Update5_Global Forum Selection

Fostering innova onfor global healthGlobal Forum Update onResearch for Health Volume 5

Innova on for health is a vital driver of development. Drawing new ideas and discoveries from research, it may cross many sectors and disciplines involved in the development and applica on of a novel product or process.

The Global Forum for Health Research focuses on promo ng an environment that fosters innova ve solu ons for the health of poor popula ons. In doing so, it places par cular emphasis on health equity as the central goal, i.e. reducing health dispari es within and between popula ons.

The fi h volume of the Global Forum Update on Research for Health provides insights into the newest thinking on innova on for global health. Some 30leading ins tu ons and professionals from around the world refl ect on how policy, social, technological and corporate innova ons can be fostered for global health.

This volume is produced to coincide with the Global Ministerial Forum on Research for Health, Bamako, which is co-organized by the Global Forum for Health Research.

www.globalforumhealth.org

EditorsMonika Gehner, Susan Jupp and Stephen A Matlin, Global Forum for Health Research

Pan American Health Organiza on

The Partnership for Maternal, Newborn and Child Health

Na onal Ins tute of Immunology, India

Pla orm on Agriculture and Health Research

European Malaria Vaccine Ini a ve

Universidad de la República, Uruguay

World Bank

PepsiCo, Inc.

Luis Gabriel Cuervo

Andrés de Francisco

Nirmal Kumar Ganguly

Stuart Gillespie

Odile Leroy

Judith Sutz

Alfred Watkins

Derek Yach

Editorial Advisory Board

ISBN: 978-2-940401-12-3

Global Forum

Update on Research for H

ealth Volume 5

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Contents

Global Forum Update on Research for Health Volume 5 � 3

Editorial Advisory Board: Luis Gabriel Cuervo Pan American Health OrganizationAndrés de Francisco The Partnership for Maternal, Newborn and Child HealthNirmal Kumar Ganguly National Institute of Immunology, IndiaStuart Gillespie Platform on Agriculture and Health ResearchOdile Leroy European Malaria Vaccine InitiativeJudith Sutz Universidad de la República, UruguayAlfred Watkins World BankDerek Yach PepsiCo, Inc.

Editorial Team:Monika Gehner, Global Forum for Health ResearchSusan Jupp, Global Forum for Health ResearchStephen A Matlin, Global Forum for Health Research

Production Team:Julia Federico, Global Forum for Health ResearchMonika Gehner, Global Forum for Health ResearchOana Penea, Global Forum for Health Research

Pro-Brook Publishing Team:Trevor Brooker, Pro-Brook PublishingTim Probart, Pro-Brook PublishingStephen Kemp-King, Pro-Brook PublishingSimon Marriott, Art DirectionJude Ledger, Copy EditorPrPhoto credits:WHO/PAHO/Carlos GaggeroWHO/TDR/Andy CraggsWyndeham Grang

The Global Forum Update on Research for Health Volume 5 is published for the Global Forum for Health Research by Pro-Brook Publishing Limited

Pro-Brook Publishing, 13 Church Street, Woodbridge, IP12 1DS, United Kingdom

CopyrightText © the Global Forum for Health Research 2008Volume © Pro-Brook Publishing Limited 2008

All rights are reserved. No part of this publication may be reproduced, stored in a retrieval system, ortransmitted in any form or by any means, electronic, mechanical, photo-copying, recording orotherwise without the permission of the Publisher.

The information contained in this publication is believed to be accurate at the time of manufacture.Whilst every care has been taken to ensure that the information is accurate, the Publisher and GlobalForum for Health Research can accept no responsibility, legal or otherwise, for any errors or omissionsor for changes to details given to the text or sponsored material. The views expressed in thispublication are not necessarily those of the Publisher or of the Global Forum for Health Research.

Application for reproduction should be made in writing to the Publisher.

ISBN 978-2-940401-12-3First published 2008

Acknowledgements: The Publishers hereby acknowledge the assistance of all the contributors who have helped in theproduction of the publication and the advertisers who have made the publication possible.

e, Southwick, UK


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Contents


009 Foreword/PréfaceGill Samuels

013 The scope and potential of innovation for health and health equityStephen A Matlin

innovating for health and development

024 Research and innovation in Brazil: the institutional role of the Ministry of Health Suzanne Jacob Serruya with Reinaldo Guimarães, Itajai Oliveira de Albuquerque and Carlos Medicis Morel

030 Health markets and future health systems: innovation for equity Gerald Bloom with Claire Champion, Henry Lucas, M Hafizur Rahman, Abbas Bhuiya, Oladimeji Oladepo and David Peters

036 Strengthening the base: innovation and convergence in climate change and public healthSaqib Shahab with Abdul Ghaffar

041 Global health diplomacy – a bridge to innovative collaborative action Thomas E Novotny and Ilona Kickbusch with Hannah Leslie and Vincanne Adams

048 Hideyo Noguchi Africa Prize Kiyoshi Kurokawa with Tamaki Tsukada and Eri Maeda

054 Health research and innovation: recent Spanish policies Flora de Pablo with Isabel Noguer

moting healt

059 The changing landscape of research for health Kirsten Havemann with introduction by Ulla Tørnæs

066 Global health and the foreign policy agenda Jonas Gahr Støre

072 “Policies for innovation”: evidence-based policy innovation – transforming constraints into opportunities Miguel Angel González Block

Social innovations

076 Interactions between populations, health workers and health programmes for prevention of malaria: teachings of an analysis “from below” Yannick Jaffré

082 Ethical aspects of innovation in health José Geraldo de Freitas Drumond

088 Ethics, evidence and innovationKenneth W Goodman

091 Seeding a global movement on neglected diseases Sandeep P Kishore with Pius Mulamira

096 Supporting implementation research partnerships for health systems strengthening: one foundation’s approach in sub-Saharan Africa Elaine K Gallin

099 The practical impact of research in South-East Asia funded by the Wellcome Trust Jimmy Whitworth with Ruth Branston and Michael Chew

Contents


Contents


104 Independence and innovation: looking beyond the magic of words Xavier Crombéddressing global challenges

107 Creating incentives to induce behavioural change and improve health: success and limitations of conditional cash transfer programmes Mylene Lagarde with Andy Haines and Natasha Palmer

Technological innovations

114 Innovation and access: medicines for the poor – the IGWG strategy and plan of action Bart Wijnberg and Marleen Monster

120 The Noordwijk Medicines Agenda: a model for changing innovation for neglected and emerging infectious diseases Bénédicte Callan with Susanne L Huttner, Iain Gillespie and Barbara Slater

124 Health dynamics, innovation and the slow race to make technology work for the poor Melissa Leach with Ian Scoones H

ealth research institutions and g

130 Leapfrog technologies for health and development Harry McConnell with Prita Chathoth, Ashley Pardy, Camille Boostrom, Eugene Boostrom, Koos Louw, Luis Gabriel Cuervo and Sumiko Ogawa

138 The IVI’s innovative approach to closing the gap between vaccines for industrialized and developing countries Denise DeRoeck with Anna Lena Lopez, Rodney Carbis and John D Clemens

143 Commercializing African health research: building life science convergence platforms Peter A Singer and Abdallah S Daar with Sara Al-Bader, Ronak Shah, Ken Simiyu, Ryan E Wiley, Pamela Kanellis, Menaka Pulandiran and Marilyn Heymann

Corporate sector-related innovations

152 Making drugs accessible to poor populations: a funding modelPaul L Herrling

157 Public-private partnerships drive innovation to improve the health of poor populations Christopher J Elias with Yvette Gerrans and F Marc LaForce

161 Innovations and incentives: why pharmaceutical companies are becoming interested in neglected tropical diseases Arianne Matlin

166 Vision for a venturing ecosystem to generate global health innovationWilliam Rosenzweig

171 Beyond product: the private sector drive to perform with the purpose of alleviating global under-nutrition Dondeena Bradley

174 Innovating against hunger and under-nutrition Josette Sheeran

177 Riders for Health: an award-winning social enterprise ensuring health care delivery across Africa Ngwarati Mashonga

182 UNITAID: innovative financing to scale up access to medicinesJorge Bermudez

186 Threshold of evidence needed for health claims on functional foodsPeter J Jones with Stephanie Jew

190 The Lilly MDR-TB Partnership: innovation to fight a diseasePatrizia Carlevaro

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Foreword


Innovation is a vital driver of development. It involves thecreation of novel ideas, processes and products and theirapplication to deliver practical solutions. In the health

field, it encompasses not only technological inventions ofproducts such as drugs, vaccines and diagnostics, but alsoinnovations in the environmental, economic, political andsocial fields that can impact on the capacity to deliver healthproducts and services and health protection and promotionmessages and that can influence the broader determinants ofhealth.

The Global Forum for Health Research especially focuseson promoting an environment that fosters innovative solutionsto health problems that are relevant to resource-poor settingsor adapted to different social and cultural contexts in low- andmiddle-income countries (LMICs). In doing do, it placesparticular emphasis on health equity as the central goal andon the importance of bringing innovation to bear on thehealth problems of the poorest and most disadvantagedpeople.

While increasing attention is now being given to the role ofhigh-income countries in contributing to research andinnovation for global health or the health of populations inLMICs, these countries need their own capacity to conductand utilize research to solve their immediate health problems.They too need to strengthen their systems of innovation asimportant drivers of development.

The global agenda must encompass how to (a) strengthenhealth research systems and innovation systems in LMICs;(b) strengthen systems incentives to create relevant productsaccessible to poor populations; and (c) enhance coherence

between policies and actions of global players and nationalforces shaping country research and innovation systems.

Some LMICs are now showing greater commitment toinvesting in research for health and to developing systematicand equitable approaches to the creation and use ofknowledge and innovation. These “innovative developingcountries” have the potential to contribute significantly to theproduction of health-related products, services and processesfor low-income countries and to south-south capacitybuilding. To do so, they will require policy and legalframeworks that need to be set nationally and globally, as wellas significant levels of public sector investment to ensure thatthe system delivers products that are accessible andaffordable to the poor and contribute to a reduction in healthdisparities.

The Global Ministerial Forum on Research for Health(Bamako, 17-19 November 2008) brings together a widerange of stakeholders in research and innovation for health. Itaffords a unique opportunity for a multi-sectoral dialogue togive impetus to this global agenda, to address theenvironment for innovation to accelerate achievement of theMillennium Development Goals and tackle some of theworld’s major health challenges.

As a contribution to this dialogue, the Global Forum forHealth Research has commissioned this collection of writingsby a range of experts and leaders in the fields of development,innovation and research. We are extremely grateful to thewriters for providing cogent summaries, fresh insights andchallenging messages to inform the dialogue. �

Gill Samuels, Chair of the Foundation Council, Global Forum for Health Research, Switzerland

Foreword

10 � Global Forum Update on Research for Health Volume 5

Préface

L'innovation est un moteur essentiel du développement.Cela comprend la création d’idées, de procédés et deproduits nouveaux et leur application pour fournir des

solutions pratiques. Dans le domaine de la santé, celaenglobe non seulement les inventions technologiques deproduits, tels que médicaments, vaccins et diagnostics, maisaussi l’innovation dans tous les domaines environnemental,économique, politique et social qui peuvent avoir un impactsur la capacité d'offrir des produits et des services de santé etsur les messages de protection et de promotion de la santéqui peuvent influencer les déterminants de la santé.

Le Forum mondial pour la recherche en santé a pour objet,en particulier, de promouvoir un environnement qui favorisedes solutions novatrices aux problèmes de santé spécifiquesaux milieux défavorisés ou adaptés aux contextes sociaux etculturels variés des pays à faibles et moyens revenus. Pour cefaire, il se donne tout particulièrement comme objetd’atteindre l'équité en santé et de faire porter l'innovation surles problèmes de santé des plus pauvres et des plusdéfavorisés.

Alors que l’on accorde une attention accrue à lacontribution des pays à revenu élevé à la recherche et àl'innovation pour la santé globale ou la santé des populationsdes pays à faibles et moyens revenus, ces pays ont besoin deleur propre capacité d’effectuer et d'utiliser la recherche pourrésoudre leurs problèmes de santé immédiats. Ils doiventaussi renforcer leurs systèmes d'innovation, en tant quefacteurs importants du développement.

L'ordre du jour global doit inclure les moyens de (a)renforcer les systèmes de recherche en santé et les systèmesd'innovation dans les pays à faibles et moyens revenus ; (b)renforcer les systèmes d'incitation pour créer des produitsadaptés accessibles aux populations pauvres, et (c) améliorer

la cohérence entre les politiques et les actions des acteursglobaux et des forces nationales qui configurent les systèmesde recherche et d'innovation des pays.

Certains pays à faibles et moyens revenus s’engagentmaintenant à investir dans la recherche pour la santé et àdévelopper des approches systématiques et équitables poursusciter et utiliser la connaissance et l’innovation. Ces 'paysen développement innovants' ont le pouvoir de contribuersignificativement à la production de services, de processus etde produits pour la santé à destination des pays à faiblerevenu, et de renforcer les capacités entre pays du Sud. Pource faire, ils auront besoin d’un cadre politique et juridiquequ'il faudra établir à différents niveaux, nationaux et mondial,ainsi que d'investissements conséquents du secteur publicpour s'assurer que le système fournit des produits accessibleset abordables pour les pauvres, contribuant à une réductiondes disparités en santé.

Le Forum ministériel mondial sur la recherche pour la santé(Bamako, 17-19 novembre 2008) rassemble un largeéventail de personnes concernées par la recherche etl'innovation pour la santé. Il offre une occasion unique dedialogue multi-sectoriel en vue de dynamiser cet ordre du jourmondial, de s'intéresser à l'environnement pour l'innovationpour accélérer la réalisation des objectifs du Millénaire pourle développement et s'atteler à certains des plus grands défisen matière de santé dans le monde.

En tant que contribution à ce dialogue, le Forum mondialpour la recherche en santé a commandé ces contributions denombreux experts et chefs de file dans les domaines dudéveloppement, de l'innovation et de la recherche. Noussommes extrêmement reconnaissants aux auteurs d’avoirfourni des récapitulations pertinentes, des éclairages nouveauxet des messages stimulants pour contribuer au dialogue. �

Gill Samuels, Présidente du Conseil de Fondation, Global Forum for Health Research, Suisse

Préface



114 Innovation and access: medicines for the poor – the IGWG strategy and plan of action Bart Wijnberg and Marleen Monster

120 The Noordwijk Medicines Agenda: a model for changing innovation for neglected and emerging infectious diseases Bénédicte Callan with Susanne L Huttner, Iain Gillespie and Barbara Slater

124 Health dynamics, innovation and the slow race to make technology work for the poor Melissa Leach with Ian Scoones

130 Leapfrog technologies for health and development Harry McConnell with Prita Chathoth, Ashley Pardy, Camille Boostrom, Eugene Boostrom, Koos Louw, Luis Gabriel Cuervo and Sumiko Ogawa

138 The IVI’s innovative approach to closing the gap between vaccines for industrialized and developing countries Denise DeRoeck with Anna Lena Lopez, Rodney Carbis and John D Clemens

143 Commercializing African health research: building life science convergence platforms Peter A Singer and Abdallah S Daar with Sara Al-Bader, Ronak Shah, Ken Simiyu, Ryan E Wiley, Pamela Kanellis, Menaka Pulandiran and Marilyn Heymann

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Information and communication technologies (ICTs) areincreasingly being recognized as essential healthtechnology, giving individuals at all levels of the health

workforce and other stakeholders access to information thathelps them protect and improve health and save lives. Radioand television are ever-present in many parts of the world,and their uses in health care, health education, and healthinformation dissemination and access continue to beinvaluable. At the clinical and laboratory level, ICTs areused to track and provide patient information, tofacilitate research, diagnosis and testing, and to deliverservices through telemedicine despite distance andtime barriers.

Debate continues as to the roles and relativeimportance of ICTs in socioeconomic development1

including health development. Many people believethat ICTs are a necessary component of every facet ofdevelopment, ranging from infrastructure projects andgeneral economic development to communitydevelopment, health care provision and education. Onthe other hand, there are many barriers toimplementing ICTs and health technologies indeveloping countries (see Table 1) and many arguethat clear precedence must be given to clean water,sanitation and jobs. There have been many efforts touse older ICTs for health and development indeveloping countries. Radio and television networkscan be powerful tools for widespread health education.There have been many efforts to donate legacy systemsand older computers to developing countries,although some argue that this is more a means ofdumping eWaste than a philanthropic effort. MIT has recently announced it is developing a US $ 10computer using the older Apple II hardware andsoftware in parallel with the One Laptop per Child(OLPC) initiative.

The concept of leapfrogging implies that developingcountries should be able to benefit from the mostcurrent technologies and bypass older legacy systemsas a more efficient means of achieving technologytransfer. This paper looks at leapfrogging technologies

as a potential tool to address the inequalities in health carebetween the low- and middle-income countries (LMICs) andhigh-income countries. We focus here on two currentexamples of leapfrogging which are already beingsuccessfully implemented in many developing countries:ePublishing and mobile phones. Other leapfrog technologiesand potential benefits and risks of their use for health in



Article by Harry McConnell (pictured), Professor of Neuropsychiatry, Griffith University,Australiawith Prita Chathoth, Ashley Pardy, Camille Boostrom, Eugene Boostrom, Koos Louw, LuisGabriel Cuervo and Sumiko Ogawa

Leapfrog technologies for health and development

Table 1: Potential barriers to implementing leapfrog technologies indeveloping countries

Barrier CommentAbsorptive capacity Inadequate ability to recognize, place value upon,

internalize and apply new knowledge (e.g., among IT support workers and system managers in LMICs)

Attitudes and Acceptability, perceived needs based on a needs analysis, perception attitudes towards technology, concepts of development and

aid, and focus on the problems to be solved (i.e. being people-driven and problem-oriented not kit-driven)

Cultural and Language, cultural views towards technology, sharing of community issues resources within the community, appropriateness of a specific

technology within a given culture or community, literacy requirements, gender issues and access issues

Legal and ethical Privacy, confidentiality, security, malpractice potential,Issues insurance, jurisdiction, copyright, patents for new technologies

and treatments, other intellectual property issues

Technical issues Access to electricity grid and alternative power supplies, power schedules and reliability, UPS back-ups, ongoing maintenance of computers. Inappropriate access devices and inappropriate Internet technologies including low bandwidth. Insufficient language and cultural adaptation of content and the digital divide

Environmental Effects of weather, temperature, humidity and dust on equipment.issues Security and accessibility of equipment. Isolation, transport

issues

Sustainability Ongoing upgrades of technology, ongoing costs, issues cost-effectiveness

Practical issues of Corruption, borders and customs in equipment transport,working internationally nationally-imposed barriers to information access or

dissemination or to information privacy, donor-imposed barriers, time zones and communication issues of working in remote geographical areas

Health care In health, insufficient means to implement health care and takeinfrastructure full advantage of leapfrog ICT technologies, e.g. lack of

treatment facilities, drug delivery systems, inadequate cold chain facilities for vaccines

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Table 2: Examples of leapfrog technologies

Technology Examples of potential applications Examples of potential risks and in developing countries implementation problems in developing countries

Telemedicine technologies eRadiology, ePathology, teleSurgery, Store and Forward Differing cultural understandings of illness; Telemedicine can enable access to necessary expertise medico-legal implications; bandwidth issuesand help in overcoming the “brain drain” of medical personnel in developing countries

Open access technologies Technologies such as Web Bibliometrics, Web 2.0 and wiki are Poor quality controls for information;making it possible to realize the principles of The Budapest Open misinformation becomes published as factAccess Initiative, The Berlin Declaration, the Open Source Initiative and Gnu License, as well as The Copy Left Movement. Projects suchas The Public Knowledge Project, HINARE, The Open Archives Initiative and online journals such as the Public Library of Science, Biomedcentral are revolutionizing medical publishing with Open Peer Review and Commentary and free access to publications. This has resulted in a paradigm shift in why and how we publish scientific research

Collaborative technologies Advances such as Web 2.0 and wiki will mean that health professionals and Poor quality controls for information;and social networking patients in developing countries can effectively network with each other misinformation becomes published as fact

and with the industrialized world and actively participate in knowledge development through projects such as medical wikis. This will also lead to patient empowerment and to better informed health care particularly for those suffering from chronic illness and disabilities

GRID technologies May deliver greater power at less cost by harnessing the capacity of Cost and limited bandwidth access limit utilitymany computers and increasing collaboration efforts

Internet2 Internet2 allows advanced centres of medicine to provide health education Risk of increasing digital divide as currentlyto hospitals and universities in developing countries through increased limited availability in developing countriesbandwidth, improved security and collaboration potential

eLearning technologies and The creation of these new resources is both exciting and precarious as Lack of acceptance; technology transfervirtual patient simulation they can offer limitless possibilities to advance in areas like distance issues

learning and interdisciplinary development. Facilitates capacity building and collaboration with other institutions through both real time and asynchronous delivery methods

Bioinformatics Identification of drug targets and understanding pathogen-host High development costsinteractions

Alternative network technology 3G, 4G mobile phone networks and digital satellite radio offer the High establishment costspotential for access in remote areas

Eco-technologies Environmental sustainability, sanitation, clean water, bioremediation High development costs

Solar technology Power for computers, phones. A lesser known health sector application Reliabilityfor solar technology is the application of solar ovens to dispose of hazardous medical waste

Genomics and recombinant Sequencing pathogen genomes to assist in development of antimicrobials; Intellectual property and patent issuestechnologies decreased costs of vaccine development; development of less expensive

and more field-useable vaccinesReduced costs of drug development; development of more effective and appropriate and less expensive drugs for priority problems in LMICs

Nanotechnology Nanomedicine offers new methods of diagnostics and could completely Concerns over health effects of nanoparticles,displace certain classes of drugs and change the ways diseases like HIV, including potential for asbestos-like effectsmalaria and TB are treated

Genetically modified crops Increased nutrients to counter specific deficiencies Cross-contamination with other crops, international regulation issues

Combinatorial chemistry New drug discovery High development costs

Molecular technologies Affordable diagnosis of infectious disease High development costs


developing/LMIC countries are outlined in Table 2. Case studies have recently been published outlining

eHealth activities and results in Peru, South Africa, Turkey,Vietnam and Rwanda2. The South African case study3

confirmed that the needs of developing countries differ fromthose of the developed world in some areas. Issues ofinteroperability, human resource development, broadbandpenetration and high cost of bandwidth are worth noting.Although several e-Governance projects have beenimplemented in South Africa and a draft e-Health WhitePaper Discussion Document has been developed, theimplementation of eHealth policy remains a concern.

The training of the workforce needed for successful eHealthimplementation is globally a common focus. Apart fromresidential degree courses, online training opportunities arenow also offered, such as Drexel University’s Certificate inHealthcare Informatics4 and Certificate in Medical Billing andCoding5. An important part of eHealth, albeit sometimesviewed as on the periphery, is consumer health sites. Suchsites should preferably be accredited by the Health On the NetFoundation (HON), whose mission is to guide Internet usersto reliable understandable accessible and trustworthy sourcesof medical and health information6. However, the apparentsuccess of consumer health sites can result in – or unveil –another problem for health-care consumers and providers. Arecent survey in the USA commissioned by Envision Solutionsfound that more than 85 million adults in the USA – almost40% – have doubted their health-care providers’ opinionswhen the information did not match what they found online7.

A good example of technology leapfrogging is mobilephones, which have enabled low- and middle-incomecountries to overcome the barriers of poor or insufficienttelecom infrastructure and leapfrog into 21st century mobiletechnology. ICT leapfrogging also applies to digitaltechnologies whereby many low- and middle-incomecountries have been able to leapfrog to the digital age withoutgoing through the analogue era technologies. This possibilityto leapfrog extends to eLearning and eHealth as well.Currently, most of the popular eLearning and eHealthprograms and applications require sophisticated hardwareand software, and in many cases access to high-speedInternet. As a result, countries that need eLearning andeHealth services the most are also the ones least able toaccess and use them. With the introduction of mobiletechnologies and devices, it is possible to provide eLearningand eCapacity building programmes to public healthproviders, even in remote and isolated areas. By 2010, thetotal number of mobile phone users is expected to grow to3.3 billion globally, or approximately half the world’spopulation. Although the more affordable mobile phones indeveloping countries may not yet have sophisticated featuresfound in Smart Phones, mobile phones are becomingubiquitous in Asia, Africa and Latin America. This is expectedto result in an increase in mobile-enabled health systems andservices throughout the world. The recent development of“mobile web” is already turning web browsing into an “anytime, any place” phenomenon. The mobile web willessentially function as “personal computers”. If at least one



doctor and one nurse in every hospital in developingcountries, especially those in rural and peripheral areas, wereto have access to (and effectively use) a mobile “smart”phone with web capability, it could have a major impact onprovision of health care.

The UN Millennium Villages Program has initiated a planin which some of the world’s poorest people in several Africancountries will be connected to cellular networks and be ableto use mobile phones. This is expected to have a significantimpact on health care and education. They will not haveaccess to mobile web browsing yet, but that could beavailable to them within a few years. The UN hopes that ifthe very poor in Africa have mobile phones they will be ableto use them effectively in medical emergencies and alsoto access appropriate and useful health information. A ruralhospital would be able to make a call to the nearest specialty hospital or specialist and thus help save lives during emergencies.

Mobile web browsing, at the very least, could provideinstant access to the most relevant and up-to-date healthinformation to health practitioners, especially if the mostrelevant and appropriate information were available in easilyaccessible forms, and it would offer a private and personalform of learning experience. The mobile web can be a“knowledge repository” for both providers and consumers ofhealth care. Other mobile devices such as patient monitoringdevices, PDAs and wireless radios can all be used in publichealth education, training and capacity enhancement. Forexample, they can be used in real-time monitoring of patientvital signs and in accessing important and useful health information.

One of the main constraints that prevents developingcountries from being fully part of the emerging global ICTinfrastructure is the lack of resources, both financial andhuman, to acquire and apply the technologies. The latter istrue, especially in public health. Even if the government ordonor agencies are prepared to invest in the requiredinfrastructure, at present there are not enough skilled peoplewithin the health sector, especially in the rural areas, who areable or willing to use most ICTs effectively. Mobile phones andsome other hand-held wireless devices, however, do notseem to pose too much of a challenge to the users.

Medical record-keeping is an area which begs forleapfrogging. In the tsunami-hit hospitals in Sri Lanka andother countries, for example, paper-based health records andpatient records were washed away or destroyed. Having one’smedical records available on a mobile phone would also helpdoctors, nurses and pharmacists make the right decisions,

The UN hopes that if the very poor in Africa have mobilephones they will be able to use them effectively in

medical emergencies and also to access appropriate anduseful health information


based on a patient’s health history. Electronic public health journals offer a very inexpensive

form of eLearning. They keep readers up-to-date on new

developments in public health research. In many parts of thedeveloping world, unlimited Internet access is now availableon a monthly rate basis. Health personnel with such access

can easily have individualized professionaldevelopment by just going through these onlinejournals. Many medical schools and colleges havecomputer centres that allow students free time on theInternet. Many journals are available on a fully open-access basis, e.g. BioMedCentral and PLOS Medicine,and in developing countries many journals areavailable through HINARI and even some evidence-based medicine websites such asdynamicmedical.com are available free of charge tohealth professionals in many developing countries.Electronic journals also offer the convenience of takingpart in blogs, debates, webchats, and other forms ofeLearning and electronic participation. This has theadded advantage of peer learning and of being part ofcommunities of practice on a global scale. ePublishingalso stands to make major changes in the way wedisseminate information. Success will be measured byweb bibliometrics analysing one’s contribution tomaking a real impact, rather than merely bycounting peer review publications and citations. Thesebibliometrics have the potential to replace the currentsystem of publish or perish merit system measured bycitations. The new system will allow anunprecedented transparency in research, makingfraudulent research very difficult. Open access, openarchives, open editorial review and open peer reviewwill make possible access to original data andcollaboration in ways not yet envisioned. An opensource approach to research dissemination will ensuretrue advancement in scientific acknowledge throughreal paradigm shifts and important innovativeadvances8.

This year’s Global Economic Prospects9 focuses ontechnology diffusion in developing countries andstates that even the introduction of relatively simpletechnologies can have far-reaching developmentimpacts. “Technological advances do not need to beextraordinarily complex or reliant on the mostsophisticated technology to have importantdevelopment impacts”. This holds true for health ICTs.With the convergence of mobile phones and the web,we expect major impacts on the way healthinformation is used and processed. More and morehealth workers will be able to access web-basedhealth and hospital information using their mobilephones than their desk top or laptop computers,which usually do not exist in many health carefacilities. Ubiquitous, portable and personalcomputing via affordable mobile phones will lead theway in leapfrogging ICTs in many parts of thedeveloping world. ePublishing and Open Access makeit possible to access essential health information at thepoint of care on these devices, and this is alreadyoccurring in many areas.



Table 3: Examples of international initiatives promoting ICTs for health anddevelopment (modified from McConnell 2004, 2006)

Initiative/organization Comment

AED SatelLife Uses ICTs, especially PDAs, in health and development. http://www.healthnet.org/whatwedo.php

Development Gateway World Bank Initiative. Portal for development partners and member countries. www.developmentgateway.org

First Voice International Uses WorldSpace Digital Satellite Radio for broadcast of health information. www.firstvoiceint.org/

Health InterNetwork Biomedical publishers, working closely with the World for Developing Nations Health Organization (WHO), allowing free or very low priced (HINARI) online access to more than 2000 key biomedical research and

healthcare journals. http://cat.inist.fr/?aModele=afficheN&cpsidt=14647338

Health on the Net Sets code of practice for health Internet sites to guideFoundation (HON) Internet users to reliable, understandable, accessible and

trustworthy sources of medical and health information. www.hon.ch

InfoDev World Bank Initiative. Sponsors ICT and development programmes and framework documents. www.infodev.org

Interactive Health Nonprofit organizations dedicated to using online Network and Academy technologies to combat health inequities through stimulatingfor Health Equity and discussion regarding effective policies for public and privateDisability health programmes and practices affecting those most

marginalized in society. Works in Africa and Asia-Pacific predominantly on eLearning and ePolicy initiatives. Uses ICTs for eCapacity Building of health-care workers and for effective national and international policy development. www.ihn.info

International Network Promotes access, use, dissemination and communicationfor the Availability of of research information in developing countriesScientific Publications http://www.inasp.info/file/434/inasp-health.html(INASP)

International Sets standards in telecommunications and monitors eHealthTelecommunication programmes; Sponsor of the World Summit on theUnion Information Society (WSIS). http://www.itu.int

IRDC Acacia Initiative Works in Africa with a focus on appropriate applications and technologies, infrastructure, policy and governance. www.idrc.ca/acacia

PATH Nonprofit organization using health technologies designed for low-resource settings, by the people who will use them; promoting health equity for women, among the world’s most vulnerable – and influential – populations and vaccine programmes. www.path.org

Rockefeller Foundation Sponsors think tank meetings on E-health aimed at improvingand the global coalition health systems in the developing world. Includes BIREME/PAHO/for eHealth in WHO Latin American and Caribbean Center on Health Sciences developing countries Information, the American Medical Informatics Association

(AMIA), International Medical Informatics Association (IMIA), Health Level Seven (HL7), Health Metrics Network (HMN), Partners in Health (PIH), Regenstrief Institute, Telemedicine Society of India, United Nations Foundation (UNF) and Vodafone Group Foundation Technology Partnership, University of Washington’s Center for Public Health Informatics, and the World Health Organization (WHO). http://www.rockfound.org; http://www.ehealth-connection.org/

WHO Essential Has eHealth branch focusing on applications in developing Technologies countries; collaborates with NGOs on programmes; sponsorsProgramme many conferences on technology and health. www.who.int


Table 3 shows some examples of international effortstoimplement Leapfrog technologies in developing countriesfor health care.

ConclusionIn public health practice, ICTs enable the identification ofdisease and risk factor trends, analysis of social anddemographic data, and increase access to publications anddatabases. As free and open source software continues toevolve, the uses of ICTs for health will expandexponentially. ICTs can be used by medical professionals andcommunity health workers to improve not only healthservices but also entire health-care systems, whilebeneficiaries can use ICTs to access health information andmake well-informed decisions regarding their ownhealth. However, not all members of the health workforce orthe public have equal access to ICTs. The digital divide – thegap between those with effective access to ICTs and thosewithout it – contributes directly to the persistent healthinequality both between and within countries. In health,lacking or limited access to ICTs impedes the provision ofhealth care and the effectiveness of public health work.Efforts to bridge the gap in access to ICTs have varieddramatically in their effectiveness and their usefulness.Beyond the creation of systems for cell phone and Internetuse, we need to ensure that access to ICTs for health will linkindividuals to the health information and modes ofcommunication that are most useful to them, and that themost necessary, valid and useful information is available inthe most acceptable and useable forms.

Thomas Kuhn in The Structure of Scientific Revolutions in1962 put forward that true scientific knowledge does notadvance as a linear increase in understanding based onlogical models. He proposed that true advances occurnaturally as a series of revolutions, replacing the oldparadigms and resulting in a “paradigm shift”: a new way ofthinking about a problem. Thus, to advance development, theuse of leapfrog technologies must extend this process toinclude ecologically, financially and socially sustainablemeans of tackling poverty and heath inequalities. Examplesof such paradigm shifts include very recently the effect of theInternet on information retrieval, and earlier the discovery ofpenicillin and vaccines for combating infectious diseases.ICTs are already having an impact in health in developingcountries through the rapidly growing use of mobiles andthrough Open Access initiatives for ePublishing10. There is aunique opportunity for developing countries to harnesseHealth technologies in a way that will ensure a paradigmshift in how we “deliver” or “support” development and howhealth is progressed in these regions. It offers the potential ofgreater transparency, improved governance and access toessential tools and expertise, irrespective of geography or offinancial or resource implications. �

Harry McConnell is a neuropsychiatrist specializing in disabilitywith more than 20 years’ experience in both the clinical and publichealth aspects of health and disability. He has published fivetextbooks and worked as a Clinical Editor at BMJ Clinical Evidence.

He has a keen interest in Open Access and innovative use of IT tomake scientific publishing more available in developing countries.Professor McConnell has worked extensively with the WHO, WorldBank and other international agencies on the implementation ofeHealth programmes in developing countries. He trained in the USA,Canada, New Zealand and the UK. Professor McConnell also has akeen interest in evidence-based policies for disability services and inhealth and disability in developing countries. He is a ConsultantPsychiatrist and Professor of Neuropsychiatry at Griffith UniversitySchool of Medicine.

Prita Chathoth PhD has more than 20 years of internationalexperience in eLearning, eHealth and ICTs for development. Sheworked at the World Bank in Washington, DC, from 1993 to 2007.During this time, for more than seven years, she served as senioroperations officer in the Global Development Learning Network(GDLN). As Task Manager of the GDLN Global Dialogues Program, DrChathoth worked extensively with all regions of the world.

From July 2005 to December 2006, Dr Chathoth was onassignment at the WHO Office in Sri Lanka as eCapacity BuildingCoordinator and Project Manager of the Sri Lanka eHealth Project.Prior to joining the World Bank, she worked at INTELSAT, inWashington, DC, as a training specialist. In 2007, Dr Chathothworked as a consultant at the Pan American Health Organization(PAHO). She has researched, written and produced more than 15broadcast quality documentaries. Dr. Chathoth currently works as anindependent eLearning/eHealth Consultant.

Ashley Pardy is the co-director of the Interactive Health Network(IHN) and project manager of the Academy for Sustainable HealthEquity and Development (AHEAD). Both are nongovernmentalorganizations dedicated to improving health and disability services indeveloping countries through the use of information communicationtechnologies. Now a full-time PhD student at Griffith University inAustralia, Ashley started her university education at QueensUniversity in Canada, where she completed her BA and thencontinued on to Australia to do her masters in InternationalRelations. She is currently focusing her dissertation on mental healthresearch in Ethiopia and is actively involved in development projectsin the Asia pacific region. Ashley has worked as a volunteer in Asia,Africa and South America.

Camille Boostrom is a PhD candidate in public health at GriffithUniversity, Australia. Her research analyses the sector-wide approachin Mozambique’s health sector and its impacts on the country’sHIV/AIDS prevention efforts, specifically on the negotiation anddissemination of HIV/AIDS communications. Camille is also aResearch Associate with the Georgetown University Medical Center.

Eugene Boostrom MD, DrPH is a public health specialist withmore than 30 years’ experience in the development of healthsystems and health personnel. He has worked in Africa, LatinAmerica and the Caribbean, the Middle East and South Asia withbilateral and multilateral agencies, universities, foundations and theprivate sector. He retired from the World Bank as Senior PublicHealth Specialist in 2002 and now lives in Okinawa, Japan, wherehe is a Visiting Researcher at Meio University Research Institute. Healso teaches public health, epidemiology, health project and human




resources planning and management, and sustainable developmentrelated topics for the Japan International Cooperation Agency (JICA),Japan’s National Institute of Public Health, and Hokkaido UniversityMedical School.

Koos Louw is an eHealth consultant living in Cape Town, SouthAfrica. He served for many years in the top management of theSouth African Medical Research Council as Executive Director:Informatics and Knowledge Management. He is an acclaimed roleplayer in the area of health informatics and knowledgemanagement, nationally and internationally, and has a track recordof various successful large multi-institutional eHealth projects. Heholds a PhD from Stellenbosch University, South Africa. Thisuniversity appointed him in the honorary position of VisitingProfessor: Information Science (Knowledge Management) and as anAssociate of its Centre for Knowledge Dynamics and DecisionMaking.

Luis Gabriel Cuervo is a Medical Doctor with an MSc in ClinicalEpidemiology & Biostatistics from the Universidad Javeriana, andqualified as a Specialist in Family Medicine at the Universidad delValle, Colombia. He brings first hand experience as producer anduser of evidence for health care in the clinical, academic, andresearch fields working in various communities in rural and urbanenvironments in Colombia. He has developed a career around

knowledge management including summarizing evidence anddeveloping strategies to systematically inform policy and practicewith research evidence. From his position as Clinical Editor at BMJClinical Evidence he emphasized evidence-based programmes andaccess to developing countries and worked closely with the WorldHealth Organization and International NGOs including the CochraneCollaboration and INCLEN. More recently he has coordinated theresponse of the Pan American Health Organization (PAHO/WHO) tothe 2004 Mexico Declaration on Health Research.

Sumiko Ogawa, MS in Medical Sciences, MPH, PhD, is AssociateProfessor at Meio University, Okinawa, Japan, where she teachesPublic Health. Her successful work with WHO and JICA indeveloping Primary Health Care and Village Drug Revolving Fundsand improving water supplies in the Lao PDR’s remote KhammouaneProvince from 1992 to 1996 led the Government of Laos to awardher its Labor Medal, and the Japan Chamber of Commerce namedher Japan’s Outstanding Young Person of 1997. With support fromJapan’s Ministry of Education and JICA, she documented the post-World War Two recovery and development of health systems andhuman resources for health in war-ravaged Okinawa. She isPresident of Okinawa’s Association of Former Overseas JICA Expertsand a member of the board of Japan’s Association for OverseasVolunteer Studies. She continues her work with the Lao PDR MOHand also teaches and consults for JICA.



1 Dzenowagis J. Bridging the digital divide in health: the role of free andopen source software. World Health Organization Expert Meeting on Free& Open Source Software UNCTAD, Geneva, 2004. Available at:http://r0.unctad.org/ecommerce/event_docs/fossem/dzenowagis.pdf

2 Refer: www.ehealth-connection.org/content/country-case-studies 3 Refer: www.ehealth-

connection.org/files/resources/County%20Case%20Study%20for%20eHealth%20South%20Africa.pdf

4 Refer: www.drexel.com/online-degrees/information-sciences-degrees/cert-hci/index.aspx

5 Refer: www.drexel.com/online-degrees/nursing-degrees/medical-billing-coding/index.aspx

6 Refer: www.hon.ch/ 7 Monegain B (ed). Online info has patients doubting doctors, survey founds.

In: Healthcare IT News, 30 July 2008http://www.healthcareitnews.com/story.cms?id=9654

8 McConell H. Pardy Medical Publishing in Snyder et al. Medicine and themedia (in press), 2008.

9 http://econ.worldbank.org/WBSITE/EXTERNAL/EXTDEC/EXTDECPROSPECTS/GEPEXT/EXTGEP2008/0,,menuPK:4503385~pagePK:64167702~piPK:64167676~theSitePK:4503324,00.html

10 McConell H. Pardy Medical Publishing in Snyder et al. Medicine and themedia (in press), 2008.

Furthur readingBerger M. Nanotechnology patents and the future of the pharma industry.

Nanowerk LLC, 2007.http://www.nanowerk.com/spotlight/spotid=2912.php

Bernhardt JM. Health education and the digital divide: building bridges andfilling chasms. Health Education Research, 2000, 15(5):527-531.

Brodie A et al. Health information, the internet, and the digital

divide. Health Affairs, 2000, 19(6):255. Dzenowagis J. Bridging the digital divide in health: the role of free and open

source software. World Health Organization Expert Meeting on Free &Open Source Software UNCTAD, Geneva, 2004. Available at:http://r0.unctad.org/ecommerce/event_docs/fossem/dzenowagis.pdf

Improving health, connecting people: the role of ICTs in the health sector ofdeveloping countries. A Framework Paper, InfoDev, 2008.http://www.infodev.org/en/Project.38.html

McConell H. Pardy Medical Publishing in Snyder et al. Medicine and themedia (in press), 2008.

McConnell H, Shields T and Drury P. Leadership in Global HealthTechnology Update. World Hospitals and Health Services, 2006.

McConnell H and Marchibroda J. Leadership in Global Health Technology(LIGHT): an international dialogue towards cooperation in medicaleducation, clinical, and research initiatives in healthcare. World Hospitalsand Health Services, March, 2004.

Salamanca-Buentello F et al. Nanotechnology and the developing world.PLoS Medicine, 2005, 2(5): e97 doi:10.1371/journal.pmed.0020097.

Singh JP. Leapfrogging development? The political economy oftelecommunications restructuring. SUNY Press, NY, 1999.

Steinmueller E. ICTs and the possibilities for leapfrogging by developingcountries. International Labour Review, 2001, 140(2):193-210.

Tan-Torres Edejer T. Disseminating health information in developingcountries: the role of the internet. British Medical Journal, 2000,321(7264):797-800.

Warschauer M. Reconceptualizing the digital divide. First Monday, 2002,7(7). Available at:http://firstmonday.org/issues/issue7_7/warschauer/index.html

Global Economic Prospects 2008: Technology Diffusion in the DevelopingWorld. World Bank, 2008.

References



Innova on for health is a vital driver of development. Drawing new ideas and discoveries from research, it may cross many sectors and disciplines involved in the development and applica on of a novel product or process.

The Global Forum for Health Research focuses on promo ng an environment that fosters innova ve solu ons for the health of poor popula ons. In doing so, it places par cular emphasis on health equity as the central goal, i.e. reducing health dispari es within and between popula ons.

The fi h volume of the Global Forum Update on Research for Health provides insights into the newest thinking on innova on for global health. Some 30leading ins tu ons and professionals from around the world refl ect on how policy, social, technological and corporate innova ons can be fostered for global health.

This volume is produced to coincide with the Global Ministerial Forum on Research for Health, Bamako, which is co-organized by the Global Forum for Health Research.

www.globalforumhealth.org

EditorsMonika Gehner, Susan Jupp and Stephen A Matlin, Global Forum for Health Research

Pan American Health Organiza on

The Partnership for Maternal, Newborn and Child Health

Na onal Ins tute of Immunology, India

Pla orm on Agriculture and Health Research

European Malaria Vaccine Ini a ve

Universidad de la República, Uruguay

World Bank

PepsiCo, Inc.

Luis Gabriel Cuervo

Andrés de Francisco

Nirmal Kumar Ganguly

Stuart Gillespie

Odile Leroy

Judith Sutz

Alfred Watkins

Derek Yach

Editorial Advisory Board

ISBN: 978-2-940401-12-3

Global Forum

Update on Research for H

ealth Volume 5

Pro-Brook

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Update5_Global Forum Selection