Millie Marriott Webb [A], Mr. William Bolton [B], Mr. Noel Aruparayil [B], Dr. Anurag Mishra [C] and Dr. Peter Culmer [A]
A. School of Mechanical Engineering, University of Leeds, Leeds, UK
B. Section of Translational Anaesthesia and Surgery, Leeds Institute of
Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
C. Department of Surgery, Maulana Azad Medical College, New Delhi, India
Many healthcare challenges in LMICs have remained unsolved for a long time. In Part 1, it became clear that innovations able to translate effectively to low-resource healthcare contexts could offer them a lifeline, both in this crisis and in the foreseeable future. Indeed, in response to outbreaks of COVID-19 in Africa, the WHO called for the exploration of the use of innovative and low-cost interventions .
So, from a healthcare perspective, LMICs are both where innovation is needed most and equally where the frugal, elegant, and rapidly mobilised technologies supporting HIC healthcare systems in this crisis originated. There is something we as innovators must learn from this to ensure a truly global response to crises such as pandemics. Firstly, reverse innovation should be viewed as the process of adopting the best innovation, from wherever it arises. But most importantly, innovators, wherever they come from, must start embedding equitable access to their crisis-critical innovations from the start of the design process, to ensure that healthcare services in LMICs get timely access to them.
How can we as innovators ensure LMICs and HICs benefit mutually from our creations?
Designs created must be tailored for successful dissemination in LMICs, which necessitates performing contextual research early in the development process, considering training and usability as well as the distribution and healthcare architectures in LMICs . For example, innovations might make use of the fact that mobile technology is widespread throughout healthcare settings in LMICs , or that 3D printing could be used to fabricate emergency medical supplies in remote areas where no manufacturer will deliver.
A simple way of obtaining contextual information is through collaboration with LMIC stakeholders in all design phases – from need identification to dissemination - and the implementation of frugal innovation principles. There are several useful resources to guide innovators in this process, such as https://www.designforhealth.org/, supported by USAID and the Bill and Melinda Gates Foundation, and the Four-Phase Roadmap developed at Delft University . There are also communities of global innovators to draw support from – global ‘collaboratories’ such as RAEng (https://www.raeng.org.uk/global) and Helpful Engineering (https://www.helpfulengineering.org/), as well as Global Health research groups funded by the UK’s National Institute for Health Research (NIHR) (https://www.nihr.ac.uk/explore-nihr/funding-programmes/global-health/).
While not a trivial process, consideration of and collaboration with LMIC stakeholders during innovation development is critical to realise high quality, disruptive innovations, like OneBreath Ventilators (http://www.onebreathventilators.com/), based in Bangalore, India, and ShiftLabs’ DripAssist (https://www.shiftlabs.com/), developed in response to the Ebola epidemic.
Figure 3: ShiftLab’s DripAssist 
Whether in times of global or local crises, these are the innovations changing healthcare systems in high-income and low-income countries alike. By considering the needs of LMICs, these innovators have not only ensured a long-term, sustainable market for their innovations in both HICs and LMICs, but they have saved countless lives in the process. With this priceless mutual benefit on offer, we innovators must embrace this approach, for ensuring the positive impact of our creations transcends the COVID-19 crisis, and lays the foundations for a new era of truly global healthcare innovation.
Click here to join GASOC’s own conference and virtual hackathon on the 25th May – to discuss addressing global surgery during virus outbreaks.
1. Tietze, F., Vimalnath, P., Aristodemou, L., and Molloy, J. April 2020. [Forthcoming]. Crisis-Critical Intellectual Property: Findings from the COVID-19 Pandemic. Centre for Technology Management Working Paper Series. [Online]. [04/05/2020]. Available from: https://ssrn.com/abstract=3569282
2. COVIDSurg Collaborative. April 2020. Global Guidance for surgical care during the COVID-19 pandemic. Br J Surg. [Online]. [04/05/2020]. Available from: https://bjssjournals.onlinelibrary.wiley.com/doi/full/10.1002/bjs.11646
3. Kleinman, Z. April 2020. Coronavirus: Can we 3D-print our way out of the PPE shortage? BBC News – Health. [Online]. [04/05/2020]. Available from: https://www.bbc.co.uk/news/health-52201696
4. MedTech Foundation. April 2020. Translate MedTech supports COVID-19 Innovation Response Hackathon. [Online]. [04/05/2020]. Available from: https://growmed.tech/news/translate-medtech-supports-covid-innovation-response-hackathon/
5. Hack Zurich. March 2020. Code Vs COVID19. [Online]. [04/05/2020]. Available from: https://www.codevscovid19.org
6. DEVPOST. March 2020. COVID-19 Global Hackathon. [Online]. [04/05/2020]. Available from: https://covid-global-hackathon.devpost.com/
7. Innovators Magazine. March 2020. MIT COVID-19 Virtual Hackathon. [Online]. [04/05/2020]. Available from: https://www.innovatorsmag.com/mit-covid-19-virtual-hackathon/
8. Philipp Grüll. March 2020. German COVID-19 Hackathon delivers more than 800 projects. [Online]. [04/05/2020]. Available from: https://www.euractiv.com/section/digital/news/german-covid19-hackathon-deliver-800-projects/
9. Royal Academy of Engineering. 2020. Project CARE (COVID-19 African Rapid Entrepreneurs). [Online]. [04/05/2020]. Available from: https://www.raeng.org.uk/policy/engineering-response-covid-19-coronavirus/project-care
10. University of Leeds. April 2020. Low-cost ventilatory support for covid-19 patients. [Online]. [04/05/2020]. Available from: https://medicinehealth.leeds.ac.uk/faculty-/news/article/397/low-cost-ventilatory-support-for-covid-19-patients
11. Diamedica. Product: Helix Portable Ventilator - Adult/Paediatric. [Online]. [04/05/2020]. Available from: http://www.diamedica.co.uk/english/product_details.cfm?id=1561
12. Global Health Research Group – Surgical Technologies. 2019. Gas Insufflation Less Laparoscopic Surgery (GILLS) Registry. [Online]. [04/05/2020]. Available from: https://ghrgst.nihr.ac.uk/gas-insufflation-less-laparoscopic-surgery-gills-registry/
13. Hopman, J., Allegranzi, B. and Mehtar, S. March 2020. Managing COVID-19 in Low- and Middle-Income Countries. JAMA. 323(16): pp. 1549-1550. [Online]. [04/05/2020]. Available from: https://jamanetwork.com/journals/jama/fullarticle/2763372
14. Nkengasong, J.N. and Mankoula, W. March 2020. Looming threat of COVID-19 infection in Africa: act collectively, and fast. Lancet. 395(10227): pp. 841-842. [Online]. [04/05/2020]. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30464-5/fulltext
15. WHO AFRO. March 2020. COVID-19 WHO African Region: External Situation Report 04. [Online]. [04/05/2020]. Available from: https://apps.who.int/iris/bitstream/handle/10665/331587/SITREP_COVID-19_WHOAFRO_20200325-eng.pdf
16. Bolton, W.S., Aruparayil, N., Quyn, A., Scott, J., Wood, A., Bundu, I., Gnanaraj, J., Brown, J.M. and Jayne, D.G. 2019. Disseminating technology in global surgery. Br J Surg. 106(2): pp. 34-43
17. Hall, C. S., Fottrell, E., Wilkinson, S. & Byass, P. 2014. Assessing the impact of mHealth interventions in low- and middle-income countries – what has been shown to work? Global Health Action. 7(1)
18. Oosting, R. M., Dankelman, J., Wauben, L. S. G. L., Madete, J., & Groen, R. S. 2018. Roadmap for design of surgical equipment for safe surgery worldwide. In E. Perkins, & S. Figueira (Eds.), Proceedings IEEE Global Humanitarian Technology Conference (GHTC 2018)  Piscataway, NJ, USA: IEEE. https://pure.tudelft.nl/portal/files/53515262/Roadmap_for_design_of_surgical_equipment_for_safe_surgery_worldwide_final_20okt.pdf
19. Avery Waite. March 2018. How a Simple Technology Can Deliver Equal Access to Global Health Care. [Online]. [04/05/2020]. Available from: https://medium.com/usaid-2030/controlling-the-flow-how-a-simple-technology-can-deliver-equal-access-to-global-health-care-b20583c4cd76)