Noted author and thought leader Laurie Garrett has highlighted in her work that, “Moreover, in all too many cases, aid is tied to short-term numerical targets.” Arguments among pundits may vary, but not many deny the bottom-line; after decades of vertical programs traditional donor models need an infusion of new ideas and approaches to help reduce health disparities world-wide. Furthermore Secretary of state Hillary Rodham Clinton in a speech at the Center for Global Development in January 2010 that there is no limit to the potential for technology to overcome obstacles to progress or potential for fruitful partnership between our government and universities, laboratories, private companies, and charitable foundations that chase and fund discovery. To best promote these ideals for scientific discovery new models for partnership and testing of ideas must be enacted.
In the summer of 2006, the authors initiated the “Innovation Sandbox” project with graduate and undergraduate business, engineering, and liberal arts students from several premier universities from the United States in partnership with the Association of Private Health Facilities of Tanzania (APHFTA). This program has fostered cultural exchange and stimulated entrepreneurship for the over 500 physician practices in the APHFTA network to improve quality of care for the estimated over two million citizens they serve. Student teams have worked on programs that focused on creating a disease surveillance system for type II diabetes and reviewing the demand for micro-credit among private health care providers to expand purchasing power for essential equipment such as new generators and essential medicines. The philosophy of the Tanzania ‘sandbox program is to support the priorities of local partners to brainstorm opportunities and remove barriers to developing new programs that had fallen through the ‘cracks’ within the traditional donor system. Often time’s local doctors and health businesses felt that the traditional approaches focused on vertical programs and high profile diseases, rather than methods to strengthen health systems between public and private stakeholders.
What is a Sandbox?
The sandbox project was in part inspired by the work of C.K. Prahalad to achieve breakthrough innovation for the health care industry in India. Professor Prahalad stressed that there while there is no generic innovation sandbox design stakeholders can come together to identify the core constraints that must be overcome to achieve a breakthrough innovation in a particular sector or region.
Global Health sandboxes provide a forum to bridge universities, industry sponsors, students, and local communities within a ‘petri-dish’ collaborative environment to examine existing financial models, technology choices, distribution, scale, workflow, and organization of global health programs at the community level. To support this effectively all technologies, existing and emerging that could be deployed would be examined within the context of cultural acceptance, feasibility, and economic sustainability. This environment also includes ‘low hanging fruit’ interventions such as use of hand sanitizer stations in each community health clinic in places where running water is limited and providing community education and ‘wellness training’ by mobile phone to expectant mothers regarding the need to follow basic hand washing and water purification standards for children under-5. Larger scale programs that include public utilities for disposal of medical waste and pooled procurement facilities can be developed in the context of assessing novel methods for municipal debt financing through the issuance of bonds or creation of new global health equity markets. These equity markets can leverage the enormous good will of the international community to contribute towards portfolio of sustainable global health projects in the public and private sectors while maintaining the scrutiny to ensure that funds are reaching those citizens most in need and organization most qualified to implement field projects.
An important gap to address in creating an innovation sandbox for developing and deploying appropriate technologies for global health programs is the shortage of human resources and technical capacity. Exchange programs and associated spin off formal short course training can help develop a critical mass of technically skilled personnel familiar with the areas of business and entrepreneurship. To sustain innovation within the sandbox, mini-grants and ‘prizes’ should be awarded on a competitive basis to help implement new ideas.
Examples of topics to be sponsored by the innovation mini-grants for global health include
1) mobile health continuing medical education (CME) modules for maternal health,
2) testing of point of care (POC) diagnostics for non communicable and infectious diseases, and
3) micro franchising of wellness and prevention kiosks at the health center and village levels.
The innovators sandbox is a method to nurture creative financing, social media, and entrepreneurship to support and sustain locally driven research, development, and implementation of global health programs. However, as with any program, without good governance and transparent reporting of how funds are used and regular assessment of the impact of deployed programs within the local community, crossing the global health innovators chasm will not be fully achieved.
* Note: This article first appeared in the Africa Health - Tanzania Edition February 2010 and was presented at a poster session in March 2010 at the NCIIA Annual Conference. Authors;
SMA Hashim M.D. Chairperson (Retired), Association of Private Health Facilities of Tanzania (APHFTA)
Samwel Ogillo M.D. National Program Manager, Association of Private Health Facilities of Tanzania (APHFTA)
Kaushik Ramaiya M.D. Clinical Director, Hindu Mandal Hospital. Vice President, International Diabetes Federation
Jeffrey Blander Sc.D Co-leader Technology Innovation Working Group, Harvard Initiative for Global Health (HIGH) and President, Bienmoyo Foundation