Jessica Crawford spoke about health delivery in last mile contexts.
Global health innovation requires us to think beyond an individual product – it’s about creating space for “last mile thinkers” to meet with the scientists and engineers whose work influences medicine availability and healthcare access in low- and- middle income countries. This is how VillageReach found itself on a stage next to representatives from GlaxoSmithKlein, Pfizer, Washington Global Health Alliance, and the Controlled Release Society, engaging in conversations about what medicine delivery means in the context of global health.
Tremendous time, resources, and efforts are invested in developing new, more effective medicines that can improve quality of life – some of these medical breakthroughs have promise to control or eliminate diseases that costs thousands of lives each year. But the challenge of delivering these innovations in low-resource settings remains a pervasive barrier to improving health care access and outcomes. New products have unintentionally strained fragile health systems. Health supply chains for example, designed decades ago, struggle today to deliver a wider range of medicines to larger populations. Infrastructure and human resource challenges limit the impact of these innovations. Life-saving medicines sit on shelves in a warehouse, or expire in broken refrigerators at a rural health facility – many of us who live and work at the last mile of rural communities are familiar with this “innovation pile-up.”
Innovating with the End in Mind
There is no single solution to this issue, yet if those on the front lines of healthcare, those working in the lab and those negotiating and building the business models that drive innovation have more opportunity to share information and collaborate, innovations may have a greater chance of reaching their full potential – that is reaching all those in need.
In an ideal world, developers and pharmaceutical companies would have a clear understanding of the on-the-ground conditions where their innovations and medicines would end up. If they knew from the outset what limitations there would be, these companies could focus on new innovations that could mitigate some of these barriers – prolonging shelf life through new formulations, reducing costs by bringing medicine manufacturing closer to these communities, adapting existing medicines for new uses, or make medicines easier to administer. These innovations won’t resolve all the challenges we face, but thinking about the end-user can make it easier to integrate new medicines into health systems.
Product Innovation Depends on System Innovation
Reducing the “innovation pile up” depends on the coordination of these two equally important yet inextricably linked efforts. Medicine availability is dependent on a multi-faceted health system that enables effective healthcare delivery – from the national level were medicines are delivered, all the way to the “last mile” – the point of care, often the most rural and remote communities. If the system is weak and inefficient, it will not be able to absorb or sustain the product innovation. We must think of ways to innovate and improve the underlying health system at the same time we are developing and delivering new products.
At this event, VillageReach tried to give an account of the reality on the ground when it comes to existing health systems and the key barrier we face in our work every day. If decision makers don’t have data visibility, they can’t make the appropriate decisions to respond to demand at the last mile. Even when data is available, human resources are inherently scarce. Health workers are overburdened with logistics tasks on top of ever-growing clinical workloads. Lack of infrastructure (power, poor roads, transport) cause significant delays and risks to medicine potency. VillageReach’s work and impact illuminates the importance of system innovation in partnership with product innovation to ensure more equitable access to quality healthcare:
- What technologies can be deployed to support better information flow and visibility at the last mile?
- How do we make supply chain systems more effective and efficient?
- How do we reduce the burden on and increase the capacity of frontline health workers?
- How do we support a sustainable path for any system change at scale?
Leveraging non-traditional partners is a clear path forward, where pharmaceutical companies, governments, businesses, and NGOs can utilize each other’s strengths for last mile innovation and potentially access new, untapped resources. But one of the biggest challenges is to listen to each other. How can we begin to connect the dots if we’re not in the same room together?
The panel at the Controlled Release Society Annual Meeting was hinting at the larger conversation. These conversations need to happen more often and at many levels – between governments, the international community and multinational corporations, but also between individual scientists and last mile thinkers. Together we can create an understanding of the larger context global health innovation exists within – and develop a shared context for us all to work together.