November 13, 2020

Integrating Technology in Global Health

Lessons for Healthcare Organizations and Funders from the Pfizer Foundation’s Global Health Innovation Grants Program

By: Victoria Hsiung and Katherine Flowers

Long-haul truck drivers in sub-Saharan Africa frequently move across borders and must remain in their trucks for extended periods of time to prevent theft of cargo or even the truck’s tires. The number of days on the road every month and the different delivery locations make it difficult for drivers to visit the same clinic, or any clinic, when they need healthcare. Sex workers also frequently travel, may be uncertain about their personal safety, and can face stigma from others. For mobile workers such as these, time, distance, and continuity of care are all barriers to healthcare. Innovations in Healthcare’s innovator, North Star Alliance, reaches these vulnerable populations through their network of Blue Box clinics: 22 converted shipping containers located throughout six countries that offer primary healthcare and HIV prevention and care services.

North Star Alliance is one of 20 healthcare innovators to receive a grant from Pfizer Foundation’s Global Health Innovation Grants (GHIG) program in 2018-2019. The GHIG program aims to improve access to high-quality, low-cost healthcare in low- and middle-income countries by providing one-year $100,000 grants to support solutions to critical healthcare challenges. About half of the 2018-2019 cohort of GHIG grantees took on the challenge of developing or integrating technology as the central component of their proposed projects. North Star Alliance was one of these. The transient nature of its patients has made it difficult to ensure continuity of care and up-to-date medical records. Thus, North Star Alliance used its GHIG3 grant to work towards building a proprietary electronic medical records (EMR) system that its staff can access regardless of which clinic a patient chooses.

We interviewed four grantees about their technology-based projects, their development processes, the challenges they faced, and the lessons they learned along the way. We share their experiences as well as recommendations for other global health innovators interested in adopting technologies to improve their services and to funders interested in impact investing. Read the full paper here.

1)    Possible Health, a non-profit healthcare organization based in Nepal, built data visualization dashboards for services offered through its network. These dashboards aggregate patient data and allow providers and health officials to view and analyze overall trends in health and healthcare. Being able to access this information helps providers make more informed choices for their patients and will also aid policymakers in establishing the best health policies for their populations. Possible Health’s dashboards are available online.

1)    North Star Alliance , a non-profit organization operating across sub-Saharan Africa, built an EMR system for its Blue Box clinics so that each patient’s information can be easily accessible from clinic to clinic. North Star Alliance had specific needs for this EMR system. It needed to work across international borders and convert currency automatically, as their clinics are located in multiple countries; it needed to have a user-friendly interface, as many of the company’s healthcare workers have low computer literacy; and it needed to function in areas with low internet connectivity. North Star Alliance will soon pilot its EMR system and train its healthcare workers to use it.

2)    Salauno, a for-profit company providing eyecare services in Mexico,developed a mobile app linking primary care physicians and ophthalmologists to each other for ease of referral and patient tracking to ensure continuity of care. The app helps eyecare specialists overcome the fragmented system of care in the country and address each patient’s needs. Primary care physicians can use Salauno’s app to make referrals to Salauno’s network of ophthalmologic clinics and keep track of their patient’s progress.

3)    PurpleSource, a for-profit healthcare company in Nigeria, had been using a paper-based medical records system which hindered its ability to efficiently gather data to provide improved care for patients. As part of their GHIG3 project, the company purchased, modified, and implemented an EMR system. This EMR system incorporates task shifting to improve efficiency and decrease wait times.

Recommendations for Health-focused Social Enterprises

  • To account for unreliable or insufficient internet infrastructure, build in offline functionality and do not rely on cloud-based systems to store and retrieve data.
  • Provide close-touch and continuous in-person training to demonstrate value, familiarize users with the technology, and encourage uptake and appropriate use.
  • Co-design with users throughout development to ensure the technology is needed, useful, and practical in design. Meet with users to gather input and map out their daily processes to inform the design of new system. Investing in human-centered design early reduces later challenges in uptake and facilitates the development of practical and helpful features.
  • Build a team that has the skills you need. When taking on a project in an area that is new to your organization, assess the skills that your team possesses and add new team members where gaps exist. Plan from the outset to make new hires dedicated to technical support, training users, and overseeing implementation on the ground rather than addressing these gaps after they become problematic.
  • Set clear expectations, both internally and externally. The scope of work, expected milestones, and working relationships should be established with the internal team, external partners, and funders. Clear communication of expectations will help mitigate difficulties and misaligned priorities that may emerge as the project progresses.
  • Prioritize interoperability, with future expansion in mind. As innovations scale, their technologies must scale with them. Technologies should be built with interoperability across languages, currencies, and systems so that they are prepared to seamlessly scale to new settings. Investing in interoperability in the initial stages of development creates greater potential for expanded, scaled, and sustainable implementation in the future. 
  • Fail fast. Do not delay implementation and roll-out until you have a perfect product. It is better to continuously learn, modify, and iterate based on real feedback than to keep working on an ideal version that may take much longer to perfect.

Recommendations for Funders of Health-focused Social Enterprises

  • Establish flexible reporting requirements. Technology-based solutions may not generate clear, measurable results during the development and implementation stages, which often require extensive back-end processes that do not directly translate into health outputs. Impact on indicators such as number of patients served or expansion to new locations might not be observed until well after full roll-out of a technology. Acknowledging this difference and implementing flexible reporting requirements empowers innovators to pursue new and disruptive solutions to problems.
  • Expect innovators to require varying levels of support. The challenges that innovators face when implementing new technologies vary greatly, so expect innovators to experience a variety of situations. Some organizations may require a higher level of technical support or connections to technical experts than others. Similarly, a single organization may experience varying degrees of difficulty and may require greater involvement and support at some points but relatively low-touch support at other times.
  • Be realistic about what can be achieved in low-resource settings. There are many external factors and constraints inherent to working in low-resource settings and with bottom-of-the-pyramid populations, and innovators often encounter unexpected delays and challenges. Additionally, the magnitude of the back-end work needed to develop technologies is not always clear to those outside of the process, potentially giving the false impression that little has been achieved. Funders should recognize these constraints and understand innovators’ work in the context of their low-resource settings.