Aug 04, 2012 Volume 380 Number 9840 p447 – 536
Technologies for global health
“How good is a cure if only ten people can have it…or we haven’t got the money to train doctors to use it properly?” So asks Nadia Fall, director of a new production of The Doctor’s Dilemma, which revolves around rationing for a new treatment for tuberculosis. Access to beneficial health technology, including essential medicines and medical devices, for those most in need is a theme explored in this week’s issue in The Lancet and Imperial College London’s Commission on technologies for global health.
The Lancet Commissions
Technologies for global health
Peter Howitt, Ara Darzi, Guang-Zhong Yang, Hutan Ashrafian, Rifat Atun, James Barlow, Alex Blakemore, Anthony MJ Bull, Josip Car, Lesong Conteh, Graham S Cooke, Nathan Ford, Simon AJ Gregson, Karen Kerr, Dominic King, Myutan Kulendran, Robert A Malkin, Azeem Majeed, Stephen Matlin, Robert Merrifield, Hugh A Penfold, Steven D Reid, Peter C Smith, Molly M Stevens, Michael R Templeton, Charles Vincent, Elizabeth Wilson
Collaboration between The Lancet and Imperial College London, UK, has resulted in a new Commission, which examines how medical technology should best be used to improve health in low- and middle-income countries. The report concludes that in many cases, medical technology—almost exclusively developed in rich countries—is simply inappropriate for use in poorer nations.
According to hospital inventories, an estimated 40% of healthcare equipment in developing countries is out of service, compared with less than 1% in high-income countries. The inappropriate deployment of medical technologies from wealthy countries plays a major part in this high failure rate.
Instead of relying on hand-me-down technologies from wealthier countries, which can be costly, inappropriate for local conditions, and even dangerous, the authors urge a renewed effort towards developing what they call “frugal technologies”—cost-effective technologies that are developed specifically to cope in local conditions. Examples of frugal technologies which have been developed to meet local needs include: the Jaipur foot, a rubber prosthetic for people who have lost their leg and foot below the knee; PATH’s Uniject injection system, which allows once-only use of needles for injectable contraceptives; and the eRanger, a durable rural ambulance, based around a motorbike and stretcher sidecar (which can be modified to carry one or two people).
The report also advocates a wider understanding of what we mean by medical technologies, pointing out that technological improvement to sanitation and road conditions could also have a far-reaching impact on public health in many low- and middle-income countries. Furthermore, the authors argue that advances in technology need to be accompanied by innovation to have a significant effect on health—this includes the development of effective delivery mechanisms and novel approaches to financing.
The Imperial College London/ Lancet Commission