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Appropriate Technology For Global
Health
Nicholas Comninellis, MD, MPH Institute for International Medicine
Presentation Objectives
At the completion of this presentation, participants will be able in the context of a low-resource community to:
• Identify the controversies connected with use of technology
• Select technology most appropriate for given settings
Healthcare In Crisis • Health is chronically in crisis, especially in low resource communities. • Wise leadership is essential by those who understand the causes of ill health, recognize effective interventions, and possess the necessary diplomatic skills to implement them.
Learn To Think Like A Leader • Few are taught to think like leaders in health. Traditional medical training addresses only individual patient care. • Health leadership requires skill. But more importantly, it requires motivation and perseverance. Armed with these virtues, many health professionals can become effective leaders.
Learn To Think About Health Systems
What Is A Health System?
A Health System:
• The way we go about organizing for better health • “The combination of resources, organization, financing and management that culminate in health services for people”
Why Consider Health Systems?
Why Consider Health Systems?
A wide variety of interventions may promote health, but may also not be appropriate or efficient for a given community.
What Basic Ethical
Principles Should Apply
To Health Systems?
Ethical Principles For Health Systems
• Sanctity of human life • Alleviation of suffering • Common good and social justice (benefits everyone) • Effective use of limited resources (cost effectiveness)
Calculating Cost-Effectiveness
Average cost of the intervention Average number of Years of Life Saved
= Cost-effectiveness
Calculating Cost-Effectiveness
Cost-effectiveness of measles vaccine in West Africa:
$2 (vaccination cost per person)
5 Years of Life Saved
= $0.40 per Year of Life Saved
Calculating Cost-Effectiveness
Cost-effectiveness of hypertension control in West Africa:
$450 (HTN control cost per person)
5 Years of Life Saved
= $9 per Year of Life Saved
Effective use of limited resources
includes appropriate
application of technology –
especially in low-resource settings
2008 Health Indicators
Nation Life Expect @ Birth Under 5 Mortality
Per Capita Health Expenditure
All Low Income 59 years (M 58/F 60) 11% $16
All Africa 51 (M 50/F 52) 16% $33 Angola 41 26% $16 Liberia 44 23% $6 Niger 42 25% $6 Sierra Leone 40 27% $6 Zambia 43 18% $18 Afghanistan 42 25% $3 Iraq 56 (M 48/F 67) 5%? $14
All High Income 80 (M 77/F 82) 0.7% $2,672
What tests can be used to determine whether a technology
is appropriate or not?
Reliability
Sustainability
Acceptability
What are some inappropriate uses of technology in low-resource health systems?
Inappropriate Uses Of Technology
Diagnostic imaging that is financially unsustainable
Inappropriate Uses Of Technology
Diagnostics & therapeutics that require personnel with skills that are unavailable
Inappropriate Uses Of Technology
Prescription of medications that are unavailable or unfamiliar
Inappropriate Medications
“Our healthcare team saw a Honduran lady who was treated by an American physician for her chronic neuropathic pain with a newly marketed and expensive medication. After the physician left, the lady developed severe adverse effects, with no one to care for her, let alone anyone who was familiar with the drug…”
Nancy Crigger
Inappropriate Medications
“While well intended, the physician's care was neither sustainable nor safe. Even if the drug had been effective, she would never be able to obtain it in Honduras. Using prudence in prescribing (limiting medications to those on the WHO Essential Drug List) and making sure that a local follow-up was in place may have helped the physician avoid this precarious situation."
What are some appropriate uses of technology in low-resource health systems?
Appropriate Uses Of Technology
Rapid diagnostic tests
Appropriate Uses Of Technology
Mobile health information and medical record keeping
Appropriate Uses Of Technology
Ultrasound imaging
Appropriate Uses Of Technology
Adherence to use of WHO & National Essential Drugs
How Can We Keep
Technology Appropriate?
Keeping Technology Appropriate:
Partnerships With Local Hosts
The guidance of local partners greatly increases the likelihood that
technology will be used appropriately.
Partnership With Whom? • Local healthcare
professionals • Local healthcare
institutions • Local educational
institutions • Local government
agencies • Local civic groups
Appropriate Technology For Global
Health
Reliability
Sustainability
Acceptability
Commit Yourself To
Thinking Like A Leader
“I don't know what your destiny will be, but one thing I do
know: the only ones among you who will be really happy are
those who have sought and found
how to serve.” Albert Schweitzer
(1875 – 1965)
Institute for International Medicine
- Equipping healthcare professionals to serve the forgotten -
6400 Prospect Ave Suite 338A Kansas City MO 64132 816-444-6400 [email protected] www.inmed.us
Nicholas Comninellis, MD, MPH