They say necessity is the root of all innovation - or at least, innovation should be rooted in addressing a real need. So, it might be unsurprising that many of the most impactful health innovations we see today didn't evolve in the shiny high-spec labs of the worlds largest pharma companies, or the meeting rooms of prestigious medical schools, but rather, in low and middle income countries (LMICs) where there was no other option - these were not nice-to-haves, they were must-haves.

Headline Photo Credit: Last Mile Health

A plethora of high impact innovations have expanded on the ground across a multitude of low and middle income settings, providing access to those who did not have it before and giving support to those most in need. This particularly resonates when you consider the record amount of capital being pumped into digital health year-on-year, versus the scarcity of health outcome success stories.

Whether you're considering a potential digital health collaboration in a LMIC context or craving for some super-charged success stories of real outcomes, here is a round-up of essential insights to whet your appetite and expand your knowledge of the great work happening in low resource settings.

With that in mind, we are delighted to announce that our November Global Gathering will be taking place in Mumbai, India in collaboration with our Members at Abbott! You can now register for your place at the gathering here. Global healthcare markets are undergoing dramatic change and India is one of the largest and most important markets in the world. This event will bring together key stakeholders from right across the healthcare continuum to discuss, debate and understand the opportunities, challenges and healthcare models in operation now and into the future. This event will allow attendees to understand first-hand the cost efficient, innovation paradigm at work in India – innovation solutions that can be exported to other markets throughout the world.

Babylon Health Rwanda - GP on Demand

What do you think of when you hear 'Healthcare in Rwanda'? What should spring to mind is a country where 90% of the population is covered by health insurance (the U.S was reported to have 11.3% of their population uninsured in 2017) and 93% of children are vaccinated against common communicable diseases. A country that has systematically increased their populations life expectancy by 19 years since 2000 though highly innovative efforts in policy and implementation. For any country these are impressive measurers - let alone for a country that was forced to rebuild following the 1994 Genocide.

A large part of how Rwanda has made healthcare so accessible was through the deployment of community health workers (CHWs) to the country’s 15,000 villages. Replicating this success and supplementing the human resources for health that do exist Babylon Health entered the market with the support of the Rwandan Ministry of Health.

Babylon Rwanda uses a combination of artificial intelligence and machine learning with live doctors and nurses to provide medical consultations to anyone with a mobile device. Like the NHS GP at Hand service, Rwanda operates a Universal Health Coverage Scheme where Babylon services are available free of charge at point-of-use to all Rwandans, in partnership with the Rwandan MoH.

Like many African countries Rwanda has leapfrogged the landline and now boasts over 75% mobile penetration, however, there is a lower level of smart phone utilisation so Babylon have developed a USSD version of their telehealth solution. Anyone with access to a mobile phone can simply dial 811#, register for the platform and access the healthcare services of Babylon. Since the 2016 launch of Babylon Health in Rwanda, the service has been used by more than 2 million people, approximately 30% of the nation’s population.

Last Mile Health - Digitally Enabled CHWs

According to the World Bank and WHO half the world lacks access to essential health services and for almost 100 million people essential healthcare expenses are high enough to push them into extreme poverty, forcing them to survive on just $1.90 or less a day.

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Last Mile Health, founded by Dr Raj Panjabi (watch his TED talk above) in Liberia in 2007, is laser focused on their mission save lives in the world's most remote communities with digitally enabled Community Health Workers (CHWs). Liberia emerged from more than a decade of civil war in 2003, leaving a devastated healthcare system in its wake with only 50 doctors remaining to treat a population of more than four million people so there was a very clear need to innovatively address this substancial human resource for health challenge.

Last Mile Health, in partnership with Living Goods and leading philanthropists, has the audacious goal to deploy 50,000 digitally-empowered CHWs to provide lifesaving healthcare to 34 million people across six countries in East and West Africa by 2021. Last Mile Health leverages mobile systems to allow CHWs to access diagnostic support of the deadliest conditions, and captures accurate, real-time data to manage thousands of rural health workers. A second digital innovation stream which is being rolled out by Last Mile Health is their online Community Health Academy, targeted at training of health workers and health systems leaders in Liberia and beyond.

To date Last Mile Health has recruited and continues to support a total of 281 CHWs across two counties. With this Last Mile Health have treated 10,000 cases of childhood illness, conducted 3,800 pregnancy consultations and 12,000 malnutrition screenings. The future is bright for this organisation who have their sights set on expanding beyond Liberia in the coming years.

Read Last Mile Health's recent BMJ op-ed with the Liberian Minister of Health here.

GenomeAsia - Genetically Representing the Under-Represented

GenomeAsia are a mission driven non-profit consortium collaborating to sequence and analyze 100,000 Asian individuals genomes to help accelerate Asian population specific medical advances and precision medicine with all data open to the public.

The genetic diversity in Asia provides valuable clinical insights that should enhanced our understanding of disease biology. In addition despite being >40% of the world’s population Asians are pointedly underrepresented in current genomic studies and reference genome databases.

The first major hurdle for GenomeAsia is to create a reference genome from 10,000. After the reference genome is created it will be followed by sequencing an additional 90,000 individuals and combined with clinical and phenotype information to allow deeper analysis of diseased and healthy individuals.

The second moonshot for Genome Asia will be to parse genomics and clinical ‘big-data’ sets, leveraging advances in data science and artificial intelligence to build upon their insights into the genome diversity. This data will then be made publicly available for further research. Nearly 60 petabytes of data, the equivalent to 30 trillion pages of text are expected to be churned out in this study.

“Advances in sequencing, computing and mobile access mandates that we begin to study these underrepresented Asian populations” - Dr Stephan Schuster

The GenomeAsia project has peaked the attention numerous actors in the space, and rightly so. The unique nature of genetic diversity in Asia, in particular in the Southern and Eastern countries, has been hailed as promising an invaluable source of clinical insights into the most prevalent causes of morbidity and mortality in the world cancers and diabetes.

AIME - AI Powered Medical Epidemiology

Finally, the AIME platform, created under the leadership of Dr Dhesi Raja, strives to provide its public health leader users with the exact geo location and date of the next infectious disease outbreak, such as dengue fever, in a timely and impactful manner.

Along with the prediction, AIME incorporate a fully customizable analytics platform, to make sense of users public health data, providing time charts, historic mapping of diseases, reports from social media, and much more.

The AIME platform can provide insights 3 months in advance of an outbreak of infectious disease with an 86.37% accuracy. The organisation is looking forward to eventually apply their model for AIDS, Tuberculosis, Malaria, and other neglected tropical diseases, recognised by the UN as essential focal points in meeting the Sustainable Development Goals (SDGs).

"Global Health should move from reacting to contain an outbreak to predicting it in real time in order to mitigate it in advance. We need to be ready for the next Pandemic" - Dr Dhesi Raja

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So, what can we learn?

In short we can learn a lot from looking at the above innovations in an effort to deliver on the promise of digital health:

1. Embrace frugal innovation - more capital does not necessarily mean more effective interventions
2. Put the problem before the solution and maintain that focus
3. Not all innovation is disruptive - understand existing systems and skateholders before you try and overhaul them
4. Closely consider the determinants of health - are you addressing a cause or a symptom?
5. Collaborate with varied stakeholders, and avoid top down innovation at all costs. Sustainable and scalable innovation in healthcare will be driven by those who understand the context

If you are interested in exploring the potential for collaborative opportunities in emerging markets or simply exploring this topic further with the HealthXL Community feel free to reach out on hanna@healthxl.org - we would love to hear your thoughts.

Don't forget to RSVP for the Mumbai Gathering in November to learn more about what our Members are working on in emerging markets!

About HealthXLHealthXL is a data-driven global digital health collaboration platform purpose-built to access and connect the brightest minds in healthcare leadership today. The company serves as a bridge, linking together the people, thinking and technology needed to drive innovation to address complex challenges facing the industry. Offering a combination of research, international gatherings and evidence-based viewpoints from the company’s select community of experts, members are able to directly access and contribute thought leadership insights, cultivate meaningful partnerships to drive change and actively participate in the most critical conversations and strategies that are shaping the future of modern health. The HealthXL community comprises healthcare, pharmaceutical and medical device industry visionaries, clinicians, investors, researchers and entrepreneurs. Member organizations revolutionizing the delivery of healthcare today include but are not limited to Abbott, Bayer, BMS, Cardinal, Cleveland Clinic, CSIRO, GE, GuideWell Innovations, IBM, Imperial College Health Partners, J&J, Merck, Partners Healthcare, Philips, Northwell Health, Novartis, Murdoch Children's Research Institute, ResMed and Roche.

For more information, please visit us at https://healthxl.com or engage with us on Twitter or LinkedIn or reach out to a team member directly hanna@healthxl.org