22 August 2017

Rwanda Has Shown That Healthcare Innovation in the Developing World Means More Than Investing in Technology

Photo: Village Urugwiro/The New Times
President Kagame with officials from Zipline Inc. at the launch of medical delivery drones in Muhanga District.
opinion

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Technology is only ever an 'innovation' once it's genuinely innovating - changing lives at scale

Rwanda's near-universal health care system has been the focus of much discussion and debate in the global health community. Now reaching nearly 90% of the population, its unique funding model, which combines tax revenue, foreign aid and voluntary premiums, has been closely studied by development agencies and governments alike across the developing world.

In the recent election, the success of the health care system came back into the spotlight. And rightly so.

As one commentator has recently highlighted, Rwanda's economic output adds up to roughly 700 US$ per person, less than one eightieth of the average economic output of an American citizen. And yet today, a new born baby in Rwanda can expect to live to 64, only 15 years less than an American baby. That's a phenomenal achievement.

Much of that achievement is a result of determined commitment to innovation - from the unique funding model through to patient delivery. Not everything about Rwanda's healthcare system is replicable across the developing world, but their innovative mind set certainly should be.

Crucially, this mind-set means far more than investing in technology.

That's an important distinction to make. As mobile penetration hits 80% across the emerging markets, and success stories like Kenya's mobile payments giant M-Pesa prove the potential for scale, there's a danger that tech-start-ups, from big data to AI, are perceived as a simple fix-all for the developing world.

There's no doubt that technology has the potential to be transformative for the health sector. Mobile diagnostics and tele-doctor services, which can connect medical professionals to people in even the most remote areas, seem to promise a simple, scalable way to build a digital-first healthcare system in developing countries.

However, technology is only ever an 'innovation' once it's genuinely innovating - changing lives at scale. More often than not, innovation begins and ends with forging partnerships, whether governmental or private, which require a willingness to innovate every aspect of the delivery chain - from regulation to infrastructure to final delivery.

On the most basic level, the challenge facing global health professionals is that the traditional model of healthcare in the west is simply not replicable in the developing world. My area of experience and expertise is in the field of vision, which provides a helpful example.

In the Europe and the US, vision correction and treatment relies on highly trained ophthalmic experts, high-cost equipment and complex, technical eyewear inventories. Without the education infrastructure or technical supply chain required, that model is impossible to recreate in the developing world.

As a result, poor vision remains one of the world' largest unaddressed disabilities - an estimated 2.5 billion people suffer from uncorrected poor vision - though 80% could be solved by a simple pair of glasses.

To genuinely create a functioning eye care system in Rwanda, working closely with the Ministry of Health and leading ophthalmic experts, we've had to innovate every stage of the traditional model. From our notion of what 'expertise' was required from the medical professionals, to the final product.

Five years ago, I founded a charity called Vision for a Nation in Rwanda with the aim of doing just that.

Our single biggest innovation wasn't a smartphone application (though we're trialling those too) but a fundamental re-think of what was needed to achieve a successful diagnosis.

For vision, that meant rolling out a three-day training course, to give local health care workers the skills they need to deliver primary eye screenings, and make referrals where necessary.

Working closely with the Ministry of Health, we've trained over 2,707 general nurses to deliver vision screenings at all 502 local health centres in Rwanda. We realised that, whilst advanced expertise will always be required, we could create impact at scale by fast-tracking training to deliver local eye care.

This week, we'll reach our two millionth eye screening, and over the coming months we will begin to transition responsibility for the management and funding of the eye care services to the Ministry of Health.

We've also harnessed in simple low-cost equipment, in the form of adjustable glasses, which reduce the need for ophthalmic staff, and significantly reduce supply chain costs. Today, Rwanda's 11.8 million citizens have local access to eye care and vision treatment - the first developing country to provide all its citizens with local access to affordable eye care.

Last October, the Ministry of Health ventured into other partnerships, announcing a collaboration with drone-tech start-up Zipline, which connects aid workers to fleets of pilotless aircraft via SMS, to deliver medical supplies to rural health centres. This simple innovation cuts delivery times for vital blood supplies from several hours, or even days during bad weather, to 40 minutes.

That partnership made Rwanda the first country in the world to integrate drones into their health system. Zipline now serves 21 hospitals nationwide, providing instant access to lifesaving blood for 8 million Rwandans, every day.

Behind these partnerships, lies layers and layers of careful, quieter innovation - which will really hold the keys to success. Over the last five years, working closely with officials at all levels of the Ministry of Health in Rwanda, I've learnt first-hand the value of those quieter innovations.

I firmly believe that technology will play a vital role in overcoming the globe's most pressing health challenges. But that shouldn't detract attention or focus from the innovations required at every stage of healthcare delivery.

Over the coming year, as part of a global campaign called Clearly, we're calling on the international community to address the issue of poor vision around the world, at the Commonwealth summit in London next year. I'm certain that the key to our success will lie in the development agencies, governments and NGO's commitment to adopting and emulating that innovative mind set.

James Chen, Founder, Clearly

Rwanda

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