Guess post by David Van Sickle:

While working on this project, I’ve been keeping track of some ways in which we might better stimulate successful open source hardware projects in global health. Many of my thoughts and suggestions focus on the academic setting, but could readily be applied to the community at large.

1. Aggregate information on open hardware projects in global health to maximize participation and activity.

There are many open source software projects in (global) healthcare, but far fewer hardware undertakings. For example, one list of 50 open source projects that are changing medicine doesn’t include a single piece of hardware.

To change this, we need an active inventory of open hardware projects in global health. As it is today, there’s more effort marshaled toward developing clever kitchen robots and fun backyard kits than global health hardware. That said, we can learn from the hobby-tech industry, by applying a similar approach to open hardware projects in global health technology that Make Magazine has done for DIY projects. Highlighting successful projects could spark a similar spirit and energy, and even draw the attention and input of the creative, resourceful, and talented members of the Make community.

2. Involve students eager to learn and apply their skills to real-world health problems.

In my experience, recruiting a team of bright and motivated students to work on the spirometer was the single best step for the project. Many universities with engineering programs require their students to participate in at least one semester of an applied design course, which often solicit project ideas from the public and from across campus. Typically, the students are eager to apply their growing skill sets to the design and development of innovative, workable solutions to challenges in global health technology. Often times, the result is a compelling proof of concept that can be very influential in securing support and funding for further development. This is the path I was able to follow with Asthmapolis – which uses a device I developed to track the time and location where asthma inhalers are used.

3. Develop innovative funding strategies that anticipate sizable requirements and unique opportunities.

Open hardware projects can have significant funding requirements, particularly when the project has an educational component. As others have noted: software can be made with time, but hardware needs time and money. Our spirometry team has to purchase and test components; buy old spirometers and take them apart; print and assemble electronics; and eventually pay for tooling and prototyping. And while this can get expensive, project teams can often generate working funds from design and prototype competitions, as well as university and community business plan contests.

In addition, the Open Source Hardware Bank aims to help open source teams move to production by achieving the scale necessary to lower their unit costs. A similar effort, especially if integrated in an incubator (see below), could provide seed funding and guidance for open hardware projects targeting global health.

4. Broaden participation to create non-obvious but essential project scaffolding.

Our open spirometry project has a growing international network of supporters and active local participants, including software and electrical engineers, clinicians and health care providers. Their help and insight is invaluable and they donate extraordinary amounts of time and equipment to the project, while actively mentoring the students. Unfortunately, with so much technical expertise, it’s easy to develop a lopsided emphasis on the mechanical and electrical requirements and overlook the need to develop marketing, manufacturing, and distribution tactics.

Here’s how to remedy the deficit: Recruit business students to outline marketing and distribution strategies, develop financial projections and draw up viable for profit or non-profit business models; rally anthropology students to conduct formative research, outline use cases, or field test and evaluate ideas and prototypes; mine other departments on campus for students and faculty who want to contribute to global health technology projects. Such efforts would likely be more successful, and would even more closely resemble the real-world interdisciplinary teams common in healthcare design and engineering.

5. This includes regulatory affairs.

Building a medical device is an engineering challenge but also a formidable regulatory one, and the process for complying with the required documentation, testing, and certifications is often neither obvious nor straightforward. Some type of not-for-profit regulatory affairs consultancy or clearinghouse could guide and advise teams designing and developing open hardware tools for global health. Such an agency could help by collecting and organizing best practice documents, providing regulatory documentation templates, developing training materials or curriculums for students, or organizing and summarizing foreign regulations on importing devices. In the absence of such a group, we have searched for and sought the assistance of law students with an interest in medical devices, so far unsuccessfully.

6. Create global health technology incubators to advise and fund open hardware projects.

Another possible strategy, that could productively encompass many of these suggestions, would be to establish global health technology incubators on campus, along the lines of startup shops such as Y Combinator or TechStars. These global health greenhouses could help to organize, fund, test, market and mentor open hardware technologies emerging on campus or off. Ideally, they would offer small-scale funding, provide access to a diverse set of committed advisors, and help avoid wasteful duplication of efforts. In addition, collaboration and cross-pollination among teams would also generate many new innovations and unforeseeable efficiencies. It should be noted that there is growing recognition that low cost innovation can have valuable applications to our own economy (See recent articles in The Economist and the Wall Street Journal). As such, these global health incubators might begin to develop solutions to rising healthcare costs in the US as well.

7. Help teams build and appropriately license solutions that are defensible against infringement claims.

As an open source project we tolerate a bit of uncertainty that we may be targeted by patent trolls or may unknowingly infringe on prior art. Yet university intellectual property (IP) offices are not organized to help open source projects navigate the IP landscape, or develop and protect alternative IP models, but rather to establish and license profitable IP. Any open hardware project, especially those working to develop low cost solutions to commercially-available technologies, has seemingly endless legal research to do in order to identify a workable solution that is defensible and to ensure that the optimal licensing is chosen for the end product. Again, it seems that an organization (on campus or off) dedicated to helping open hardware teams working on global health technologies develop an appropriate IP approach, and respond to any threatened litigation, could accelerate many of these projects.

In the end, I hope that an alliance could be formed to encourage a broader partnership between university teams, nongovernmental organizations, and private medical device companies, and to make the development and distribution of open hardware in global health a focus of international advocacy and action. Hopefully these thoughts and observations will help start a discussion about how to get us taking steps in this direction.

David Van Sickle, PhD, (http://www.davidvansickle.com) is a Robert Wood Johnson Foundation Health and Society Scholar at the University of Wisconsin-Madison and a friend to Global Health Ideas. He is the founder of Reciprocal Sciences LLC (http://reciprocalsciences.com), which specializes in the development of innovative public health tools and services. He kindly contribued this post to GHI which was posted on the PopTech blog a couple weeks ago.

Students Jeremy Schaefer (left) and Andrew Dias (right) work together at the University of Wisconsin (March 2009) on a project designed by David Van Sickle to create a low-cost spirometer, a device used to measure lung function, that could be used in low income countries to diagnose and manage respiratory disease. ©UW-Madison University Communications 608/262-0067
Photo by: Bryce Richter

Time for some more desk clearing, here are recent items on mHealth, many are worth skimming.

1. Bringing mHealth back to earth, link
2. Using sports to teach about AIDS, climate change and recycling, link
3. Interview with Frontline SMS and Kiwanja.net founder, link
4. mHealth data collection pilot in India – Mobile-SCDRT, link
5. Health Education Response ( HER ), software distributes health information on major topics, link
6. Mobile phone that recognises objects will aid the blind (SeeScan), link
7. Driving mobile activism adoption, Ashoka crowd sourcing ideas, link
8. Another example of learning going South TO north -Text message finds nearest AIDS test center, link
9. MIT Groups Use Mobile Phones To Boost Health in Developing Countries, link
10. Cell phone towers can help predict the next big flood, link
11. How Uganda’s health care problems can end with a phone, link
12. MOH Zambia, UNICEF join with mobile phone companies for Child Health Week, link
13. Harnessing Both Sun and Cell Phone to Close Gaps in Local Health Care, link
14. MTN, Google and Grameen partner in Uganda, link
15. CNN covers EpiSurveyor – weapon against epidemics, link
16. Consortium Collaborates on Mobile Technology for Social Good, link
17. We’ve covered this before, but some early results are back: A mobile phone microscope to diagnose disease, link

Update, add at least one more to the list:
18. Via Pulse + Signal EXCLUSIVE: Video Footage of FrontlineSMS:Medic in Action, link

BONUS:
See #2 the Bamboo Green Concept Phone, link
Is Mayo Clinic leading the way in the US? check out their strategy, link
IBM ploughs $100 million into mobile research, link
Mobile phone chip that diagnoses disease at your bedside ‘available in five years’, link
Mobile phones ‘more dangerous than smoking’, link

(You can follow on us twitter: ghidieas or subscribe to this blog here)

*Previous Links on mHealth*
Mobile Phones for Global Health Link Drop V (May 19, 2009)
Mobile Phone & Development Link Drop (Mar 10, 2009)
Mobile Phones & Global Health III: Ultrasound, Imaging & ECG to Go! (Aug 27, 2008)
Mobile Phones and International Health Links Part II (Aug 3, 2008)
Mobile Phones and Global Health Link Drop (July 28, 2008)

Back in mid-April Grameen Health in conjunction with the 6th Annual World Health Care Congress put out a request for a poster session on extremely affordable global health solutions: “The poster Session will promote such innovations that seek to meet demands for low-cost, high-quality health care through a bottom-up understanding of unmet health needs and display a culture for continuous, incremental improvement of existing services to meet needs better… This session is intended as a platform for extremely affordable solutions in health care delivery using innovative enabling technologies and business models.” Abstracts were judged by their innovative approaches, focused objectives and outcomes, and measurable results. What is considerable affordable I don’t know – also keep in mind you can’t do apples to apples comparisons on the below (some are system level innovations and others are point of care innovations). The system level innovations include CFW Shops, Aravind and the point of care ones include low cost ventilators, infusion pumps, needle free immunizations, infant incubators, urine based tests for malaria and many more. Listed below are all 42 abstracts (click on “View Abstract” to get more info). Many of these submitted entries are from well known organizations, but there are also some that are much less well known. This list is great as a starting point, however it is a real shame the cost structure of these submissions is not included in the abstract.

1. Mobile Solutions for Nutrition Monitoring, Sean Blaschke, Columbia University View Abstract
2. A Chlorhexidine Product for Umbilical Cord Care, Mutsumi Metzle, PATH View Abstract
3. LifeSpring Hospitals, Tricia Morente, LifeSpring Hospitals View Abstract
4. “Car Part” Incubator: An Innovative Solution, Aya Caldwell, CIMIT Global Health Initiative View Abstract
5. Cost-Effective Asphyxia Intervention in Aceh, Aya Caldwell, CIMIT Global Health Initiative View Abstract
6. MIDA (Medical In-Field Diagnostic Assistant), Alexander Albertine, MIDA International View Abstract
7. Women-Owned Franchises: Diagnostics in Rural India, Ann Rogan, Drishtee View Abstract
8. Resdida: Affordable Bi-Directional Communications, Karen Vincent, Resdida View Abstract
9. Hot Diagnostic Technologies: Low cost, point of care, Paul LaBarre, PATH View Abstract
10. Ultra Rice: Expanding markets for fortified rice, Rae Galloway, PATH View Abstract
Read the rest of this entry »

The haze, smog and pollution in Beijing never seems to lift completely in the heat of summer, but here are some observations that were clear to me in my first day. I arrived in Beijing, China on Saturday and was immediately greeted by Shaq at the airport, an awesome sight in an empty airport, he is apparently feeling “Buddha Blessed“. In addition to China importing a sports culture (there are more basketball hoops in China than anywhere else in the world according to the Spaulding CEO) they are also importing a culture of food and industrialization/globalization which has massive implications for their health system. Here are some select headlines I saw in China’s national English language paper:

1. China is now Coke’s third largest single market, link [think about this in the context of obesity and chronic diseases in Asia]

2. Ensuring better air quality for the Asian Games, link

3. Vigilante public health supported by the public, link

This last story really caught my attention:
A retired teacher has become an Internet sensation after he lobbed dozens of bricks at cars that ran a red light in Lanzhou, Gansu province. “I just want to catch people’s attention and tell the drivers to think of pedestrians,” the 74-year-old man said. The elderly man, has attracted a lot of attention online, with nearly 400,000 netizens responding to a Sina.com poll. Nearly 80 percent said they supported his actions. A netizen called Biyuding20008 said too many drivers do not follow traffic rules like stopping at red lights and not talking on phones while driving. The man became a crusader for road safety after a female pedestrian was killed in his community last year. “Even when the light is green, drivers just ignore it and don’t slow down for pedestrians,” the man told the paper. In order to punish drivers and draw attention to poor driving habits, the man planned to throw bricks at all cars that ran red lights…

Traffic and road accidents are a major problem in Asia and will be one of the top 5 “disease categories” by 2020. In my first 24 hours I got a glimpse into what China is hurtling towards. In conjunction with the failed climate change talks at the G8, the stakes are huge and China is also dealing with cultural transformation, demographic and employment/labor issues, all happening at warp speed. As the United States is going through a major reset and downturn and continues to buckle under the weight of special interest groups from the financial, food/beverage (from soda to tobacco) and health industries I wonder what lessons China will import from a failed health system in the US as it undergoes it’s own health reform.  Maybe they will need more vigilante public health to make sure they move in the right direction.

Other related posts:

The Power of Image in Public Health Education: China 1930-2004
A Massive Wave of Chronic Disease in China and India
Beijing Olympic Cause Marketing & Global Health Ads
China and Global Health
China is Choking
Trends: Global Pharmaceutical Manufacturing and Investment

Thanks to Tyler from Ashoka for sending the below synopsis. Great stuff, I’ll try to post more detail when I am back, in the meantime read the full post at Changemakers – Simple Solutions Nudging Extraordinary Change. “A simple piece of cloth or a heap of compost can redirect the course of a community’s health and wellbeing…two winners are demonstrating how everyday items can drastically improve access to wholesome foods and lifesaving hygiene…”

Fact 1: Eleven cent sanitary cloth napkins help 20,000 women in India safely manage their menstruation cycles.

Fact 2: A community-driven waste management in Peru inspires 95% of their community to take control of their garbage and recycling.

Fact 3: 700 Venezuelan children have trained as oral health promoters, providing educational and preventive dentistry programs in their own schools.

What do all these facts have in common?

They are all the winning innovative entries in Ashoka’s Changemakers competition, “Designing for Better Health.” Sponsored by the Robert Wood Johnson Foundation, 335 entrants entered to provide a variety of innovative design solutions to address complex issues in healthcare – how can our choices be shaped to help us make the best ones?  After narrowing down the list to 10 finalists, the public voted for these three as their favorites.

The winners are compelling examples of “nudges” – innovative little pushes – that empower people to make better decisions regarding their own health and the health of others.

I am bouncing for Beijing this Friday, so I thought it would be a good time to do some desktop clearing. Some good links below:

GIS for a changing health landscape, link
Open Source/Science’s Greatest Need Is … Non-Scientists?, link
Interview with Isaac Holeman of FrontlineSMS:Medic, link
New Female Condom Campaign Set for Uganda, link
Sending out a (Google) SMS in Uganda, link
IDEO Ripple Effect at the Water Summit India, link
Africa Could Feed and Fuel the World, link
Web 2.0 Goes Bollywood-for GOOD, link
Brickmakers and Human Rights in Pakistan, link
Debating Which Aid Works Best is to Miss the Point, link
Who’s in charge of global health spending? link
Poverty tourism is getting a lot of attention lately, link

Bonus: Recycling Solutions
In Mali turning plastic bags into paving stones, link
Global recycling efforts, link
Is paper better than plastic? link
For the do it yourself’ers a plastic laptop bag, link

Related articles by Zemanta

• Designing useful mobile services for Africa (googleblog.blogspot.com)
• 5 US Cities and States Fighting Plastic Bags, 5 Cents at a Time (treehugger.com)
• Uganda’s Appfrica Labs (whiteafrican.com)
• Location Based Services in Uganda using SMS. (mobilewellbeing.info)

Image courtesy of kiwanja.net

Late last week I read news from three different sectors, all about “South-North” innovation transfer, a topic we’ve discussed here before, particularly in the context of mHealth. Earlier this year Fast Company reported on the concept of trickle-up innovation, citing the examples of yogurt microplants in Bangladesh (Group Danone, Grameen Bank) and Mosoko, touted as Craigslist for the next billion in Kenya (Nokia). In addition to these cases of MNCs from the global North testing out concepts in the South, Fast Company presented examples of corporations from the South, including ICICI (banking, India), Natura (cosmetics, Brazil), and Goodbaby (infant products, China).

Here are the three articles from this past week:

1. HEALTH SERVICES: To Fix Health Care, Some Study Developing World, Wall Street Journal, 2 Jul 2009. The University of Alabama-Birmingham AIDS clinic turned to Zambia for a model of increasing the number of patients who showed up for treatment. Based on early successes, they are continuing under the project name “Zambama”.
2. FINANCIAL SERVICES: DOCOMO to Launch Mobile Remittance Service, NTT DOCOMO press release, 2 Jul 2009. Later this month Japan’s DOCOMO will enable individual subscribers to use their mobile phone to remit money to other subscribers. Such a branchless banking/financial remittance service is certainly prompted by Safaricom’s M-PESA service from Kenya.
3. CLEAN TECH: Worldchanging Interview: Shawn Frayne, 2 Jul 2009. The interview is about wind technology, but touches on broader issues related to South-North innovation flow. Frayne thinks that “the constraints of the developing world can provide the necessary inspiration to make significant technological leaps that can benefit the Global South and Global North simultaneously”.

There are various other examples from the last several years suggesting a growing trend in countries from the North learning from the South. Here are examples just around financial services for the poor:

• Opportunity NYC was the first conditional cash transfer (CCT) program in the U.S., based on the Oportunidades program developed in Mexico.
• Less than one month ago international development micro-lender Kiva launched a pilot program in the U.S.
• Grameen Bank supports microcredit in places like Norway

Add to that the various management principles we’ve learned from the Aravind Eye Care System and Mumbai’s dabbawallas. Extending the argument presented by Fast Company, these examples show that South-North innovation transfer doesn’t have to be focused on corporations.

While it’s enticing to think about mining untapped innovation potential in the South for the benefit of the North, the real potential is much broader. Innovation can (and does) flow in all directions, not just South-North, but also North-South, South-South, and within countries. The challenge is to learn from different ways of approaching the same problem. Or even similar problems: see how Kaiser-Permanente visited a flight school to reduce medication errors and how the NHS worked with Formula 1 team to improve ICU procedures.

Given this potential, the big, open question is this… How do we increase global sharing of ideas and models to spur innovation?