathway Complexity of regulatory and research requirements Market dynamics: viable commercial product aligned with global health need

7 From: USAID CII “Idea to Impact: A Guide to Introduction and Scale of Global Health Innovations

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9 Development Understand the market, develop solutions, test and evaluate, plan for “launch” Development Understand the market, develop solutions, test and evaluate, plan for “launch” WHAT IS THE PATHWAY FROM AN IDEA TO IMPACT Assessment Define and characterize the problem and identify solution requirements Assessment Define and characterize the problem and identify solution requirements Introduction Program integration, supply chain, manufacturing and distribution, approvals Introduction Program integration, supply chain, manufacturing and distribution, approvals Scale Institutionalize, sustained investment, maintenance Scale Institutionalize, sustained investment, maintenance Common Challenges and Success Factors Clear definition of the right solution for that problem Understanding the market factors that influence development, adoption, and scale Having the right research and stakeholders to introduce product Identifying regulatory and registration requirements at global and national levels Finding right partners along and throughout the pathway

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11 Development CASE STUDIES Assessment Introduction Scale Why Problem Definition Matters: Developing an Improved PPE Suit Why Program Implementation and Introduction Matters: PrePex Device Why Program Implementation and Introduction Matters: PrePex Device Why Markets Matter: Scaled use of life-saving MNH Commodities Why Markets Matter: Scaled use of life-saving MNH Commodities Why Partnerships Matter: MamaU, ePartogram Why Partnerships Matter: MamaU, ePartogram

12 Brinnon Mandel WHY PROBLEM DEFINITION AND SOLUTION REQUIREMENTS DO MATTER: DEVELOPING AN IMPROVED PPE FOR EBOLA Case Study #1 Assessment Development

13 THE “PROBLEM” Challenges to current personal protective equipment (PPE) used by healthcare workers treating Ebola: 1.Most of the exposures occurred at the time of PPE removal 2.Many HCWs were not following the appropriate guidelines for using PPE 3.The high temperatures and humidity in Liberia, Guinea and Sierra Leone are such that it is difficult for any HCW to be in the PPE for more than minutes.

14 DIVERSITY OF PERSPECTIVES IN DEFINING PROBLEM AND SOLUTION REQUIREMENTS  JHU-CBID, Jhpiego, and Clinvue hosted 3 day event with JHU Schools, the Applied Physics Laboratory, the Maryland Institute College of Art, private sector partners, as well as a seamstress, midwife, architect, and robotics expert  65 participants produced extremely promising and innovative concepts (100) that were refined and December 2014 USAID Announced that JHU-CBID and Jhpiego were one of several recipients Responding to USAID Fighting Ebola Grand Challenge, October 2014

15 THE SOLUTION (IN DEVELOPMENT)

16 Tigistu Adamu WHY RESEARCH AND PROGRAM INTEGRATION MATTER: PREPEX FOR VMMC Case Study #2 Development Introduction

17 SEEK TO IDENTIFY DEVICES THAT: Make adult male circumcision procedure safer, easier and quicker than current methods; Facilitate more rapid healing and/or entail less risk of HIV transmission in the immediate post-operative period; May be used safely by health-care providers with a shorter period of training (mid-level providers); Are more cost-effective for male circumcision scale-up than standard surgical methods. Courtesy: WHO

18 Scale-up of voluntary medical male circumcision program and coverage in 14 priority countries: growth scenarios, 2008−2016. Sgaier SK, Reed JB, Thomas A, Njeuhmeli E (2014) Achieving the HIV Prevention Impact of Voluntary Medical Male Circumcision: Lessons and Challenges for Managing Programs. PLoS Med 11(5): e doi: /journal.pmed

19 BACKGROUND  Initial devices consultation, 2009  Technical Advisory Group formed Dec 2010  met July 2011 and January 2012  Formal prequalification programme established, September 2011

20 STUDY TYPES AND REQUIREMENTS  Initial safety and efficacy clinical studies involving skilled surgeons in the country of origin or manufacture and the country of intended use  Comparative clinical studies involving skilled surgeons in the country of intended use  Acceptability studies in the country of intended final use  Field studies involving trained clinical personnel in a low- resource setting, reflecting anticipated conditions of intended use Minimum for WHO global consideration: at least 2 comparative and 2 field studies in 2 different settings /countries

21 PREPEX STUDIES REVIEWED Study (type)LocationClientsType of providers Safety StudyRwanda50 healthy HIV-negative menPhysicians and nurses Randomized Comparison with Surgery Rwanda144 PrePex, 73 surgeryPhysicians and nurses Pilot StudyRwanda49 healthy HIV-negative men age 21–54 years Nurses Field StudyRwanda666 generally healthy men [5 HIV-positive] Lower cadre nurses Safety StudyZimbabwe53 HIV-negative menPhysicians and nurse assistants Randomized Comparison with Surgery Zimbabwe240 HIV-negative menAs above Field StudyZimbabwe641 HIV-negative menNurses with physician back-up support Field StudyUganda (IHK)634 healthy menSurgeons, medical officers, clinical officers and nurses Field StudyUganda (Rakai)187 HIV-negative menNot stated

22 THE WHO PQ PROGRAMME : PROCESS

23 Two Years Application: 2011 PreQual: 2013 Integration to Routine Service : 2014

24 INTEGRATING PREPEX IN ROUTINE SERVICES : RWANDA 24

25 2015

26 Deepti Tanuku WHY MARKETS REALLY DO MATTER : SCALED USE OF MNHH COMMODITIES Case Study #3 Introduction Scale

27 27 IF YOU WANT TO GO FROM INTRODUCTION TO SCALED USE, MARKETS MATTER Assessment Development Introduction Scaled Use Problem Identification and Priority Setting Applied research to fill implementation knowledge gaps Catalytic activity to facilitate adoption of product Country-level program/ policy rollout/ diffusion into sustained use Fig 1: Accelerating the Path to Introduction and Use 1 From identifying a problem to developing an appropriate solution 23 From developing a solution to planning for its introduction into the “real world” From planned product introduction to its full integration into policies and programs Source: USAID-Accelovate Program, 2014

28 28 IF YOU WANT TO GO FROM INTRODUCTION TO SCALED USE, MARKETS MATTER Assessment Development Introduction Scaled Use Problem Identification and Priority Setting Applied research to fill implementation knowledge gaps Catalytic activity to facilitate adoption of product Country-level program/ policy rollout/ diffusion into sustained use Fig 1: Accelerating the Path to Introduction and Use 1 From identifying a problem to developing an appropriate solution 23 From developing a solution to planning for its introduction into the “real world” From planned product introduction to its full integration into policies and programs Source: USAID-Accelovate Program, 2014

29 FAILURE TO ADDRESS MARKET REALITIES DERAILS INNOVATIONS 29

30 FAILURE TO ADDRESS MARKET REALITIES DERAILS INNOVATIONS

31 MARKET BARRIERS ARE COMPLICATING SCALED USE OF MgSO 4 31

32 FAILURE TO ADDRESS MARKET REALITIES DERAILS INNOVATIONS * Top 3 MgSO4 Presentations Considered Most Practical 5g in 10 mL (52%) 4g in 20 mL (28%) 10g in 25 mL (16%)

33 33 FURTHER INVESTMENT IN MH MARKETS WILL HELP SCALED USE OF MgSO 4

34 34 FURTHER INVESTMENT IN MH MARKETS WILL HELP SCALED USE OF MgSO 4

35 Brinnon Mandel WHY PARTNERSHIPS MATTER : MAMA U AND EPARTOGRAM Case Study #4 Introduction Scale Development Assessment

36  Jhpiego partnered with Laerdal Global Health to develop Mama-U, an anatomical model for PPIUD insertion training  We knew of challenges with the current model, but didn’t have the capacity to improve it  Working closely and with numerous iterations of the design  Product was ready and being evaluated within 1- year MAMA-U: A PPIUCD TRAINING SOLUTION

37 MamaU: a Postpartum ICUD Insertion Training Solution MAMA-U, ON HER WAY TO SCALE!

38 EPARTOGRAM  Jhpiego’s ePartogram is a tool that will be used by health care providers in LMIC to manage labor and guide decision-making by helping to detect complications during labor and delivery, which will reduce neonatal and maternal mortality and morbidity.

39  Developed early concepts with  Sought design and user interface with  Working with ICT4D and Platform Partner  Developing path to scale strategy with support from PARTNERS ON EPARTOGRAM

40  Product Development Partnerships (PDPs)  International AIDS Vaccine Initiative  Aeras Global TB Vaccine Foundation  Drugs for Neglected Diseases Initiative  Foundation for Innovative Diagnostics  Global Alliance for TB Drug Development  International Partnership for Microbicides  Medicines for Malaria Venture  MISSING: for maternal and newborn health  Chlorhexadine Working Group, led by PATH  as an international collaboration of organizations to advance use of 7.1% chlorhexadine digluconate for umbilical cord care  Diversity of partners addressed all critical elements in pathway: product, programs, research, advocacy, manufacturing, regulatory, etc OTHER PARTNERSHIP EXAMPLES: ALL SIZES AND SHAPES

41 Lessons SO WHAT?

42 Implementing Community Clinical Experts Regulatory Bodies Users Commercial Partners “Choosers” (payors)

43 LESSON #2: IT IS REALLY NOT LINEAR! Clinical and Technical Performance Programmatic Effectiveness Market viability Strong Need Definition to Inform Solution All along the pathway these four major areas have to be considered, re-evaluated, and show proof of concept

44  Saving Lives at Birth: A Grand Challenge for Development  Round 5 Announced a few weeks ago  Community of Innovators from past 4 years  Great resources and lessons- focus on scalability and addressing bottlenecks   Center for Accelerating Innovation and Impact- Warm off the Press SOME EXCITING RESOURCES AND OPPORTUNITIES

45 “It takes a system to save a life” - Tore Laerdal, Laerdal Global Health “It takes a system to save a life” - Tore Laerdal, Laerdal Global Health


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