In the U.S. it can be difficult to avoid getting an MRI, laboratory analysis or at least an X-ray in any given year. But in poor areas, medical technologies—from expensive screening machines to simple devices—are often as rare as specialists who know how to work them. So, in an effort to improve health the world over, many well-meaning organizations and governments donate new or used equipment or medicines to areas that lack them.
These contributions have surely saved lives and improved health in many places, but too often, that technology goes unused—or misused—because it is a poor match for the setting where it lands, according to a new report published online July 31 in The Lancet Commissions. Some of those donations can even "place a burden on recipients," the authors led by Peter Howitt of the Institute for Global Health Innovation noted. Some 40 percent of all health care equipment in the developing world, for example, is not currently in use, whereas in developed countries, that sum is less than 1 percent, according to the report.
The vast majority of health technology is designed for—and sold to—developed countries and thus requires "high spending on health, a reliable energy supply and large numbers of trained health care professionals," the authors noted. But when this technology is deployed without careful planning in middle and lower income nations it can cause more trouble than good.
Oxygen concentrators donated to a medical center in Gambia, for example, needed a different electrical voltage than was available there. The staff then had to try to find a way to make the machines work, to no avail, thus wasting valuable time and energy in the process. "Technology should therefore only be donated when the donor and recipient work together to identify beneficial technology" and figure out ahead of time how the technology is going to be used most effectively, the report authors noted.
The researchers concluded that an even better approach to spreading health technology would be to focus on locating and developing "frugal technologies that are specifically designed to meet the needs of low-income countries." One simple example of this is the Jaipur prosthetic foot, which is now used in 22 countries. The basic rubber prosthesis does not have a patent and can be made locally, allowing for the low, $40 price. Unlike more advanced prosthetic feet, which can cost upward of $8,000, this one does not even require shoes for walking.
Another reason innovations often fail to be adopted is that the needed procedures are not in place to make them work. Vaccines, for example, often require large enough coverage to establish herd immunity and banish an infection. In remote locations, it can be difficult to spread public health messages and keep track of individuals in need of vaccination. One immunization officer in Bangladesh created a program that obtained due date, location and contact information from pregnant women in two districts. That way, vaccinators would know roughly when new children would be born and how to contact the mother to make sure that the kids received immunizations. Under his watch, immunization rates jumped from 67 to 85 percent and 60 to 79 percent in the two provinces in just one year. (He was awarded a Gates Vaccine Innovation Award for his work.)
Finally, innovations often fail in resource-poor areas because there are not enough trained professionals to implement them. One way to break down this barrier has been telemedicine, which can be implemented via the internet or even cell phone networks, which now cover 90 percent of the world's population. The African Teledermatology Project, for example, has allowed hundreds of cases of dermatological disease in sub-Saharan Africa to be photographed and uploaded for review by experts in the U.S., Australia or Europe.
Of course the U.S. also has some catching up of its own to do. Roughly 60 percent of hospitals in India were using electronic health records to track surgeries as of a few years ago, whereas fewer than 20 percent of U.S. surgeries were being logged in EHRs. "Technology is making a substantial contribution to global health, yet it could do so much more," Lord Ara Darzi, of Imperial College London, and a co-author on the new report, said in a prepared statement. That's true, it seems, both abroad and at home.