Placed on a hospital cupboard about two meters from the ground, the little box glows with a brilliant blue light, beautiful in the dark. Unlike the normal incubator used in Paediatric Intensive Care Units (PICU), the box measures approximately about 1m x 0.5m x1m (3ft x 2ft x 2ft) and weighs a little above 5 kilograms (11 pounds) . This box has saved the lives of many babies since a young mother and her team first produced it, three years ago.
Originally conceived, designed, tested and launched in Yenagoa, Bayelsa State, the box now sits in the paediatric units of various hospitals in the Federal Capital Territory (FCT), including Maitama, Wuse and Asokoro District Hospitals.
Named Crib A’Glow, it is a low-cost phototherapy solution to treat newborn babies with neonatal jaundice. It was developed by a young mum and professional graphic designer, Virtue Oboro, after her son’s experience with jaundice. With a group of medical professionals and biomedical engineers, she built a prototype, but it took four failed attempts and several trials before the product worked and she started her company, Tiny Hearts Technologies.
Addressing a Silent Child Killer
Data from the World Health Organization’s Global Health Observatory shows that in 2017, newborn deaths accounted for 47% of deaths among children under five, and in 2016, 1 million children died as a result of complications arising from premature births. While jaundice occurs in about 50% of babies reaching full term, it occurs in 80% of preterm babies. A paediatric specialist at the Asokoro District Hospital in the FCT estimates that 8 out of every 10 premature births in their unit have the condition.
Image credit: Nigeria Health Watch
Jaundice is usually caused by an excessive build-up of bilirubin, a substance made when the body routinely breaks down red blood cells. However, a newborn’s still-developing liver often cannot remove bilirubin quickly enough, causing an excess. Another predisposing factor is Rhesus (Rh) incompatibility between a mother and her baby. Although a small number of babies have different rhesus blood types from their mothers, these mismatches can lead to jaundice. Occurring in the first few days of life, the most notable symptom is a yellow colouration of the skin, which with time, is also observed in the whites of the eyes. While many mild cases do not require treatment, the common treatment for severe jaundice is phototherapy which involves placing the baby under a special type of light that helps break down the excess bilirubin.
A harrowing experience with jaundice
If the bilirubin isn’t broken down quickly enough, it can lead to death or severe disability. Early detection is therefore very important because the symptoms can be missed by new mothers. In the case of Oboro, she thought her son, Tonbra, “just had a fair complexion.” Oboro was discharged from the hospital about 48 hours after delivery, and it wasn’t until her mum, a nurse, came visiting that she realised the yellowish colour was unusual. Once they returned to the hospital, little Tonbra was diagnosed with jaundice. Oboro described the experience that followed the diagnosis as “harrowing“, as the excitement of the birth of her first son was replaced with fear and uncertainty, especially when she learned of the possibility of brain damage if the diagnosis was not properly handled.
With all phototherapy treatment units in use at the PICU of the hospital where Tonbra was admitted, a mother whose baby had almost recovered asked that her baby be discharged to give baby Tonbra a chance. Almost immediately, he was placed inside the phototherapy unit, but then, there was a power outage and other alternative sources of power in the hospital failed. The doctors performed an emergency blood transfusion which sustained him until he was able to access a phototherapy unit. After about a week, Oboro returned home with her baby but the experience was not to leave her for weeks.
Nurses at Wuse General Hospital search for space to place the Crib A’Glow phototherapy unit. Photo source: Tiny Hearts
Necessity usually leads to invention but for Oboro, it was a combination of the near-death experience of her son, curiosity, a passion for problem-solving and empathy for other babies who might face similar situations, that led to the development of Crib A’Glow.
Once she and her son had recovered from the experience, she set out to learn more about jaundice and possible ways for other parents and healthcare providers to overcome the challenges they had faced. The main problems turned out to be lack of quick access to treatment and unstable power supply.
After extensive research, Oboro and her team came up with Crib A’Glow, a simple solar-powered phototherapy system that can be easily moved around to locations where it is needed.
Powered by the sun, the unit solves the problem of unreliable power supply. It also improves ease of access as the equipment can be easily disassembled and moved from one location to another where it is needed urgently.
As a social enterprise, the company is sustained by selling and hiring out the Crib A’Glow phototherapy units. A unit sells for N150,000 and can be rented at the rate of N3000 for 24 hours. Tiny Hearts Technologies also produces disposable phototherapy blindfolds, conducts training programs and recently launched a sensitisation initiative called Yellow Alert to help raise awareness about neonatal jaundice among pregnant women.
Medical staff at the neonatal and pediatric unit in Asokoro District Hospital watch a demonstration of the Crib A’Glow phototherapy unit. Photo source: Tiny Hearts
Beyond Bayelsa: Scaling up a home-made solution
Since the inception of Tiny Heart Technologies in 2016, over 1250 babies have benefitted from their initiative, says Oboro. For her, the task of pitching their services to hospitals is a difficult process because most times, they are met with scepticism. “They usually prefer big equipment from big companies outside Nigeria and usually don’t want to try homemade solutions,” Oboro said. However, they continue inventing strategies to win them over. She recounted how such efforts saved a baby’s life and led to bringing the Crib A’Glow unit to three hospitals in the FCT.
In February 2018, Oboro walked into the paediatric intensive care unit of the Niger Delta University Teaching Hospital (NDUTH) in Yenagoa, Bayelsa state capital. Her mission was to retrieve the phototherapy unit she had rented to the hospital for use. An attending paediatrician told her that a baby was to start treatment with the unit, but the parents were unable to afford it. After hearing the story and with a plea from the doctor to assist, she decided to see the baby.
Medical staff at Wuse General Hospital receive a free unit of the Crib A’Glow phototherapy equipment from Tiny hearts technologies. Photo source: Tiny Hearts
Baby Ndukwe, as he was called, had jaundice but presented at the hospital when complications had set in. His parents had turned to herbal remedies when they first noticed he was sick. On seeing the state of the baby, Oboro decided to assist by starting a fundraiser for him even though it was out of their line of business. She got consent from the parents, took baby Ndukwe’s picture and asked for financial help through her WhatsApp network. Within 24 hours, over N70,000 was raised. This helped offset his medical bills, rent the phototherapy unit for the duration of his treatment and even covered the next baby in need of treatment.
Someone who donated to the fundraiser for baby Ndukwe bought three units of the phototherapy unit and anonymously donated them to three hospitals in Abuja. Oboro said the donor’s motivation was simple. “She said since the Crib A’Glow helped save the life of one baby, she wanted to extend that opportunity to other babies who might need it,” she said.
Twin babies placed inside a Crib A’Glow phototherapy unit in a private hospital in Bayelsa. Photo source: Tiny Hearts
Can Nigeria sustain innovative homegrown start ups?
The challenges with the Crib A’Glow solution are not different from other Nigerian start-ups and largely revolve around the cost of running a business, hiring and retaining talent, government support and regulations. But as a Nigerian medical equipment and device start-up, Tiny Hearts Technologies has its unique set of challenges too, one of which is the inherent preference for imported products. Oboro said this is one of their biggest challenges because it’s difficult to convince hospital executives to adopt their solution.
The cost of using the equipment is another challenge. Hospitals that rent the units need to make profit because they are running a business. This is likely to increase the cost for patients’ relatives and introduce a barrier to access. This can be overcome if there is an effective health insurance system that covers citizens in the formal and informal sectors.
The Crib A’Glow phototherapy unit was donated to Maitama District hospital by an anonymous donor after it saved a baby’s life in Bayelsa. Photo source: Tiny Hearts
A challenge which raises an important question is the issue of patents and protecting intellectual properties. How well are these innovations protected especially in a highly competitive market like Nigeria? Oboro says she has a patent right which offers protection for her design. The legal framework for patents is enshrined in the Patents and Designs Act of 1971. In place for nearly five decades now, is the Act still in tune with current realities, and able to protect young inventors?
Globally, there is a need for affordable technologies to tackle neonatal jaundice. The Crib A’Glow is one of such but for it to thrive, we must develop a culture of adopting and supporting Nigerian-made solutions once they are proven to be effective. The team has plans of expanding to other African countries but charity, they say, begins at home. Let us adopt and use our own, so that other babies like Tonbra and Ndukwe can be given a fighting chance.
By Chibuike Alagboso (Lead Writer)
Universal Health Coverage: Local action driving universal achievements
The world has never been as aligned on a common global health priority as it is now on universal health coverage. It is a global imperative for cohesive societies and economic prosperity. A consensus has existed since 1948 that health is a human right, and the call for health for all has been a lingering voice since 1978 at Alma-Ata. But there has never been such high advocacy as there is today with the current call for universal health coverage with access to essential services for all without financial hardship.
The United Nations High Level Meeting on 23 September 2019 in New York may be the climax of this building advocacy. Despite this celebratory moment, there remains a real fear that the political endorsements, high fives, dinners and numerous side events, will bring little change for half of the world’s population, living in Malawi, Vietnam, Somalia and other countries. This includes large numbers of people living in developed countries such as the United States who still do not have full coverage for essential health services.
As the world converges in New York this September, many issues will need to be prioritised. The UHC2030 movement, through its various multi stakeholder constituencies and wide-ranging consultations, has identified six key areas of focus. They start with political leadership beyond health and commitment to health as a social contract. Health is the foundation for people, communities and economies to reach their full potential – and the achievement of universal health coverage is primarily the responsibility of governments.
Governments ensure that people’s health is a social contract, noting that achieving universal health coverage is essential for inclusive development, prosperity and fairness. It requires political decisions that go beyond the health sector.
Second, half the world’s population is left behind. That includes the poor, migrants, criminalised populations and women. Health is enshrined as a fundamental right of every human being. Universal health coverage is key to reducing poverty and promoting equity and social cohesion.
Extending geographic coverage and reaching the most marginalised and hard-to-reach populations are essential to achieving positive health outcomes. For real action in all communities, governments must commit to report disaggregated data for the official statistics compiled on the Sustainable Development Goals in order to capture the full spectrum of the equity dimensions of universal health coverage.
The third priority is to ensure that governments create a strong, enabling, regulatory and legal environment that responds to people’s needs and builds institutional capacity, so the rights of people and their needs are met. There is no debating the fact that governments bear this primary duty under the International Covenant on Economic, Social and Cultural Rights.
The fourth call is to uphold the quality of care by building health systems that people and communities trust. That starts with primary health care as the backbone of universal health coverage. It is best achieved through creating confidence in public health systems that respond to people’s needs and deliver desired outcomes.Where private health services are required, leadership should come from the public sector.
The fifth call is for leadership through public financing and efficiency by investing more and investing better through sustainable public financing and by harmonising health investments from all players including development assistance and the private sector. Governments must adopt ambitious investment goals for universal health coverage and make progress in mobilising domestic pooled funding towards existing targets, such as 5% of gross domestic product or the African Union’s Abuja Declaration of 15% of government expenditure. This funding should be equitable and driven by the need to reduce impoverishing and catastrophic out-of-pocket expenditures for communities.
Furthermore, development assistance for health should reduce fragmentation and strengthen national capacities for health financing.
Finally, and in line with SDG 17 on the need for partnerships – and in recognition of the fact that health can only be achieved by a whole-of-society approach – countries should take active steps to engage non-state actors more meaningfully. In providing clear direction from the public sector, civil society and the private sector, they too can shape the universal health coverage agenda.
As in many other sectors, there is no one-size-fits-all answer. Solutions for each country must be tailored to that country’s particular context and population needs. The international community and global health partners should unite to support all countries to build a healthier world. The UN High Level Meeting in September must therefore reach high enough to mobilise political leadership but local enough to drive meaningful country action.
Githinji Gitahi joined Amref Health Africa as the group chief executive officer in June 2015. He is also a member of the Private Sector Advisory Board of Africa CDC, the Global Health Investment Advisory Board, and of the World Health Organization’s Community Health Worker Hub. Gitahi is co-chair of the UHC2030 Steering Committee, a global World Bank and World Health Organization initiative for universal health coverage. Gitahi has a doctor of medicine degree from the University of Nairobi and a master’s in business administration from United States International University.
GE Healthcare Advancing Universal Health Coverage in Ghana
GE Healthcare’s Eyong Ebai, General Manager West Central & French Sub-Sahara with Hon Alexander K. K. Abban Ghana’s Deputy Minister of Health, Farid Fezoua President & CEO GE Healthcare Africa and Sulemana Abubakar, CEO GE Ghana during Ghana Healthcare Dialogues event. Source: GE
A key highlight of the event was the unveiling of GE Healthcare’s new budget-conscious ultrasound system, the Versana Essential
ACCRA, Ghana, June 12, 2019 – GE Healthcare has kicked-off a two-day “Healthcare Dialogues” event in Ghana, bringing together public and private sectors’ industry stakeholders including policy makers, healthcare professionals, decision makers, academia, investors and financing institutions to drive conversations around innovative sustainable healthcare solutions to help progress Ghana’s Universal Health Coverage (UHC). Under the theme of Elevating Healthcare through Collaborations, key topics to be discussed include Structuring Innovative Healthcare Financing Solutions; Ghana’s Vision for UHC; the Future of Radiology with Artificial Intelligence (AI); Healthcare Technology Innovations, among other topics.
A key highlight of the event was the unveiling of GE Healthcare’s new budget-conscious ultrasound system, the Versana Essential. It has excellent image quality and can be used by obstetricians and gynecologists, family and general practice physicians, and clinicians in a number of other specialties, making healthcare accessible to promote maternal healthcare in Ghana. It also comes with local product and clinical training backed with GE’s solid aftersales service to help healthcare professionals gain comfort and proficiency with the system to enhance patient care.
“Promoting health for all is key in accelerating Ghana’s vision for Universal Health Coverage,” said Eyong Ebai, General Manager, GE Healthcare West Central Africa & French Sub-Sahara Africa. “Through collaborations, continuous investment in sustainable healthcare solutions and capacity building, GE Healthcare will continue driving access to quality and affordable healthcare in the region.”
Ghana has been recognized for its commitment to address barriers to health care services and attainment of UHC by 2030 by providing formal support to its vulnerable population through its National Health Insurance Scheme (NHIS). In 2018 https://bit.ly/2ZnK1yV, NHIS had increased to about 11 million people from the 1.3 million memberships at inception in 2005, representing 38% of Ghana’s population. In addition, the healthcare system engages over 4,000 public and private providers and accounts for about 85% of its internally-generated fund.
“We are proud to host the GE Healthcare Dialogues in Ghana and provide a platform for the industry stakeholders to advance the country’s healthcare agenda,” said Sulemana Abubakar, CEO GE Ghana. “This is a testament of our role as a global leader with local presence, to drive better outcomes for people in the markets in which we operate.”
GE started its operations in Ghana in 2010 with only 5 employees and has grown to 100+ employees currently 90% Ghanaians, with two offices in Accra and Takoradi. Through strategic partnerships and localization commitments, GE is supporting co-creation of solutions to tackle key challenges in Healthcare, power and oil & gas to help improve life for the people of Ghana. GE Healthcare in collaboration with the Ministry of Health and the Ghana Health Service is also training and equipping healthcare professionals at the primary healthcare level with over 500 portable ultrasound machines across 125 of Ghana’s 216 districts. As a result, 1.5 million expectant Ghanaian women are expected to benefit from the initiative by 2020.
Engaging community healthcare workers in addressing primary healthcare crises in Nigeria
Image credit: VON
We are currently facing a primary healthcare crisis in Nigeria and speedy intervention is needed to salvage and enhance access to health care for our ever growing population.
Community health workers have the potential to enhance primary care access and quality, but remain underutilised in Nigeria.
A WHO report by Uta Lehmann and David Sanders from the School of Public Health University of the Western Cape, says;
‘The use of community health workers has been identified as one strategy to address the growing shortage of health workers, particularly in low-income countries. Using community members to render certain basic health services to the communities they come from is a concept that has been around for at least 50 years. There have been innumerable experiences throughout the world with programmes ranging from largescale, national programmes to small-scale, community-based initiatives’ (Evidence and Information for Policy, Department of Human Resources for Health Geneva, January 2007)
It is common knowledge that we do not have trained physician associates or assistants in primary care facilities to support medical doctors in providing primary care services; rather what we have in some communities are quacks, people parading themselves as medical doctors with no medical qualification what so ever.
But I don’t see any reason why we should not welcome the idea of training physician associates or assistants to fill in the gap for medical staff shortage, when other developing and developed countries that have better healthcare systems do have them.
In Nigeria we do not have enough doctors per population or geographical area, This is the time to train up more community health care workers as this would help in the much needed awareness creation and community based interventions for managing long term conditions, reducing childhood illnesses due to lack of immunisation. Trained birth attendants will also help reduce maternal mortality and community nursing care will reduce infant mortality.
In a typical medical centre in the UK for instance, healthcare assistants, advanced nurse practitioners, health trainers, clinical pharmacists or prescribers, work alongside doctors to provide patient centered care. This helps to reduce the work load on the doctors as these other clinicians and allied health workers have enough training and experience to manage long term conditions and participate in triage system.
In the UK, a lot of research has been done and there are calls to increase the health work force in the National Health Service (NHS) through the utilisation of community-based lay workers.
Below is an extract from a research published in the journal of Royal society of medicine curated by Dawn O’Shea:
‘’Introducing a workforce of community-based lay health workers in the NHS could address current general practitioners (GP) workload demands, while improving clinical outcomes, according to research published in the Journal of the Royal Society of Medicine.
In the 1960s, programmes in the US funded members of the community provide a bridge between patients and health care providers. By facilitating appointment-keeping and increasing medication compliance, community health workers improved access to and quality of health care, while reducing costs.
In Brazil, community health workers receive basic training in disease identification and monitoring, immunisation, screening and health promotion. They support patients with medication adherence and chronic disease monitoring and liaise proactively with GPs and practice nurses…..
The authors conclude that systematic integration of community health workers at scale in the NHS could be an effective and a rapidly implementable approach to the current primary care workload crisis’’.
(Hayhoe B & al. | J R Soc Med | 4 Oct 2018 from Dawn O’Shea | UK Medical News | 8 Oct 2018)
Another important area where the community healthcare workforce could be utilised effectively is emergency care or first aid. In most public and private places in Nigeria, there are no ambulance or paramedic services; having well trained community first aid responders would go a long way to save lives in times of emergency for example; cardiac arrest, collapse, and respiratory distress. Having a health unit manned by well-trained first aid responders in all public places like markets, motor parks etc is highly essential.
Healthcare provision anywhere in the world is capital intensive but we can start from the basics; we can reduce the burden or costs in secondary healthcare provision especially in our public hospitals if we lay more emphasis on patient health education and encourage people to engage in healthy living and self-care. Integrated healthcare practice at all levels is an efficient way of providing patient centered care where every member of the healthcare team contributes their quota.
Community healthcare workers are well placed to offer advice on healthy living and self-care in the language people of a specific demographic area would understand.
Hypertension, Chronic Kidney Disease, Type 2 diabetes mellitus, malaria, HIV/AIDs are among the diseases that could be prevented or well managed through patient education and lifestyle advise.
The role of health education cannot be overemphasized. For instance, there is still some form of stigma around epilepsy in some areas in the country; where people who are epileptic are believed to be possessed by some sort of evil spirits, in an unfortunate event of epileptic fits in public places, patients are not well cared for and objects like spoon etc. are inserted into their mouths in the believe that it keeps the airways open, this could be a choking hazard and has made recovery time worse for some patient. Community healthcare workers could perfectly fill that gap of providing basic health education and public health enlightenment.
In conclusion, addressing the primary healthcare crises in Nigeria is no mean feat, but we need to look at the issue holistically, it involves a multifaceted, public and private partnership, but the Government has to lead on this through the inaction of relevant laws and provision of training programmes, monitoring and evaluation etc.
Without health, life is not life; it is only a state of languor and suffering.
Clinical Pharmacist/UN SDG Advocate
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