Gita N Mody

Nathan C Lo

Sidhartha R Sinha

Tiffany E Chao

Chao, Tiffany E

Lo, Nathan C

Mody, Gita N

Sinha, Sidhartha R

Elsevier - Publisher Connector 

Strategies for last mile implementation of global health technologies 

Directory of Open Access Journals

The Lancet Global Health

Strategies for last mile implementation of global health technologies

Comment
www.thelancet.com/lancetgh   Vol 2   September 2014 e497
Strategies for last mile implementation of global health 
technologies
Many global health technologies, including medical 
devices and interventions, have been developed 
speciﬁ cally for low-resource settings, and aim to be 
of low cost, easy to use, and culturally appropriate.1 
Although their design, development, and clinical 
validation are often well funded, these devices 
commonly fail to reach scale of production and 
implementation in their intended markets.2,3 Some 
international organisations have emphasised the 
ability of global health technologies to support 
universal health coverage.4 However, the extremely 
diﬃ  cult so-called last mile translation (eg, the ﬁ nal 
phase when the product is ﬁ nally delivered to patients 
and providers) for existing, highly eﬀ ective medical 
devices has to ﬁ rst be addressed to improve health-
care in low-resource settings.
In 2009, WHO, after realising the shortfall in 
appropriate medical devices in developing countries, 
called for innovative health technologies to address 
the technological gap between health-care settings 
in developed and developing countries.1,5 WHO’s 
programme, the compendium of innovative health 
technologies for low-resource settings,5 features some 
of the most promising global health technologies. 
Examples include a sleeping bag incubator to keep 
newborn babies warm, a breathing assistance device 
to prevent respiratory failure in premature babies, and 
phototherapy lights to prevent neonatal jaundice. 
Although WHO features these technologies, the 
responsibility for the quality, safety, and eﬃ  cacy of 
each technology is with the developer or manufacturer.5 
Similarly, in 2012, the UN Commission on Life Saving 
Commodities produced a list of 13 low-cost, highly 
eﬀ ective interventions to improve neonatal and 
maternal health, which included three medical devices: 
a female condom, neonatal resuscitation mask, 
and a syringe to administer  antibiotics.6 Both these 
programmes provide a clear picture of technologies 
that could potentially have a great eﬀ ect on health in 
developing countries, but can also easily falter in the 
scale-up and commercialisation processes.
There are several barriers to the taking of existing 
global health technologies to market that range from 
problem identiﬁ cation and problem validation, and 
extend to last mile implementation. Many technologies 
are developed by individuals with strong engineering 
and technical skill, but who are often inexperienced in 
the commercialisation and business of medical devices 
that is necessary to scale-up the device. Often, inventors 
from developed countries ﬁ nd a dilemma in whether to 
seek regulatory approval in their own country, which 
might lead to changes in design, increases in cost of 
goods sold, and increased time to implementation. This 
dilemma is exacerbated by the decrease in investments 
in medical technologies during the past few years and 
the challenge of attracting investors to low-margin 
medical devices for global health. To secure international 
intellectual property protection, patent applications 
need to be ﬁ led in each country the device will be used 
in. Some international agreements exist, but these 
provide restricted protection, and operations outside 
of these regulations would be likely to prevent licensing 
agreements from being reached with medical device 
corporations and could restrict reverse innovation. Once 
these initial challenges are overcome, issues will remain 
for last mile implementation such as management 
of the supply chain—which includes components of 
procurement, distribution, and maintenance—and 
obstacles from aﬀ ordability, biomedical engineering 
requirements for device maintenance, and adoption. 
These barriers show that last mile implementation 
of global health technologies is complex, and could 
be strengthened by policies to encourage inventors 
and investors to pursue innovation in global health 
technology.
To address these barriers, we propose a new funding 
structure that provides incentives for collaboration 
between developers of global health technologies and 
private-sector medical device companies that might have 
the infrastructure, expertise, and networks necessary 
to launch these devices into the environments they are 
designed for. The programme we envision would select 
promising health technologies, and link inventors and 
devices to a contracted multinational medical device 
company. This programme, subsidised by government or 
the non-proﬁ t sector, could then produce and distribute 
This online publication has 
been corrected. The corrected 
version ﬁ rst appeared at 
thelancet.com/langh on 
October 30, 2014
Comment
e498 www.thelancet.com/lancetgh   Vol 2   September 2014
a set number of devices in designated low-resource 
regions. Our programme would provide a proof of 
principle for the translation process, knowledge about 
many unexplored components of the commercialisation 
process, and could be the necessary catalyst to upscale the 
entire specialty of global health technology. Additionally, 
we advocate increases to funds allocated directly to 
the commercialisation process for qualiﬁ ed global 
health technologies that have shown clinical eﬃ  cacy, 
international recognition towards universally accepted 
regulatory standards in low-resource countries, and 
reciprocal intellectual property protection.
Improvements in access to health technologies will 
facilitate universal health coverage in both urban and 
rural settings in developing countries. Although we 
support continued investment into the development 
of new technologies for global health, there should be 
speciﬁ c policies to support translation of needed and 
validated devices that have already been developed into 
common health practice, to break the stagnation in last 
mile translation of these global health technologies.
*Tiﬀ any E Chao, Nathan C Lo, Gita N Mody, 
Sidhartha R Sinha
Departments of Biodesign Programme (TEC, SRS) and Division of 
Gastroenterology and Hepatology (SRS), Stanford University 
School of Medicine (NCL), Stanford, CA, USA; and Center for 
Surgery and Public Health, Brigham and Women’s Hospital, 
Boston, MA, USA (GNM)
tiﬀ any.chao@stanford.edu
TEC and NCL are joint ﬁ rst authors. We declare no competing interests.
Copyright © Chao et al. Open Access article distributed under the terms of CC BY.
 1 Howitt P, Darzi A, Yang G-Z, et al. Technologies for global health. Lancet 
2012; 380: 507–35.
 2 Simiyu K, Daar AS, Singer PA. Global health. Stagnant health technologies 
in Africa. Science 2010; 330: 1483–84.
 3 Sinha SR, Barry M. Health technologies and innovation in the global health 
arena. N Engl J Med 2011; 365: 779–82.
 4 WHO. Health intervention and technology assessment in support of universal 
health coverage, SEA/RC66/R4. Geneva: World Health Organization, 2014.
 5 WHO. Call for innovative health technologies: medical devices, assistive 
devices, and eHealth solutions for low-resource settings 2013, 2013. 
http://www.who.int/medical_devices/compendium_2013/en/ (accessed 
April 1, 2014).
 6 United Nations. UN Commission on Life-Saving Commodities, 2012. 
http://www.everywomaneverychild.org/resources/un-commission-on-life-
saving-commodities (accessed April 1, 2014).


Strategies for last mile implementation of global health technologies

Abstract

Similar works

Full text

Available Versions

Elsevier - Publisher Connector

Directory of Open Access Journals

Elsevier - Publisher Connector