Appropriate
Technology
For Global
Health
Nicholas Comninellis, MD, MPH
Institute for International Medicine
Presentation
Objectives
At the completion of this presentation,
participants will be able in the context of a
low-resource community to:
• Identify the controversies connected
with use of technology
• Select technology most appropriate for
given settings
Healthcare In Crisis
• Health is chronically in crisis, especially
in low resource communities.
• Wise leadership is essential by those
who understand the causes of ill health,
recognize effective interventions, and
possess the necessary diplomatic skills to
implement them.
Learn To Think Like A Leader
• Few are taught to think like
leaders in health. Traditional
medical training addresses
only individual patient care.
• Health leadership requires
skill. But more importantly, it
requires motivation and
perseverance. Armed with
these virtues, many health
professionals can become
effective leaders.
Learn To Think
About Health Systems
What Is A
Health System?
A Health
System:
• The way we go about organizing for better
health
• “The combination of resources,
organization, financing and management that
culminate in health services for people”
Why Consider Health Systems?
Why Consider Health Systems?
A wide variety of
interventions may
promote health, but
may also not be
appropriate or
efficient for a given
community.
What Basic
Ethical
Principles
Should Apply
To Health
Systems?
Ethical Principles For
Health Systems
• Sanctity of human life
• Alleviation of suffering
• Common good and
social justice (benefits
everyone)
• Effective use of
limited resources (cost
effectiveness)
Calculating
Cost-Effectiveness
Average cost of the intervention
Average number of Years of Life Saved
= Cost-effectiveness
Calculating
Cost-Effectiveness
Cost-effectiveness of measles vaccine in
West Africa:
$2 (vaccination cost per person)
5 Years of Life Saved
= $0.40 per Year of Life Saved
Calculating
Cost-Effectiveness
Cost-effectiveness of hypertension
control in West Africa:
$450 (HTN control cost per person)
5 Years of Life Saved
= $9 per Year of Life Saved
Effective use of
limited resources
includes
appropriate
application of
technology –
especially in lowresource settings
2008 Health Indicators
Nation
Life Expect @ Birth
Under 5
Mortality
Per Capita Health
Expenditure
All Low Income
59 years (M 58/F 60) 11%
$16
All Africa
51 (M 50/F 52)
16%
$33
Angola
41
26%
$16
Liberia
44
23%
$6
Niger
42
25%
$6
Sierra Leone
40
27%
$6
Zambia
43
18%
$18
Afghanistan
42
25%
$3
Iraq
56 (M 48/F 67)
5%?
$14
All High Income 80 (M 77/F 82)
0.7%
$2,672
What tests can be used to
determine whether a technology
is appropriate or not?
Reliability
Sustainability
Acceptability
What are some inappropriate
uses of technology in lowresource health systems?
Inappropriate Uses Of
Technology
Diagnostic imaging that is financially
unsustainable
Inappropriate Uses Of
Technology
Diagnostics & therapeutics that require
personnel with skills that are unavailable
Inappropriate Uses Of
Technology
Prescription of medications that are
unavailable or unfamiliar
Inappropriate Medications
“Our healthcare team saw a
Honduran lady who was treated
by an American physician for
her chronic neuropathic pain
with a newly marketed and
expensive medication. After the
physician left, the lady
developed severe adverse
effects, with no one to care for
her, let alone anyone who was
familiar with the drug…”
Nancy Crigger
Inappropriate
Medications
“While well intended, the physician's care was
neither sustainable nor safe. Even if the drug had
been effective, she would never be able to obtain
it in Honduras. Using prudence in prescribing
(limiting medications to those on the WHO
Essential Drug List) and making sure that a local
follow-up was in place may have helped the
physician avoid this precarious situation."
What are some appropriate
uses of technology in lowresource health systems?
Appropriate Uses Of
Technology
Rapid diagnostic tests
Appropriate Uses Of
Technology
Mobile health information and medical
record keeping
Appropriate Uses Of
Technology
Ultrasound imaging
Appropriate Uses Of
Technology
Adherence to use of
WHO & National Essential Drugs
How Can We
Keep
Technology
Appropriate?
Keeping Technology
Appropriate:
Partnerships With Local Hosts
The guidance of local partners
greatly increases the likelihood that
technology will be used
appropriately.
Partnership With Whom?
• Local healthcare
professionals
• Local healthcare
institutions
• Local educational
institutions
• Local government
agencies
• Local civic groups
Appropriate
Technology
For Global
Health
Reliability
Sustainability
Acceptability
Commit
Yourself To
Thinking
Like A
Leader
“I don't know what
your destiny will be,
but one thing I do
know: the only ones
among you who will
be really happy are
those who have
sought and found
how to serve.”
Albert Schweitzer
(1875 – 1965)
Institute for International Medicine
- Equipping healthcare professionals to serve the forgotten -
Nicholas Comninellis, MD, MPH
6400 Prospect Ave
Suite 338A
Kansas City MO 64132
816-444-6400
office@inmed.us
www.inmed.us