Rice 360° Institute for Global Health | 100&Change: The Finalists Live Presentation

Rice 360° Institute for Global Health | 100&Change: The Finalists Live Presentation

October 9, 2019 0 By Ewald Bahringer


Continue your tweeting. Don’t
let me interrupt. So what comes to mind when you
think of technological innovation in healthcare? If you’re here and you’re
fortunate enough to live in the United States or developed land
you might think it’s a piece of wearable technology. One that
counts our steps and tracks our heart rate. Maybe it’s a state of the art
imaging machine that can detect illness earlier. But what about those not quite
as fortunate? What about those living in
Africa? A place where more than 1 million newborns die each year
from what are mostly preventable causes. Preventable but only if
lifesaving technologies, many of which we take for granted are
available. Our next finalist team has been
working together to develop lifesaving technologies for 10
years. Welcome Rice 360 Institute for
Global Health. Dr. Queen Dube from the
University of Malawi. Rebecca Richards-Kortum from
Rice University. Robert Miros from the 3rd stone.
And Joy Lawn from the London School of Hygiene and Tropical
medicine. Every year in africa. One point one million newborn
babies die. Most of these deaths could be easily prevented but
the existing lifesaving tools are too expensive or break down
in the harsh conditions of African hospitals. That’s why we created NEST, a
special portfolio of newborn essential solutions and
technologies designed specifically to work in Africa.
To be effective, affordable, and sustainable. With one hundred and change we
will complete the innovations to NEST. We will distribute NEST to
hospitals across Africa. And we will continually measure its
impact to improve results. One point 1 million newborns
died in Africa this year. That’s why your investment is
needed in NEST. Now. My name is Queen Dube. I’m a pediatrician working in
Malawi. I look after newborn babies. Every day I go to work I see
babies die. And the most painful pain for a doctor is actually
knowing that you could have saved those lives if you had the
tools to enable you to do so. Sadly what I see in my hospital
is happening all across Africa. So every year in Africa we lose
one point one million newborns. The heartbreak is ladies and
gentlemen, 75 percent of those deaths are actually preventable.
Preventable with technologies that have been available in the
United States for over 50 years. What actually kills these
newborns hasn’t changed over the past hundred years. It’s either they are born too
early, they have an infection in birth, or they suffer from some
base related trauma. My hospital back home every year
around about June, July we receive container full of
donated equipment. It’s a joyful moment. But the equipment fails. It
doesn’t save the babies. Because the devices are not tailor made
to withstand the harsh African environments. The heat. The
dust. The frequent power outages. And we don’t have this spare
parts to fix the technologies. So the equipment ends up in the
equipment graveyard. This is a picture of the
equipment graveyard in my hospital. At the end of my long shift I go
there and I pay my respects. These technologies donated
technologies, they don’t save the babies they are supposed to
save. What Africa needs is a solution. Africa needs technologies that
are effective. Technologies that are affordable. Technologies
that are sustainable. Equipment that doesn’t just
break down. And that’s what this team, the NEST team is all
about. NEST standing for, newborn
essential solutions and technology. As a team we’ve developed a
package of 17 technologies. A package that addresses all of
the three major killers of a newborn. Addresses nutrition
infection, birth related trauma, jaundice! The baby you see in the middle
is on breathing support. On top of us supporting their
breathing, they need to be kept warm. They need to feed. If they
have an infection at birth an African doctor should be able to
treat them. And that’s what NEST is all about. What really excites me as an
African is the cost of NEST delivered at scale. Ladies and gentlemen NEST as a
package actually cost one dollar for eight cents per birth
delivered at scale. But for us as a team to bring it to scale
we need a hundred million dollar investment. NEST is ready to scale for the
things that we’re going to do as a team, innovate complete the
package we’ll distribute the package first in my home country
Malawi home is best. Tanzania, Nigeria, the rest of Africa. What about Asia? Brazil? Nepal? We want NEST to be there. We want to measure the impact of
NEST. How many lives are we going to save as a team. We are more than ready to make
sure that NEST is available ensuring that these African
newborns have a secure environment. Closing the survival gap for
Africa. We’re in the SDG era. Sustainable Development Goals. Everybody says, leaving no one
behind. And as a team we are ready. Not
to leave that African newborn behind. So many African newborns fifty
years from today, they share the stage. To tell you how we plan to build
the NEST is a member of the team. Great engineer. A powerful
innovator who would take us through how we plan to build the
NEST Rebecca. Thank you Queen. When the one hundred and change
initiative came out we knew it was our chance together with
Queen and her colleagues to make sure that clinicians all across
Africa have the tools they need to help babies survive. A hundred million dollars means
the chance to solve this problem. It is within our grasp. Our solution has three parts. It begins with innovation. We will deliver the 17
lifesaving innovations of the NEST package. We will partner with nursing
schools, with medical schools, and with engineering schools to
train the clinicians, the technicians, and the engineers
who are dedicated to improving newborn survival. Hospitals in Africa, they need a
simple way to order NEST. We will solve this problem by
establishing a non-profit distributor. By the end of one hundred and
change this distributor will be financially sustainable creating
a permanent solution. Now we know that we can’t scale
on NEST without broad demand. We need demand from governments,
from W. H.O. from UNICEF, and also from the private sector.
Generating that demand requires rigorous evidence and we will
measure the number of lives that are saved by NEST and the cost
to save those lives. And we will use that data to
generate multi country demand. How do we know that we can do
this because when we have already done it for the first
NEST technology. I will never forget my first
visit to Queen’s Hospital in 2005. I saw many tiny babies like
Chigonjetso who you see here fighting to breathe. And Queen
she explained to me that half of babies who are born too soon
they struggle to breathe because their lungs are immature. And we
know that without treatment most of these babies will die. She also took me to the
equipment graveyard at her hospital and she explained why
the breathing machines that are used in America do not work in
her hospital. Now I am an engineering
professor. My job is to teach students how
to build new innovations to solve real problems. So we got to work. We got to
work with Queen and her team and we designed a breathing machine
that was effective, that was affordable and that was
sustainable. And we have our first prototype
here today and I got to tell you when we showed that it delivered
the same therapeutic flow and pressure as breathing machines
used in the United States we were so excited. And we got on a plane and we
proudly took it to queen. And we showed it to her and she
told us everything that was wrong with it. She said it’s in
a shoe box. It’s too flimsy. It’s going to break you have
tubes coming out the front and tubes coming out the back. They
need to be polarized. The buttons need pictorial icons. But she said, can we keep it? Can we use it to start treating
our babies? And so we worked and we made all
of the improvements that they requested and we were so
fortunate to receive one of the very first saving lives at birth
grants from USAID. And we worked with Queen to
measure the impact of this technology and we showed that
for premature babies treated with this breathing device
survival went up by 40 percent. And that mirrors the improvement
that was seen when this technology was introduced in the
United States in the late 1960s. Together we named the device
Pumani. It’s a Mallawian word that means
breathe restfully. And with this data in hand we partnered with
Malawi’s Ministry of Health. We got more support from USAID. We got support from Elma
philanthropies and we were able to roll Pumani out to every
hospital in the country. And we trained nurses and doctors to
use it. Today Pumani is saving lives in
every hospital in the country. It costs less than one tenth the
price of systems used in the United States. Pumani worked. It worked even in
district hospitals. Instead of ending up in the graveyard it is
up in the newborn unit. We thought we were done but in
rolling Pumani out we saw babies who were cold. We saw babies who
had jaundice. And we met many clinicians who are frustrated
they didn’t have the tools they needed to treat these
conditions. And so we went back to work. Since 2006 our team has worked
with hundreds of engineering students in the United States,
in Malawi, and in Nigeria. And with support from the
Lemelson Foundation and from the Fogarty’s center, together these
students have created many other newborn technologies, That
became the NEST. In assembling the NEST we
included not just our own innovations but we looked at the
medical marketplace to find the very best other innovations. And
together put together a package that allowed Queen to have what
she needs to treat those babies. Now this afternoon you will have
a chance to comment see all 17 of those technologies and our
breakout room. I am so excited for you to see
it. It’s awesome. Today I only have a chance to
tell you about three. Left untreated newborn jaundice
can cause brain damage and death. District hospitals often don’t
have the tools they need to diagnose jaundice. This one hundred and fifty
dollar reader can diagnose jaundice at the bedside in less
than two minutes with the one drop of blood for less than five
cents per test. If a baby has jaundice there
there’s another tool in the NEST that they can immediately use to
treat jaundice. These phototherapy lights they
are made by a non-profit called D-rev. They are commercially available
but they are not distributed in Africa. And so if Queen wants to order
these lights it costs more in shipping to get them to her
hospital than the lights actually cost. Our non-profit distributor will
solve this problem. Finally hypothermia is such a
challenge for newborn babies in Africa. They’re tiny. They lose heat so quickly and we
know for every 1 degree that their temperature drops the
chance they will die goes up by 28 per cent. You can’t tell by
looking if a baby is too cold. This 50 dollar reuseable
temperature monitor clips right onto the crib side and with just
a glance a nurse can know if a baby is too cold and immediately
intervene to warm them up. So are we ready to roll out
these 17 technologies? The good news is that eight of
them are already commercially available. They are just not yet
distributed in Africa. And our non-profit distributor will
solve this challenge. We have four more that are in
successful multicenter clinical trials and with investment from
100 in change we will take them to products in 24 to 27 months. We will take working prototypes
of the last five to products within 36 months. The power of value engineering
is that these are simple technologies and the development
timelines are predictable. Remember each one of these
technologies, it began with a team of students. Students who
learned to use the process of innovation to solve a real
problem. Students who had a chance to see
their work have an impact on someone else’s life. And I
think, I think these students they are our most important
product. Because they are what will keep the cycle of
innovation going after 100 and change ends. With just six million dollars we
took Pumani from a shoe box prototype to a medical product
that is not used just in 37 hospitals in malawi, it is
saving newborn lives in 30 countries. With 100 million dollars we are
ready. We are ready to deliver the 17 lifesaving innovations of
nest. We are ready to solve the
challenge of distributing medical products in Africa. And
we are ready to measure the impact of this technology and
use that data to drive uptake across Africa. We are ready to save hundreds of
thousands of newborn lives every year. Now to crack the distribution
nut we know we need the right partner. And we are so fortunate
to be joined by Robert Miros. Robert shares our commitment to
distribution at non-profit rates so that these technologies are
available to the poorest families. When I look back on the journey
of Pumani I know we could not have taken it from this shoe box
to a medical product without Robert’s partnership. When I joined the NEST team in
2012, my company was already developing medical devices for
global health applications. We specialize in product design
and have a unique focus on bringing global health products
to market. Our challenge with Pumani was to
take that shoebox prototype and transform it into a real medical
product. As you can see here we took the
concept through several stages in development and advanced it
to a final successful design. In two years we secured the CE
mark and found the right manufacturing partner to produce
the devices according to global quality standards. In 2015 we began selling the
lowest cost, easiest to use all in one breathing machine on the
planet. Today there are 1000 Pumani
machines in use and in production. And Pumani is saving
newborn lives in 30 countries across the globe. We prove that we can go from a
prototype to large scale manufacture for a single medical
device and offer it at an affordable price. So how do we replicate this
success for the rest of the products in NEST? The challenge lies in the
distribution system. For purposes of illustration let
me walk you through the costs involved in making, selling, and
distributing one Pumani unit. A unit costs us five hundred fifty
dollars to manufacture. We sell it into the market for
eight hundred dollars leaving us 250 dollars for sales,
engineering, and regulatory costs. Then Pumani leaves a
warehouse and gets on an airplane. When it lands in
country goes through customs and regulatory clearances. Then we deliver it to a hospital
where we conduct training for healthcare providers and to
assure long term functionality we provide service and technical
support. And though it varies somewhat
from country to country these costs add up to about 750
dollars. So what started out as an
affordable product with a reasonable margin in the
beginning ends up with a 500 dollar downstream loss. Every time one leaves our
warehouse. This is where NEST comes in
though and why it’s so exciting. Though the costs of goods for
the devices and the sales price is necessarily higher because
we’re offering an entire bundle of products, the relative
distribution costs are much less. This is possible because the
distribution activities involved for a breathing machine or a
tool to diagnose jaundice, or a temperature monitor are all
essentially the same. So when we deliver all the
devices together, and we conduct the training all together, and
we send one service technician to service the whole suite all
in one visit, we effectively spread the costs over the whole
suite. Becoming sustainable in the
process. So how are we going to achieve
this? We start by distributing NEST in
Malawi, Tanzania, and Nigeria. We set up distribution hubs in
Tanzania and Nigeria and from those places, we then reach the
other four African countries that have pledged with UNICEF to
cut newborn mortality in half in the next five years. These seven countries account
for 46 percent of the births in Africa and we believe will bring
us to a tipping point for the continent. This is the power of the 100 and
Change grant. It breaks through the initial
barriers to effective distribution and allows for
economies of scale for NEST which will allow the overall
enterprise to become self-sustaining indefinitely.
And perhaps even more important we’ll be establishing a
functional market so that those future medical innovators that
were educating will have a place to take their Products year
after year and close that health equity gap in the next decade. Without 100 and Change we’ll be
stuck in a business as usual situation. One product at a time
with incremental health benefits and high costs of distribution.
With 100 and Change we’ll build a sustainable distribution
system that will allow us to deliver world class medical
products. And after 100 and Change is spent we’ll have a
financially sustainable way for NEST to achieve its long term
goal of saving 500000 newborn lives per year. Now as any of you in business
know just because you build it doesn’t mean they will come. We will have to generate the
demand and the global will to recommend and procure this
lifesaving technology. To drive this demand with
measured results I can think of no one better than Dr. Joy Lawn.
If there is one leader that can be credited with shifting the
international policy landscape for the care of newborns, It is
Joy. Thank you Robert. But what he didn’t mention is
that my true qualification for standing here today is that I
should have been a new born death and I should have been a
newborn death in the bush in northern Uganda. So this is where my family lived
for 20 years. My mother had an obstructed
labour. She was taken into this
maternity home. No running water. No
electricity. She was there overnight and in
the morning they were able to find somebody who in fact had
never done this Cesarian section hadn’t been properly trained,
but he was able to do this as Cesarian section and that saved
my life, and my mother’s life. So I’m standing here today in
front of you because people stood up for me and stood up for
my mother. Because people spoke up for us. And I’ve spent the last three
decades working on newborn survival and speaking up for
mothers and their babies around the world and particularly in
Africa as a medical doctor and as a professor of epidemiology.
And I’ve personally seen hundreds of newborn deaths that
should not have happened. And today I’m wearing my
Ghanaian funeral dress. And I’m wearing it because this year
2017, one point one million newborn babies died in Africa,
most of them preventable. Invisible and yet something that
we can and must change. And my job and the job of our
NEST team is to stand up, to speak up for newborns and to see
that that changes. Well that sounds great but maybe
we’re just a bunch of dreamers. Is this actually possible or is
we are just hoping and wishing? It is possible. It’s possible because of three
important shifts that mean we can do this now as never before. And the first is that we have
powerful evidence about this situation. 99 percent of the
world’s newborn deaths actually happen in low and middle income
countries but it’s only the last 15 years that we’ve started to
pay attention to those 99 percent of deaths. We now know where and why those
deaths happened. We know that one tenth of the
whole global burden of disease of all conditions all over the
planet is actually related to newborn deaths. We have trials showing what we
can do at community level with community health workers or with
traditional birth attendants. And we know that we can do
something, but without providing high quality care in hospitals
we can’t truly reduce deaths and also disability. Well I used to think that if we
publish lots of papers particularly if we managed to
publish them in Lancet and then we got WHO, (no never the
fastest moving organization but we managed to get lots of global
guidelines.) That the world would change. While about 200 papers and a
whole heap of WHO guidelines later I can tell you, necessary
but not sufficient. Why? Because newborns weren’t on
people’s political to do list. We didn’t have political will. So what’s the second shift, is
that we do now have political will in the new Sustainable
Development Goals just launched a couple of years ago for the
first time in history. We have a target that specifies
newborn survival. Every country on this planet has
to meet that target by the year 2030. So the newborn has finally
emerged on the global agenda. But it’s really painful to me as
an African and to Queen my sister African we swapped
outfits today. She’s she’s here and glamorous
Gucci maybe. I hope not. It’s painful to me that Africa
has the highest risk of newborn death and still the slowest
progress. But the good news here again is the African leaders
recognize this and they want to change that situation. Seven African countries have
pledged to reduce hospital deaths by 50 percent in five
years. Ambitious target. And here today we are honored to
have the honorable minister of health from Nigeria who’s
carrying the greatest weight of what needs to be done for
Africa, for Africa’s newborns. So that’s all very well but what
happens if we can’t reach mothers and their newborns? We
could have the evidence we can have the political will but we
can’t reach them? So the third shift is that the
place of birth has changed. Now 80 percent of the world’s
births happen in hospitals. Big recent shift into hospital
wards that in many cases look like this. Poor quality of care,
not the right equipment, things in the hospital graveyard,
equipment graveyard Queen talked about earlier. An opportunity
but also a place maybe where if we fail women and families will
start going back to home instead of coming into hospital. So we need to change this. We have the opportunity but
something different needs to be done. So never before have we had this
opportunity. We have powerful evidence. We have political
will. And we now have a place where we can reach women and
their babies. And this gives us a platform. Where NEST now is able to come
in and have that impact. But we can only drive that
change if we’re able to measure the impact and show cost
effectiveness. And that’s an important
component of what the investment of 100 and Change would bring.
And with 100 and Change we will be able to measure that. So in Malawi we will learn from
what has already worked or not worked for scaling up the
package of. NEXT. We’ll move to Tanzania. where shockingly the neonatal
mortality rate is double that within Malawi. And we will
measure cost and impact. And then we will work with the
rest of these four countries and the United Nations network
across Africa to pull the lever of larger scale change. Our team as you have heard has
experts in innovation, in distribution, and in
measurement. Our team is composed of unlike minds, it’s
slightly unlike accents as well, but with a common passion to
change this situation. We are ready to do this and we will do
it together. Ladies and gentlemen this year
one point one million newborns died in Africa. We could have
prevented most of those deaths only if effective, affordable
and sustainable technologies were available in my continent
Africa. We are ready to solve this
problem by delivering the 17 effective affordable and
sustainable tools of NEST It gives clinicians the tools
they need to treat and prevent the three leading causes of
newborn death and it can be delivered at scale purchased one
dollar and 48 cents per birth. With 100 and Change we will
innovate to complete the NEST. We will solve the tough problem
of distributing medical devices in Africa. And we will measure
the number of newborn lives saved by the NEST. Without NEST if we continue
business as usual it’s going to be a hundred and ten years
before a baby born in Africa has the same chance as a baby born
here in Chicago. But with NEST we have the
opportunity to close that survival gap dramatically
reducing deaths for newborns in Africa. Here is Chigonjetso. You met him
earlier when he was one day old struggling to breathe. Now he’s thriving, surviving and
kind of almost smiling. Chigonjetso means the Conqueror.
With NEST hundreds of thousands of newborns would also have the
opportunity to conquer, to survive and thrive. You and I are part of the first
generation that can make this change. There are not many things left
in global health which are a big problem but also with big
impact. We’ve got the tools. Our team is ready. African leaders are saying the
time is now. With your support we will deliver. Thank you. Thanks to their presentation and
their commitment to improving the survival rate for newborns
in Africa. Going to take our final brief
break before hearing from our fourth finalist.