In the last several decades, the global health ecosystem has improved the health of millions of people by advancing technologies that are specifically designed to be affordable, accessible, and appropriate in resource-constrained settings. Many other innovative technologies, however, never achieve wide-scale impact. Why is this? While innovators have learned to incorporate needs-driven design into their technologies, they often lack the capabilities or means to overcome the many hurdles associated with the delivery and introduction of technologies in developing-world markets.
At PATH—an international nonprofit health organization that develops and delivers high-impact, low-cost health solutions—we have found that well-designed technologies are just the beginning of effective solutions. For more than 30 years, we have used a multidisciplinary product-development process based on user needs, health-system requirements, and political and cultural environments. And we have learned that good design and development are only half of the battle. Success requires a concentrated focus on availability and demand. Our experience has shown that a range of complex factors—including individual opinions and behavior, engagement of the private sector, and public policy—can affect the uptake of a product. The technologies that achieve widespread adoption require effective delivery and generation of demand. When the global health community invests in downstream activities—such as strengthening or establishing distribution networks, navigating regulatory pathways, training healthcare providers, informing users, and advocating for policy change—success can be achieved.
Historically, there has been a significant gap between technology innovation and effective implementation. Stakeholders and decision makers do not always have the resources, knowledge, or skill sets needed to overcome challenges inherent in low-resource settings. There are few viable business models that keep the products affordable and yet allow private-sector manufacturers and distributors to generate a profit. Moreover, global health markets are not predictable. Country governments face shifting priorities, limited budgets, and competing demands. Donors, who have been the primary source of funding for global health solutions, have traditionally supported the technology innovators and implementers but have not focused on the “translators”—the missing middle piece in a global health solution.
The environment is changing for the better, however. Participants in the global health ecosystem—donors, governments, nongovernment organizations, and corporations—have begun to focus on the challenges of translating innovations into viable solutions. Here is what PATH has learned about facilitating both availability of and demand for new health technologies.
Availability requires functioning distribution networks and regulatory approvals, both of which can be challenging. PATH has worked with private-sector partners, governments, and nongovernmental distribution channels to reach underserved populations. We have also worked with partners to help build evidence of safety, effectiveness, and acceptability of new technologies developed either by us or by our innovation partners. That evidence has been essential to obtaining approval from regulatory bodies.
This work is complex but has enabled the transfer of technology to manufacturing and distribution partners. For instance, PATH’s Woman’s Condom—a new female condom designed and developed by PATH and licensed to a Chinese manufacturer—was the result of a decade of work in design iteration, evidence gathering, and regulatory approvals.
Generating demand, especially for disruptive technologies for which the value proposition is not well understood, is another difficult piece of the global health puzzle. PATH and its partners have used a variety of promotional and communication strategies focused on health providers, community leaders, and end users to generate demand. Behavior-change communication—one of these approaches—has been useful in increasing the awareness of a new technology, transforming public perceptions and attitudes, and encouraging people to adopt healthier behaviors.
We can also boost demand for new technologies by carrying out economic analyses aimed at decision makers that demonstrate the benefits of these new technologies. Innovative marketing approaches, such as microlending, have been useful in some settings as well. For example, PATH’s Safe Water Project conducted a promotional campaign to help consumers realize that adopting a water-purification system in their home could help save their child’s life. In one country, PATH worked with microfinance partners to support purchase of the treatment systems. Both approaches led to a significant increase in product adoption.
For many technologies, generation of demand requires gaining the support of international stakeholders and country governments. To influence global and national policies and standards, it is necessary to demonstrate value by articulating the cost benefit, safety, and acceptability of a new technology. For example, it took PATH, the World Health Organization, and the United Nations Children’s Fund nearly five years to convince vaccine manufacturers to start using vaccine vial monitors (VVMs)—small stickers that adhere to vaccine vials and change color if the vaccine is exposed to heat. Since these indicators were introduced in 1996, more than four billion VVMs have helped ensure the effectiveness of vaccines administered in immunization programs and campaigns.
We are in the midst of a significant shift in global health: the global health community is working hard to make these successes more common. Donors and countries are demanding demonstrable impact. To achieve that outcome, we must invest as much in delivery as in the initial product design. To ensure that lifesaving technologies make a measureable impact on the health of the communities we serve, we must remain committed to translating innovation beyond design and development.
The following PATH colleagues contributed to this article: Steve Brooke, Michele Burns, Maggie Kilbourne-Brook, Neeti Nundy, Rachel Seeley, Jill Sherman-Konkle, and Gretchen Shively.