Innovating to improve women and children's health

Lifespring is a rapidly growing chain of hospitals in India that provides maternity and delivery care. For one low price, as little as $90, it provides complete delivery services. This is one-third to one-half of the fees charged at other hospitals.

The first pilot hospital opened in 2005. Within a year, Lifespring grew to six hospitals. It now has nine and will open another six by the end of 2011. Each hospital aims to be profitable after 18 months. Lifespring's staff has delivered more than 10,000 babies.

"Like many social businesses, the genesis for LifeSpring began with the simple belief, that 'there has to be a better way'," says Anant Kumar who launched Lifespring.

This is one of many new ideas and innovative tools being published in a new report, Innovating for Every Woman, Every Child to improving health and save the lives of women, infants, and children in low income countries.

"Innovation is rapidly transforming the way health care is delivered in low income countries, especially for the 350,000 women who die each year from complications of childbirth and pregnancy and the 3 million children who succumb in the first month of life," says Tore Godal, M.D., PhD, special adviser to the Prime Minister of Norway, co-chair of the UN Secretary General's Every Woman, Every Child Innovation Working Group (IWG) and publisher of the new report.

"There are a multitude of ideas," says Scott Ratzan M.D., M.P.A., Vice President of Global Health for Johnson & Johnson, co-chair of the IWG together with Godal and also a co-author in the report. "We need to engage entrepreneurs in all sectors. They are potential game changers which can make a substantial contribution."

New report describes a new era and details projects

On September 12, the report is being published online by The Lancet and Every Women, Every Child, the website for the United Nation's Global Strategy for Women's and Children's Health. It was prepared as part of the UN Secretary-General Ban Ki-moon's "Every Woman Every Child" Initiative, a global strategy for improving women and children's health, launched last year.

The Secretary-General will revisit the strategy on September 20 at the UN General Assembly to review progress and to, once again, assess efforts toward meeting the two most elusive Millennium Development Goals, MDG 4 to reduce child mortality, and MDG 5 to improve maternal health. The United Nations set the Millennium Development Goals in 2000 with a target of ending poverty and improving global health by 2015.

The drive to provide health services for women and children in new, innovative ways has been bolstered by policy, service delivery and financial commitments amounting to $40 billion from governments, foundations, non-governmental organizations, the private sectors and others.

"Every Woman Every Child has catalyzed an ambitious but achievable set of commitments to improve the health of women and children around the world," says Robert Orr, Assistant Secretary-General for Policy Planning at the United Nations. "We are seeing a strong culture of innovation develop as we accelerate efforts. Progress in this area will have a great multiplier effect for all development goals."

Recently the IWG received 50 proposals on innovations that focus on women's and children's health and Saving Lives at Birth: A Grand Challenge for Development, sponsored by USAID, Norway, the World Bank, Bill and Melinda Gates Foundation and Grand Challenges Canada, received more than 600 proposals on innovation on the same topics.

Implementing successful innovations takes time, commitment, start-up funds, local support, and often public-private partnerships. IWG aims to bring 5 to 10 sustainable innovations to scale every year over the next three to five years.

Development, Beyond Assistance

Innovative projects pioneer a new approach to development. They focus not on assistance, but on creative, homegrown ideas with potential to be self-sustaining and serve the self-defined needs of a population.

"We need a fundamental change in our approach to development assistance," says Richard Klausner, M.D., also a contributor to the report and managing partner of the Column Group. "This is not a question of whether traditional aid and assistance programs work, but of reframing expectations about development. It is the time to confront the profound differences between development and assistance."

Some Innovative Approaches

Mobile phones are already a worldwide phenomenon; more than 1 billion women in low and middle-income countries own a mobile phone.

In some remote areas, health workers equipped with fetal monitors and wireless ultrasound transmit information by phone to a clinic; others use mobiles phones to keep track of high-risk patients and alert health workers when a woman is being referred to a clinic or simply to remind patients to keep appointments.

"We've seen the potential of mobile technology to improve maternal and newborn health outcomes worldwide, but innovators often meet obstacles when expanding their projects," said Kathy Calvin, CEO of the UN Foundation, a sponsor of Every Woman, Every Child and the mHealth Alliance, a partnership founded by the UN Foundation, the Rockefeller Foundation, and the Vodafone Foundation. "This report points to best practices, business models, and sustainability solutions that will help people break down these barriers and get to the important business of improving lives."

"Projects must respond to demand from the community and must become self-sustaining," says Dr. Klausner, a former director of global health for the Gates Foundation and of the US National Cancer Institute.

The mobile revolution demonstrates that uptake and scaling are possible when there is a demand and a sustainable business model. In the long run, a sustainable model for development needs to become increasingly donor-independent. This requires a clear understanding of both the beneficiaries and the payers on the demand side; households, government health systems, the private sector or a combination of them.

The report describes a number of innovative projects that are focused on improving the health of poor women, newborns and children.

• Cell-Life is a South African cell phone project to remind HIV positive mothers to keep appointments, bring infants for HIV testing, and, if needed, treatment. Forty percent of deaths of children under 5 in South Africa are due to AIDS-related illnesses, many because mothers are not able to bring their infants for treatment or drop out of programs.

In Cell-Life's program, mothers get short text messages for 10 weeks with helpful tips, and reminders to keep appointments and give medications. In a trial of 738 mothers, more than 90 percent of the 323 who got messages brought infants for testing, compared with 78 percent of those who didn't receive messages. The project costs $1.50 per mother to send messages, nothing to the mother who receives them. An estimated 80 percent of South Africans have access to mobile phones.

• The Clinton Health Access Initiative (CHAI) uses specially designed printers to reduce turnaround time from laboratories to clinic for critical HIV test results. Working with two engineers, CHAI modified existing printers to operate on Global Service for Mobile Communications (GSM) networks so that labs could send test results directly to battery-backed clinic printers.

After a successful pilot in Nigeria, which reduced the turnaround time from 33 to 14 days, the system is going nationwide. Already 50 printers have been installed for four laboratories, with another 200 ready to be installed. The government is stepping up their financing. Plans for expansion include automating and analyzing results and adding other tests to the system.

• D-Tree installs interactive software on mobile phones to help front-line health workers treat acutely malnourished children in Tanzania, where about 6 percent of children are malnourished and as many as 30 percent die. Guidelines for treating acute malnutrition are complex and may need to be highly individualized.

In Zanzibar, where the system was tested, the software equipped phones helped health workers calculate correct weights and treatments. This is communicated directly with mothers. The phones, which cost about $120 a month for each health worker and $1.33 for each child, provide a low cost way to treat malnutrition.

• colalife. As many as 20 percent of children in the developing world die of easily treated diseases, such as diarrhea, before the age of 5, even though inexpensive and effective treatments are available.

But these treatments are not always accessible where they are needed, mainly in remote, rural areas where little medical help exists. Yet somehow Coca-Cola is always on hand.

That's why Simon Berry came up with the idea of using the Coca-Cola supply chain to take anti-diarrheal kits to remote, rural areas where local entrepreneurs could sell them. At this writing, colalife is being tested in Zambia.

"We know how to save lives of women, newborns and young children," says Carole Presern, PhD, a midwife and director of The Partnership for Maternal, Newborn & Child Health, which has 400 members including governments, foundations, non-governmental organizations, universities, the private sector and others. "As these and other technologies are scaled up, we will be much more effective in our job."