Ikonne, E. Uche

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Journal of the Nigerian Optometric Association Vice Chancellor, Abia State University Uturu andRegistrar, Nigerian College of OptometristsProfessor E. Uche Ikonne 2EditorialAppropriate Technologies For Health And Disease: An Innovative Approach To Drive Sustainable Health Care Delivery.Preamble What is Appropriate Health TechnologyIkonne E.U.The term “Appropriate Technology” emerged in the context of the 1973 energy crisis and the 1970s environmental movement. E. F Schumacher in his book “Small is beau�ful- a study of Economics as if people ma�ered” introduced the term intermediate technology.  The term was used in two primary contexts i. Technology that most effec�vely meets    people’s needs in developing or limited    resource se�ngs ii. Technology that is environmentally    friendly and socially acceptable in the    developed world.Intermediate technology simply explains the technology that is between ar�sanal and industrial but simple, effec�ve, cheap environmentally sound and sustainable with emphasis on local community ownership, management and maintenance.Primary health care according to the Alma Ata Declara�on is “essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination”Health technologies, especially those dealing with medical devices, are crucial for the services offered in preven�on, diagnosis, and treatment of illness, disease, and disability.Appropriate health technologies (AHT) are methods, procedures, techniques and equipment that are scien�fically valid, adapted to local needs, acceptable to users and recipients, maintainable with local resources. Appropriate technologies are either new or adapta�ons of exis�ng technologies of demonstrable effec�veness that can sustainably meet the varied condi�ons of developing countries and the unique needs of underserved communi�es. The criteria for adop�ng an Appropriate Health Technology include the following: Effec�ve - both in theory and prac�cal use Safe - and not easy to use incorrectly Affordable - in ini�al and recurrent costs Acceptable - to all who are affected by it Sustainable - can be maintained, repaired or               re-supplied.It is therefore evident that health technologies developed for developed world countries may be inappropriate for use in resource- poor environments lacking physical infrastructure, trained health care providers or the means to buy and maintain complicated technologies. For instance appropriate technologies such as Oral Rehydra�on Solu�on (ORS) and Contracep�ves faced significant obstacles to wide spread adop�on.Appropriate technologies are solu�ons that crea�vely integrate the need for new and culturally relevant technologies in addi�on to substan�al behaviour change in order to reduce inequity between rich and poor countries. Therefore appropriate technology must be part of a health care Ecosystem JNOA.2018;20(2): 2 - 7   Journal of the Nigerian Optometric Association Figure 1: Appropriate Technology: Part of a Health Care EcosystemFigure 2: Disconnected value chain within the low and middle-income country health innovation system3An ‘appropriate’ innovative technology is one that leads to improved access to essential health products and services; and/or leads to improved human health by providing affordable and accessible products for the population in need.Health innova�on systems therefore acknowledges the interrela�onship between educa�on, research and development (R & D), manufacture, domes�c and export markets, intellectual property and regulatory policies.For high income countries health innova�ve systems involve actors from mul�ple sectors and disciplines. Training and basic research are funded by the public sector through universi�es and government research ins�tu�ons. Transla�onal research and product development such as prototype produc�ons or small-scale produc�on are conducted by pharmaceu�cal or other companies or, depending on the na�onal system, government ins�tu�ons. In low-income countries, however, the health innova�on system is o�en rudimentary and fragmented. The public sector provides most, if not all, funding and infrastructure for research. Although research is conducted in academic ins�tu�ons, o�en there is li�le applicability to local health problems, due to the lack of capacity to conduct transla�onal research and limited manufacturing capacity.In developing countries, researchers and innovators face tremendous challenges, including the lack of technical training, research tools, financial resources, and up-to-date scien�fic informa�on.  These barriers impede ac�vists from developing and implemen�ng innova�ve and low cost technologies.Innova�ve technologies for health care are very high in developed countries as medical technology is the second technology field with highest number of patents applica�ons (Table 1).Ikonne E.U. JNOA.2018;20(2): 2 - 7             TECHNOLOGIES Infrastructure  - Facili�es, equipment  - Communica�on systems      - Policies  - Regula�on      People             - Knowledge             - Skills             - Culture/Beliefs - FinancingTable 1: Top eight technology fields by total of patent applications worldwide (WHO, 2010) Journal of the Nigerian Optometric Association 4• The insec�cide treated bed nets is an   innova�ve combina�on of two different   products namely bed nets and insec�cides• This led to the development of long   las�ng impregnated nets (LLIN) that   provided two effec�ve forms of vector   control for 2-3 year life of the Net• However an addi�onal cost resulted to   challenges in dissemina�on• Compulsory purchases• Public Sector subsidies• Free distribu�on to the most vulnerable   popula�on• Public-private partnerships• Reduc�on in overall mortality by ± 20%   in Africa• For every 1,000 Children 1-59 months   protected, 6 lives are saved per year• 38% reduc�on in malaria parasitemia• 28% reduc�on in risk of low birth weight• 25 % reduc�on in adverse outcomes of    pregnancy:Dracunculiasis, also called Guinea-worm disease (GWD), is an infec�on by the Guinea worm. A person becomes infected when they drink water that contains water fleas infected with guinea worm larvae. In humans, the only known cause is Dracunculus medinensis Control of Guinea wormIkonne E.U. JNOA.2018;20(2): 2 - 7   Figure 3: Top 10 countries with the highest number of patent applications in the field of medical technology (WHO, 2010)Figure 4: Oral rehydration therapy: Another successful appropriate innovative health technologyExamples of Appropriate Technologies and Innovations that improved healthInsecticide treated Bednets (ITNs)Innovative Distribution ModelsImpacts of AHT (ITNs)• Water-related diseases: a leading cause of   death for ‹ age 5 children• 20% of <age 5s die of diarrheal illness   a�ributed to water sanita�on related diseases• About 1.8 million child deaths annually• An o�en forgo�en cause of diarrhoea is non    hygienic food prepara�onOral Rehydration Therapy• Introduced at the Interna�onal Centre for   diarrheal disease Research in Dhaka, Bangladesh• One of the most important contribu�ons to   saving life• Simple solu�on to prevent dehydra�on and   electrolyte imbalance related to diarrhea• Given by mouth to prevent and/or correct   dehydra�on caused by diarrhoea• Can be ini�ated at home and might prevent   need for medical services• Composi�on - Commercial packs are available - Can be made at homeORT Innovative Health TechnologyDRACUNCULIASIS (Guinea worm) EradicationJournal of the Nigerian Optometric Association 5LAPARASCOPYAdvantages of Laparoscopic SurgeryDisadvantages of Laparoscopic Surgery(i) provision of a safe water supply, (ii) filtra�on of one's drinking water to remove   cyclops, (iii) searching for pa�ents with ac�ve cases and   proper management of cases, (iv) ensuring that pa�ents avoid contact with   ponds, and (v) Killing or removing cyclops in ponds.• Visual magnifica�on — use of a large viewing   screen improves visibility• Stabiliza�on — Electromechanical damping   of vibra�ons, due to machinery or shaky   human hands• Simulators — use of specialized virtual   reality training tools to improve physicians'   proficiency in surgery • Reduced number of incisions Robo�c surgery   has been touted as a solu�on to underde-  veloped na�ons, whereby a single central   hospital can operate several remote   machines at distant loca�ons. The poten�al   for robo�c surgery has had strong military   interest as well, with the inten�on of   providing mobile medical care while keeping   trained doctors safe from ba�le.Given the transmission cycle of the parasite and the absence of an effec�ve vaccine, the interven�ons include: Laparoscopy is a surgery that uses a thin, lighted tube put through a cut (incision) in the belly to look at the abdominal organs or the female pelvic organs. Laparoscopy is used to find problems such as cysts, adhesions, fibroids, and infec�on. Tissue samples can be taken for biopsy through the tube (laparoscope).In recent years, electronic tools have been developed to aid surgeons. Some of the features include: Since the overall trauma to the skin and muscles is reduced, less post-opera�ve pain and disability, a shorter hospital stay, and a quicker recovery period are major advantages that laparoscopic surgery offers when compared to tradi�onal opera�ons.Another advantage is a reduced infec�on rate. This is because delicate �ssues are not exposed to the air of the opera�ng room over long periods of �me. Video magnifica�on also offers surgeons be�er exposure of the diseased organ and its surrounding vessels and nerves. As a result, delicate manoeuvers can be performed to protect these structures during the surgery.The disadvantages of laparoscopy include the expensive equipment involved in performing it. Not all hospital opera�ng rooms can afford to offer it because of cost containment.The other major issue is the need for surgeons to take special training in performing the many opera�ons that are available by this means.The need for addi�onal training is because laparoscopicIkonne E.U. JNOA.2018;20(2): 2 - 7   Figure 5: Using a matchstick to wind up and remove a guinea worm from the leg of a humanFigure 6: Filter Cloth and Pipe Filters: Appropriate technologies in eradication of Guinea worm in resource poor countriesJournal of the Nigerian Optometric Association 6Need for Appropriate BalanceChallenges facing use of Appropriate Health Technologies in Resource Poor Environments.i. Diffusing a new innova�on requires understanding   of the local environment. ii. Innova�ve technology can be disrup�ve   and trigger a backlash from incumbents.i. Lack of Infrastructure: Most of the appropriatei. Health educa�on is cri�cal and an integral   part to control the AIDS pandemic as is the   use of condomsii. Self-adjusting eye glasses which allows   patients to be in full control of their   prescriptions and to change the power of   their glasses at will is not and can never be   a substitute for comprehensive examination   and treatment by medical and health care   professionals.  techniques require constant supply of electricity   and use in controlled atmosphere and no   subject to power fluctua�ons and use of   standby generators. When government or   health care professionals acquire sophis�cated   modern machines for improved health care   delivery, the challenges of infrastructural   deficit most �mes results to lack of op�mal   u�lisa�on of the machines. A situa�on   where pa�ents must wait for designated   �me for switching on power genera�ng   plants is worrisome. ii. High Cost: The cost of most modern equipment   appropriate for efficient health care delivery   developed and fabricated in the advanced   countries are usually high. The cost of   acquiring one machine can be higher than   what can be used to develop a small co�age   hospital in a developing country. iii. Lack of Man Power: Some�mes when these   machines are acquired, there is counterpart   development of the appropriate manpower   that can manage and maintain them. It is   not just man power that can u�lize them.iv. Poor maintenance and lack of replacement   parts: There is generally lack of technicians   that maintain medical equipment in the   developing countries in addi�on to the   problem of lack of replaceable parts. In   some instances when a machine breaks   down, it will be abandoned for months un�l   the spare parts arrive from abroad and   replaced.surgeons leave the familiar territory of a three-dimensional opera�ng field to working on a two-dimensional flat video display. The shi� is a cri�cal one, and requires some degree of prac�ce moving around long laparoscopic instruments while handling delicate �ssues. Despite these temporary disadvantages, with the proper training, surgeons are able to adapt to this means of opera�ng.Finally, laparoscopy cannot always be performed on everyone. Some pa�ents with many prior opera�ons may have so much scar �ssue within the body that a safe opera�on cannot be done. In �me, what disadvantages exist may be overcome with con�nued laparoscopic research and development.Whereas improving the health of the poorest people in the developing world depends on the development of many varie�es of health innova�ons such as new drugs, vaccines, devices and diagnos�c tools as well as new techniques in process engineering and manufacturing, management approaches, so�ware and policies in health systems and services; It is important to note that There is therefore need for appropriate balance for instance- Countries around the world are making significant investment to redesign and strengthen sustainable and efficient health system through using innova�ve technologies; with the goal of achieving be�er care, be�er health and lower cost of health care delivery. For us in Africa to be part of this innova�ve development, we must develop the capacity to invent, deploy and scale-up solu�ons that are sensi�ve and appropriate for both the Urban and rural communi�es.- African entrepreneurs and Research scien�sts must be well posi�oned to address the needs of theConclusionIkonne E.U. JNOA.2018;20(2): 2 - 7   Journal of the Nigerian Optometric Association 7communi�es while considering the exis�ng structural, cultural and poli�cal menaces – something that is o�en overlooked in aid-driven health programme.We must encourage local innovators- for instance the use of rapid diagnos�c blood tests to defeat malaria is largely limited in rural African communi�es due to its risky and complex diagnos�c procedure. Ins�lling a culture of innova�on must be a promising way to propel Africa in its efforts to eradicate diseases and improve health.Selected ReferencesBarry, M (2007) The tail of the Guinea worm. Global eradica�on without a drug or a vaccine. New England Journal of Medicine 256(25): 2561-2563.Barry M and Hughes J. (2008) Talking dirty. The poli�cs of clean water and sanita�on. NEJM 359(8); 784-787.Carter Founda�on and WHO (2016) Eradica�on of Guinea worm disease. Case statement www.cartercentre.org/guineaworm Goodyear, L; Tsu, V; Kaisel, D and Lalwani, T (2009) Appropriate Health Technologies, Concepts, Criteria and Uses. PATH Sea�le Washington.WHO (2007) Everybody’s business: strengthening health systems to improve health outcomes. Geneva, World Health Organiza�on, 2007.WHO (2008) The World Health Report 2008. Primary health care: now more than ever. Geneva, World Health Organiza�on, 2008.WHO (2010) Landscape Analysis of Barriers to developing or adap�ng Technologies for Global Health Purposes. Global Ini�a�ves on Health Technologies. www.who.int/medical_devices/en/ Roscigno, G; Yuthavong, Y and Manderson, L (2012) Innova�on and New Technologies to tackle Infec�ous Diseases of Poverty In Global Report for Research on Infec�ous Diseases of Poverty. www.who.int/en�ty/tdr/ Ikonne E.U. JNOA.2018;20(2): 2 - 7   

Editorial: Appropriate technologies for health and disease: an innovative approach to drive sustainable health care delivery

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Editorial: Appropriate technologies for health and disease: an innovative approach to drive sustainable health care delivery

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