There is a simple formula for shortlisting innovations with the greatest capacity to achieve the new Sustainable Development Goals for women’s and children’s health: Step 1: Isolate the largest populations where preventable deaths among women and children are concentrated and identify their leading causes. Step 2: Determine the innovations that target the leading causes most cost-effectively. Step 3: Invest in the development and uptake of these innovations in ways that strengthen local economic development. A critical point that is too often overlooked – the secret of success lies not just in the what of health innovations (Step 2), but in the where (Step 1) and the how (Step 3).
It all starts with the where.
More than 80 percent of the estimated 3.2 million women who die before they turn fifty and the 6.3 million children who don’t make it to five live in South Asia and sub-Saharan Africa, where just five countries are responsible for more than 40 percent of all deaths – India, Nigeria, Pakistan, Democratic Republic of Congo, and Ethiopia. Deaths are not evenly spread in these countries but cluster in specific sub-regions, especially the northern States of India and Nigeria, the heavily populated eastern Provinces of Pakistan, the northern Provinces of the Democratic Republic of Congo and the central regions of Ethiopia. As many of these areas are experiencing rapid urbanization, deaths are no longer clustered in rural regions alone.
And what is killing women and children in these areas?
Essentially the same few causes. For women of reproductive age (15 to 49), HIV-AIDS, deaths in pregnancy and childbirth, tuberculosis, heart disease, and self-harm are the top five leading causes of death, while among children under five, pneumonia, preterm birth, birth trauma, malaria and diarrhea dominate. Innovations with proven capacity to cost-effectively prevent, diagnose and treat these ten threats are our best bets to accelerate achievement of the new global health goals.
Putting all of this together and coming up with a priority list of the highest-impact medical innovations is not difficult.
For women, new technologies that can prevent the spread of HIV/AIDS and TB by making rapid testing easy, accurate and closer to home are a top priority. Diagnostic tests that can identify women at high risk of pregnancy complications early on could prevent many maternal and newborn deaths. Integrated diagnostic platforms that include the major infectious diseases and chronic conditions that threaten healthy pregnancies are also desperately needed. Invisible, long-lasting, self-administered contraceptive devices that combine protection from sexually transmitted diseases are potentially transformative. And the entire field of innovations that reduce the burden of mental health disorders among women in low resource settings is wide open. For children, devices that can quickly, accurately and easily identify pneumonia together with new devices to deliver oxygen (e.g. bubble CPAP, oxygen concentrators) are needed to drive down the high death toll from pneumonia. For malaria endemic countries, the holy grail is a rapid diagnostic test that can identify viral pneumonia, bacterial pneumonia and malaria in minutes. And an entire suite of products is needed to retool the NICU for low resource settings, ranging from resuscitation devices to infant warmers to human milk banks.
How these innovations are developed, financed and ultimately made available to these target populations matters.
Innovations that emerge from their country contexts or that are sourced elsewhere and adapted locally by local institutions, often in partnership with external stakeholders, stand the best chance of success. As private financing for development now dwarfs foreign aid by more than 8 to 1, investment vehicles that crowd in private capital have the greatest potential for impact. These vehicles will need to work in close partnership with public sector stakeholders – at the local, national, regional and global levels – who can smooth the path to impact by subsidizing the costs of early stage innovation (e.g. R&D and pilot testing costs), by building a robust pipeline of investable high-impact projects that are ranked according to global health impact, and by connecting all of the partners. And as the private health sector dominates in many of the countries with the steepest health challenges, the path to impact for many of these innovations travels right through local private health sectors.
Not every innovation will be equally important in every setting.
Africa’s higher fertility rates and infectious disease burden make contraceptive and infectious disease diagnosis and treatment technologies highly prized, while South Asia’s higher burdens of maternal and newborn deaths and non-communicable diseases call for innovations that reduce the risks of pregnancy and childbirth, and relieve the growing chronic disease burden. Where investment vehicles can use their private sector capital and expertise to match the innovations to the markets where they can save the most lives, they will make a major contribution to the achievement of the Sustainable Development Goals. For these vehicles, success will be measured in the scale of lives saved and sickness averted, and in the way their investments lay a solid foundation for local medtech market development. Further, where private medtech dollars – offered as loans, subsidies, guarantees, grants and/or equity – find their way to companies that pursue shared value strategies and/or to local start-up social businesses they have the potential to leave a lasting legacy of better health for future generations of women and children.