A tribute to CK Prahalad - The Tanzania Global Health Innovation Sandbox*

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

Olympus 2010 - Humbled, Asante, Challenge, and Magic

2010 Olympus Innovation Award
Blander Acceptance
National Collegiate Inventors and Innovators Alliance (NCIIA) Conference
Friday March 26th, 2010
http://tinyurl.com/olympus2010

Dear distinguished colleagues and friends,

I have just a few minutes to make some remarks before they kick me off the stage. So I have tried to reduce these remarks to focus on 4 key words: Humbled, Asante, Challenge, and Magic.

The first word: humbled

• I am very humbled when I look around this room and see the remarkable group of professionals who all are deserving of awards.
• I am very Humbled when I think of the amazing heroes such as the patients and doctors I work with in field such as Tanzania would put their lives and talents on the line every day.
• I am very Humbled with the extraordinary privilege of working with the brilliant and passionate students, mentors, and administrators who by their actions can turn a white board into a transformative universe of hope and statement of “yes we can” despite the obstacles in front of us.
• So when I think of all of you and those mentioned, one must accept such an award with great humility and acknowledge all my colleagues dedication, hard work, courage and brilliance that have made my own accomplishments possible.

The second word: Asante (Thank you)

Accepting this award is an acknowledgment of all the amazing people in my life who have made me look much better than I am. While the list is too long, a few specific people & organizations need mentioning.

• NCIIA. Olympus. Lemelson. Golinharris. Fogarty. Phil, Rachel, Tim, and Jennifer. Without your support. None of this would be possible.
• Dr.’s Hashim, Ogillo, Kaushik, and Mugusi my super hero colleagues in Tanzania. I will walk through fire for you.
• Patty, Linda, Steven Locke, Bryan Bergeron Danny Sands and Utkan Demirci, Jock Herron and rest of the HST939 crew from Harvard and MIT. Amy Smith who has led the way for so many.
• Philip Kong and Vikram Kumar, my fellow Directors of the Bienmoyo Foundation
• The amazing and endless list of graduate and undergraduate students from Harvard, MIT, UPENN.
• The single most important person in my life, my amazing and talented wife Michelle. I wonder each day, hour, and minute how she puts up with me.
• My family and my grandparents Rose and Fred. Thank you for encouraging me to pursue my dreams no matter what the odds.

The third word: Challenge

Despite the amazing efforts of the people in this community, the fact remains that Billions of citizens in the global community live in poverty without access to clean water, basic sanitation, or health care services. As shown during the first day group exercise, everyone in this room is capable of great accomplishments individually, but when we work together we have the power to transform the world with smarter technology and systems to break the unforgiving cycles of poverty and disease to create opportunities and empower all the worlds citizens.

The fourth word: Magic

Ms. J.K. Rowling of Harry Potter Fame said at a recent Harvard Commencement address “We do not need magic to change the world, we carry all the power we need inside ourselves already: we have the power to imagine better.”

My colleagues and friends, I look forward to working with you in this wonderful NCIIA global community to imagine better and to make our own brand of magic, through hard work, perseverance, and resolve knowing that the best is yet to come.

Thank you all so much.

Photo Credit: Michelle Levine

Happy Valentine’s Day: Healthy Hearts for all - A reflection on 5 years of public service in Tanzania

In the Fall of 2005, while attending ward rounds one day at the National Hospital in Tanzania I met a 9 year old girl named 'Rosie' being treated for rheumatic heart disease (RHD). Some of you reading this might be wondering how a 9 year old girl acquires heart disease. Rosie is one of millions of children living in low income countries with RHD, a condition that was mostly eradicated in the US in the 1950s and 1960s through the widespread availability and use of antibiotics to treat streptococcal infections (more commonly known as strep throat). RHD follows a neglected strep infection which can cause severe damage to the heart. Once severely damaged, the only course of treatment is expensive valve-replacement surgery, something Rosie is not even a candidate for, as her condition is too severe.

Inspired by Rosie, I joined my colleagues in Tanzania and at Harvard/MIT to launch a US 501 c(3) foundation called Bienmoyo. Bienmoyo in French and Swahili translates to ‘Good Heart’ or ‘Good Soul’. Through the generous support of colleagues, friends, and acquaintances almost five years later we have managed pilot programs to find ways to help prevent rheumatic heart disease in children living in Tanzania and accomplished so much more. During this time we have had over 50 volunteers join us in the field working closely with our dedicated colleagues from the public and private health sectors to support programs ranging from developing a business plan to expand cardiac care services at the national hospital, strategic planning workshops to help provide micro financing to over 600 physician practices, and most recently ways to use emerging mobile health (mHealth) technologies to improve maternal and child health by reducing infant death from obstructed airways after birth.

Ms. J.K. Rowling of Harry Potter fame stated at the 2008 Harvard Commencement Address, “We do not need magic to change the world, we carry all the power we need inside ourselves already: we have the power to imagine better.” The Bienmoyo philosophy stresses how by working together and using our collective imaginations as a global community we can create new approaches and innovations to improve quality of life for the world’s most vulnerable populations.

The journey for my colleagues and me began anew in 2005, with the knowledge that through hard work and great perseverance a difference can be made to help those most in need. We have learned so much over the past five years through our successes and the challenges we have overcome. We now more than ever sincerely believe that answers to global health delivery problems are best found locally to provide high quality and affordable health services.

So thank you Bienmoyo family and friends for all for the wonderful support over the years and we look forward to an amazing 2010 and beyond.

Jeffrey Blander
President
Bienmoyo Foundation
Sunday February 14th, 2010

Health Care Reform We Can Believe in!!!

Focusing on expanding health care access is a very noble social goal. But in a fiscally conservative leaning country plagued by debt and recession, access driven models are not winning strategic arguments for passing legislation, winning elections, or garnering public opinion.

What seems to be a missing element from today’s dialogue on health care reform, is how enabling health technologies can have an important impact on opportunities to embolden existing stakeholders, create new jobs, and stimulate the grow of small businesses to reduce costs and improve quality of care.

Integrating responsible "demand side" consumer driven empowerment models,
implementing sensible comparative effectiveness components within the USFDA
regulatory approval processes, and reducing the cost of medical education for newly minted MD’s will help to usher in a "new new" beginning of impactful health reform, quality improvement, and cost containment strategies.

There are no easy answers or shotgun solutions.

A key will be the "Chutzpah" or courage to continually adopt incentives and test new payment
models that help drive innovation at the state or local levels. These new models can help break the chain of established "practices and habits" that create inefficiencies, drive up costs, and provide disincentive for quality improvement.

These seeds of innovation can be planted in a range of activities that include prevention programs, chronic disease management, and long-term care. Having the frameworks in place at the state, community, or organizational levels to reward new ideas, reject broken parts, and adopt the most innovative practices is a critical component of sustaining and driving a bold vision for health care we can believe in during 2010 and beyond.

As our friend Machiavelli has said the hardest thing to do is create a new order of things!

........or thinking more optimistically and emphatically, Dr. Seuss would say, "Oh, the places we will go....!!!

Reaching for the ‘moon’, our time is now.

On May 25^th, 1961 John F. Kennedy laid out a vision for the USA to land an American on the moon and safely return him/her back to earth. JFK realized that landing on the moon was not as important as setting a bold vision that would capture all America’s attention to strive for greatness and not settle for mediocrity.

In his now famous “Man on the Moon Address”, JFK stated, “Now it is time to take longer strides--time for a great new American enterprise--time for this nation to take a clearly leading role in space achievement, which in many ways may hold the key to our future on Earth.”

It has been almost 50 years since JFK provided a vision for which all Americans and the world’s citizens could look towards as an example to better themselves, albeit in school, at work, or the global community.

Is there not a better time than in 2010 to set such a bold and focused vision once again for America? After almost a decade of zero economic growth and job creation, with unscrupulous business practices on Wall Street that brought our economy to the brink, it is time to raise up and strive for a better future for our children and children’s children.

Today, one in eight Americans now receives food stamps, including one in four children who live in poverty. Furthermore WHO estimates that almost 50% (1 billion) of all children on this planet (2.2 billion) live in poverty. Of these children over 1.4 million die each year from lack of access to safe drinking water and adequate sanitation.

While not as potentially captivating as putting an American on the moon, I suggest we strive to find a way to set bold goals to eliminate childhood poverty, and ensure that all infants under five years of age receive adequate nutrition by 2030.

JFK believed that innovation in science, business, medicine, and education is not the byproduct of a few privileged members of our global society, but rather an outcome of all the world's citizens efforts to reach their potential through equal opportunity and by breaking down the barriers that cause poverty, tyranny, and illiteracy. Let us once again rise up and take on these challenges through bold new goals and vision in 2010 and beyond.