September 26, 2013
Innovations Save Lives Of Mothers And Children
10 inexpensive, proven systems could slash death toll by 1.2 million
Ten health care innovations, if brought to scale immediately in low-resource countries, could have the potential to save the lives of some 1.2 million mothers and children in 2015.Right now the annual global death toll of mothers and children under 5 is 6.9 million.
Between 2016-2020, these innovations have the potential to save the lives of nearly 7.5 million women and children.
The ten, identified by international experts from hundreds of candidates, are ready to be deployed where they are needed most by the end of 2015, according to a new publication, Breakthrough innovations that can save women and children now, released this week by PATH, an international nonprofit organization that transforms global health through innovation.
UN Secretary General Ban Ki-moon, who wrote the introductory message to the PATH report, says "the need for innovation has never been more paramount" and considers it an integral part of his Every Woman Every Child movement and its effort to save the lives of 16 million women and children by 2015.
The report was presented at a high level UN panel at the United Nations General Assembly this week. The panel included Jens Stoltenberg, Prime Minister of Norway Bill Gates, The Bill & Melinda Gates Foundation; Sheryl Sandberg, COO, Facebook; Judith Rodin, President, Rockefeller Foundation. These innovations are proven and inexpensive. When available, they will save the lives of the poorest women and children in some of the poorest countries of the world. It is these areas that account for more than 95 percent of the global toll of maternal, newborn and young child deaths.
"Simple and effective health interventions exist to prevent millions of needless deaths of women and children in sub-Saharan Africa and South Asia," says Chris Elias, M.D., president of the Global Development Program at The Bill & Melinda Gates Foundation. "But to address this, it's critical that we scale up the delivery of innovative tools and services to communities facing the greatest need."
Tore Godal, M.D., Ph.D., special advisor to the Prime Minister of Norway and a leader behind the push for innovation puts it another way. "If we are going to make further progress on reducing death and illness of poor women, their newborns and children, we will need to ensure access to these innovations in hard to reach pockets of very poor, marginalized populations."
These ten innovations address the leading causes of maternal and child deaths. Almost 50 percent of maternal deaths are attributed to two conditions: postpartum hemorrhage, characterized by severe bleeding after childbirth, and pre-eclampsia/eclampsia, which is detected during pregnancy through elevated blood pressure and can lead to deadly seizures and organ failure. Inadequate spacing of a woman's pregnancies is another contributing factor to maternal deaths globally. Among children under 5, pneumonia, diarrhea, and malaria are among the leading causes of death—and 44 percent of child deaths occur among newborns who succumb to premature birth-related complications, neonatal infection, and respiratory disorders such as pneumonia.
This call for focus on innovation is led by PATH, The Bill & Melinda Gates Foundation, the Government of Norway, the United States Agency for International Development, the United Kingdom's Department for International Development, UNICEF, Grand Challenges Canada and the United Nations Foundation.
"Innovation is at the heart of global health progress," says Steve Davis, president and CEO of PATH. "But even the most effective tool that's developed cannot save lives unless it is available at the right time and in the right place. Now is a critical time for the global community to band together to deliver and implement today's most promising innovations to increase global health equity."
Supporting the drive for innovation are governments, multinational agencies, non-governmental organizations, the private sector and health care workers, who are coming together to avert the deaths of children and women. The ongoing efforts involve both making better use of commodities, equipment and health workers already in place and finding ways to adapt these innovations where most needed. Here are the ten innovations:
"If we can get these low-cost innovations to people who need them the most, we have the potential to save millions of lives," says Kathy Calvin, President & CEO at the United Nations Foundation.
Kit Yamoyo is a kit that packages anti-diarrheal treatments with zinc and oral rehydration solution (ORS), along with soap, in a container that doubles as a measuring and mixing cup. The kit is designed to fit over Coca Cola bottles in delivery cartons. Colalife, the nonprofit designer of the kit, chose Coca Cola as a vehicle for distribution because it reaches remote areas, especially in sub-Saharan Africa and South Asia where most of the world's 600,000 diarrhea deaths occur each year. A pilot program in Zambia underscored the great promise for co-packaged ORS and zinc to significantly curb deadly diarrhea in low-resource settings.
Anti-Shock Garment. This non-pneumatic anti-shock garment wraps around the lower part of the body to stop excessive bleeding after childbirth and keeps blood in vital organs until the mother can receive treatment at an emergency care facility. Post-delivery hemorrhage is the leading cause of maternal mortality, killing an estimated 72,000 women each year.
Researchers from the University of California San Francisco are carrying forward PATH's work with manufacturers to lower the price, increase production and expand access to the garment in low-resource settings.
Low-Cost Antiseptic. Chlorhexidine is a low-cost antiseptic that prevents infections that can enter an infant's body through newly cut umbilical cords. These infections cause some 12 percent newborn deaths each year. The Chlorhexidine Working Group, an international consortium led by PATH, is taking steps to improve access by improving supply lines for this medicine, which has the proven potential to save hundreds of thousands of newborn lives.
Rotovac is a new vaccine to prevent rotavirus related diarrhea, which is common in developing countries. The vaccine, delivered with ORS and zinc, could virtually eliminate diarrhea deaths. Bharat Biotech and the India Department of Biotechnology are still testing the vaccine. Once licensed in India, it can be produced at less than $1 a dose and made available by the end of 2015.
The Backpack-PLUS delivers essential commodities that community health workers need to do their jobs at the "last mile" of delivery. The toolkit includes medicines such as zinc, ORS, antibiotics and anti-malarial drugs. Moreover, it can be instrumental in a country's planning, training and extension of its supply chain. It was developed in a partnership between UNICEF, Save the Children, the MDG Health Alliance, frog design and others.
Helping Babies Breathe, an initiative of the American Academy of Pediatrics and others, is working to train one million birth attendants to ensure every baby's first breath, no matter where they are born. The program, which reduced early newborn mortality by as much as 47 percent in Tanzania, uses innovative teaching tools—including NeoNatalie, a newborn simulator, created by Laerdal, a Norwegian foundation. This device teaches health workers to safely deliver babies in any setting with simple supplies.
Bubble CPAP, a bubble continuous positive airway device, saves lives of babies with severe respiratory illness, including pneumonia, by forcing oxygen into babies' lungs. An undergraduate student at Rice University developed a $400 version of the bubble CPAP, using an aquarium pump and a water bottle. This can be used in place of the $6,000 CPAP that is far too expensive for low-income regions. The low-cost version was tested in Malawi, where it dramatically improved newborn survival.
Phone Oximeter, a low-cost, mobile phone-based monitoring device that measures blood oxygen levels can help front-line health workers diagnose and manage pre-eclampsia and pneumonia. The University of British Columbia and LionsGate Technologies developed the potentially lifesaving device.
Sayana Press is an inexpensive contraceptive packaged in a prefilled, single dose injection system called Uniject. The device can be used by less skilled health workers after minimal training and is effective for three months. This easily used contraceptive gives women more choice and enables healthier spacing between children. If a woman gets pregnant too soon after delivery, it puts the pregnancy and ultimately both the newborn and the mother at risk.
Magnesium sulfate is the most effective treatment to stop severe pre-eclampsia and eclampsia —pregnancy-related conditions that are the second-leading cause of maternal death. The current World Health Organization (WHO) treatment regimen is extremely complex, making it difficult for health care providers in low-resource settings to provide the medicine correctly. Jhpiego, PATH, Merck for Mothers and others working in collaboration with WHO are developing a simplified dosing regimen that is easier to learn and use in any setting.
Estimated cost: $1 billion
Innovation supporters estimate that $1 billion will be needed to implement these and other innovations.
The money is available through the more than $45 billion in financial commitments to support the United Nations Millennium Development Goals (MDGs) for reducing childhood deaths by two-thirds (MDG 4) and maternal deaths by three quarters (MDG 5) by 2015.
Innovation starts with the end user and requires sustained support
"Innovation is an ongoing process," notes Amie Batson, chief strategy officer at PATH. "It starts with understanding the needs and barriers of the affected communities and often requires years of research and development before it is ready for introduction. These 10 innovations will be ready before the end of 2015, but there are some amazing innovations in the pipeline that show great promise beyond as well."
Innovation involves a sharp focus on each problem and the barriers that surround it, followed by the important work that researchers and scientists conduct in the labs and through clinical trials to find the ways we can tackle it.
First a product must be developed with rigorous scientific testing before going through regulatory processes. Then it needs the evidence base so governments can decide whether it's important for their programs. It must be funded. But most important of all, it must have the user in mind.
"Delivering healthcare in the last mile is a tough job. Frontline health workers face broken supply chains, huge distances and limited training. Innovation has to start with the end user," says Erica Kochi, UNICEF Innovation Advisor, who in 2013 was named one of the TIME 100 most influential people in the world. "This means going beyond individual products and services and focusing on building holistic systems that are designed to help frontline health workers save lives in the last mile."
"Developing exciting technologies is only half the battle," says Ms. Batson. "You must make sure that these innovations are affordable, that they reach the people who need them, that healthcare workers are properly trained to deliver them and that they are acceptable to the families—the mothers, fathers and elders who make care decisions."
Despite the barriers, significant progress is being made and major partners are optimistic.
"The existing pipeline of innovations has potential game changers that could bring an end to preventable child and maternal deaths," says Rajiv Shah, M.D., Administrator of the U.S. Agency for International Development. "Accelerating innovation makes this ambitious target possible."
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