The maternal and newborn health (MNH) field is currently flooded with technologies in various stages of development but intended to save women’s and newborns’ lives in resource-limited settings. From the ePartogram to the anti-shock garment, from the Odón device to chlorhexidine, dozens of new and improved products have been developed over the past decade. However, as more technologies join the queue, a number of these are quietly piling up and gathering dust on the shelves or getting stalled along the pathway to reaching health care providers and women. Why? Jhpiego hosted a webinar series Ideation to Impact** (recordings available here), which examined some of the primary challenges but also keys to success for improving the design, development and delivery pathway of a growing pipeline of MNH) technologies.
The factors contributing to the innovation pile-up are as numerous and complex as the number of technologies in the actual pipeline. We have identified five “active ingredients” that innovators should consider as they navigate the major roadblocks to development, commercialization and scale-up of lifesaving MNH technologies.
- Strong health systems are the best way to ensure that technologies reach the hands of health care workers where they can enrich and save lives. Technologies themselves are merely gadgets. As Tore Laerdal, Chairman of Laerdal Global Health, noted during Jhpiego’s webinar series last week, “It takes a system to save a life.” Many resource-limited countries are beginning to take steps to strengthen their supply chains through logistics management, procurement and product forecasting improvements. By doing so, they are becoming better equipped to reach the last mile—those remote regions with the greatest need for lifesaving technologies. The global health community should continue to galvanize efforts to strengthen health systems and delivery platforms for essential products to assure a clear path to women and newborns in even the most difficult-to-reach areas.
- Investment that spans all stages of innovation is critical to push and pull the most promising solutions to the market.Today, funding is often limited in scope and focused on the first stage of innovation: early product development and prototyping. Technologies often get stuck after this stage because financing opportunities are critically lacking for market introduction and commercialization activities. Innovators need to think earlier about securing funding to go the distance. Philanthropic dollars and donor funds are not sufficient. Innovative business models, including creative financing mechanisms that ensure sustainability, are needed to advance the most promising technology solutions.
- Partnerships that bring broad-reaching and complementary skills to support a single innovation are necessary each step of the way. Too often,innovators find themselves creating technologies in a bubble, even though successful development requires integrating a wide range of expertise and knowledge of the context in which the product will be used. Innovators need to engage a variety of partners who can provide critical information and insights about clinical and technical matters, the context for implementing public health solutions, regulatory affairs, market shaping, demand generation and more. The success of an MNH technology requires interdisciplinary coordination. If we want to accelerate product development, we need technology innovators to take a comprehensive approach—one that considers scientific, health and business perspectives and connects innovators with implementers more systematically at the outset.
- Guidance on evidence requirements is needed to propel new technologies forward. New technologies must demonstrate efficacy, safety, acceptability, public health effectiveness and market viability to gain regulatory approvals, secure manufacturing and commercial partnerships, and prepare for market introduction. Though the threshold of evidence to satisfy each of these requirements is likely to vary depending on the technology innovation, guidance is needed to prevent fragmented and redundant research efforts from limiting advancement of MNH technologies to market. Innovators need to work more closely with stakeholders and public health program specialists to better define research goals and coordinate assessments that yield a robust evidence base.
- Standardized and streamlined global and country-level approval processes would likely speed adoption of new technologies. The requirements to achieve national approvals for product registration, inclusion on essential medicines lists, guidelines and job aids vary across countries. Many innovators are ill-equipped to navigate the complexities of these processes, which can be arduous even for major pharmaceutical companies. Tailoring product applications for individual countries to distribute a lifesaving medicine or device requires substantial investments of time and money, both which could be better allocated toward program development to maximize access and availability. The global health community must find ways to coordinate these processes to shorten the runway and deliver solutions to providers and women as safely and efficiently as possible.
The active ingredients described above offer just a glimpse of the complexities of the roadblocks across the innovation pathway. Moving MHN innovations from conceptualization through commercialization to impact at scale requires sustainable funding, innovative partnerships, robust research, better regulatory processes, and strong health system programming and infrastructure—not to mention a great deal of grit and stamina. Each step requires significant time and resources, and can take years to complete. But these roadblocks are not insurmountable. Integrated innovation that addresses science and technology, business and social factors will be the key. There are many lessons to gather to evolve our thinking around the process of innovation so we can deliver on the promise of lifesaving technology solutions.
Stay tuned for more articles and commentary from the Ideation to Impact Series and about delivering on the promise of lifesaving MNH innovations.