A Lesson in Development: How to continue the work of MED International

Last June, we arrived in Tanzania with laptops, business plans, and sales presentations in hand – ready to observe, adapt, and pitch our way to serving hospital needs and establishing a sustainable customer base. Our mission: to improve healthcare by alleviating medical equipment breakdowns with software that better manages hospital equipment inventory.

An X-ray department in Ghana without functioning X-ray equipment

Over the course of 8 weeks, MED International visited more than 40 hospitals across Tanzania and Ghana to work towards that mission. We toured hospitals and encountered both modern operating theaters and medical equipment graveyards (rooms full of broken medical equipment), often in the same facility. We met with hospital executives, biomedical equipment technicians, and IT managers who verified that their hospitals had poor or absent systems for tracking important (and expensive) pieces of medical equipment. We presented our inventory management software – named “Zanhealth” for MED’s 2012 start in Zanzibar – to hospital staff and leaders, nearly all of whom were impressed by and excited to use our product.

We learned valuable lessons about what did and didn’t belong in a hospital’s inventory management system and applied those lessons to construct a robust software solution in Zanhealth.

Now, 7 months later, we are making Zanhealth open-source to share our work and accelerate its progress. Between then and now, we encountered our fair share of obstacles. We’d like to share the lessons we learned with you and encourage those interested in our mission to continue the work.

So what did we learn?

1. Product development must happen closer to the ground 

We built Zanhealth after an initial successful 5-month pilot in Zanzibar, but the bulk of development took place within the confines of Brown University. This meant that several key product features were not in sync with the daily reality of the Tanzanian and Ghanaian hospitals that we eventually targeted. Though we spent two summers training technicians in Zanzibar’s hospitals, mainland Tanzania and Ghana, where we arrived this summer, had unique challenges for running and maintaining software.

The slew of challenges included: unreliable internet infrastructure, low software utilization and overstretched hospital budgets. Zanhealth, as it was then designed, was a web application for hospital staff to monitor equipment statuses, report breakdowns, and perform repairs more efficiently. The web-based model had initially made sense to us. We envisioned it being valuable in the long run, with a Software-as-a-Service (SaaS) subscription model enabling easier updates, greater integration with international partners and the opportunity to create a global data set of equipment use. However, without reliable internet, Zanhealth was not a reliable management system for life-saving medical equipment; without extensive experience using the software, users had trouble updating equipment status; and without room in hospital budgets, we could not guarantee long-term user support.

Yao, Sara, and Alan (left to right) collecting inventory data in a Ghanaian hospital

Even with our best efforts at long-distance data-gathering with few accessible hospital resources, we realized there was no substitute for being on the ground and iterating our product first-hand. We couldn’t build a successful product without continuous hospital input and a leaner production model.

2. Local connections and end-user engagement are necessities throughout the process

Our biggest challenge lay in correctly identifying the greatest pain points of hospital staff. Not that doing so would have been an easy task; dozens of emails and international phone calls to Tanzania and Ghana elicited responses that were hard to accurately discern. Our months in Zanzibar’s public hospitals where we piloted also turned out to be very different from the facilities we approached in Ghana, and on the Tanzanian mainland. Without rich participation from our new constituents, we had only limited data and our own ideas of what could and couldn’t work.

Once in Ghana, we encountered a handful of successful software developers who built loyal customer bases for their hospital software packages. While they were mostly on-premise solutions that did not operate at scale, they worked with hospital executives and staff from the beginning of their projects to study user behavior and design appropriate solutions. While limited in scope, they targeted low hanging fruit that brought quick value for the user at a price point we were unable to match.

Being able to collaborate with local hospitals to learn about their infrastructural challenges, software adoption, and financial conditions would have helped us design a more appropriate solution much earlier. However, after observing maintenance and repair workflows, we gained a more sophisticated understanding of how hospitals respond to medical equipment breakdown, how their processes may be improved, and what solutions can help. In the big picture of improving health systems, the perspectives and experiences of individual technicians and staff members are invaluable.

Yao leading Zanhealth user training for key staff at a Ghanaian hospital

3. Structural issues are challenging but not insurmountable.

The obstacles we faced in Tanzania and Ghana could easily be deemed structural barriers that social enterprises have no business overcoming. Social entrepreneurs will never create a silver bullet for structural issues like poverty, corruption or poor technology infrastructure, but we can still innovate to improve existing systems step by step.

Software utilization and computer literacy is still low in many developing nations. The culture of automation and computerization that has taken hold in developed states has yet to achieve critical mass in places like Tanzania and Ghana. Yet, we identified many hospital executives and staff actively seeking to innovate and improve hospital efficiency through technology. More developing country hospitals are looking to software to increase efficiency, reduce costs, and deliver better health care.

A key utilization barrier Zanhealth encountered was hospitals’ perception of its high cost. We offered trial versions to demonstrate cost savings with 3 hospitals (including one of Ghana’s largest) signing on. However, they weren’t able to continue using Zanhealth because of the internet requirement, another barrier that could be overcome. We tinkered with mobile platform integration, but could not get quite the right balance between functionality, platform integration and usability.

Internet access remains unreliable in many developing countries. Most hospitals rely on local area networks (LAN) to run locally-hosted software without the need for an internet connection. Hospitals were much more likely to purchase and use Zanhealth on a LAN – without an Internet requirement. Internet infrastructure, while important, is not necessary for hospitals to use Zanhealth software and reduce medical equipment breakdown.

Now, what can you do?

We’ve done the legwork to compile market research and build the bulk of a software to improve medical equipment management in developing country hospitals. Our learnings from Tanzania and Ghana are included in the latest version of Zanhealth, now optimally suited for hospital staff to integrate into their workflow.

After 4 years working from abroad to effect hospital systems change in developing countries, MED International recognizes that we are not in the best position to take on this challenge. We believe the best team suited for the deployment is one based on the ground, working in local settings, and with direct access to hospital users.

For these reasons, we are making Zanhealth open-source software to accelerate innovation and support these developers in solving a pressing social problem. Our source code is now freely and publicly available for you to modify and to hospitals to use.

We are providing a platform for social entrepreneurs and programmers to build off MED International’s work and see hospitals use Zanhealth to operate more efficiently and deliver better patient care. If using technical expertise to build on Zanhealth and generate social impact interests you, we encourage you to get in touch.

You can find the open-source Zanhealth software and accompanying documentation at the following links:
Access Github repository
View Zanhealth software readme

Alan, Fauziya (MED’s Summer Intern from Ashesi University), and Yao (left to right) scrubbed to enter an operating room with Ghanaian hospital staff

MED Sets Vision for 2014 and Announces Recipients of Fellowship

Strategic Planning:  On February 9, MED’s Computer Science (CS), Engineering (BMES) and Operations (Ops) teams gathered to set our strategic vision for the year. This was the first organization wide meeting since the various functional groups were developed in the Fall of 2013. To meet the growing need for our services in Tanzania, Zanzibar and Haiti, MED is focusing on 5 key areas:

  1. Customer acquisition and relationship management
  2. Product development
  3. Leadership development
  4. Fundraising and revenue growth
  5. Product deployment
Fellows Yao Liu and Sara Peletz
Fellows Yao Liu and Sara Peletz

MED Fellows: We are excited to announce the recipients of the MED Fellowship Sara Peletz and Yao Liu. Sara comes to MED having run development projects in El Salvador and Honduras. She also has experience working with D-REV, an engineering social enterprise that designs medical devices for resource-poor regions. Yao is no stranger to MED and served as our Grants Manager prior to receiving the fellowship. As Fellows, they will work with the existing Directors to grow MED International.

MED-CS, BMES and Ops get together to plan for the year
MED-CS, BMES and Ops get together to plan for the year

MED International Team Advances to Hult Prize Regional Finals

The Hult Prize Foundation recently announced that MED International will represent Brown University at the Boston regional finals of the 5th annual Hult Prize. The Hult Prize is the world’s largest student competition and start-up platform for social good, with $1 million in start-up funding awarded to the winning student team. The 2014 Hult Prize will focus on solving non-communicable diseases in the urban slum.

Student teams compete in six cities around the world for a chance at $1 million in start-up funding to launch a sustainable social venture. The Hult Prize regional competitions will take place on March 7 and 8, 2014 in Boston, San Francisco, London, Dubai, Shanghai and Sao Paulo.

About the Team

Our team consists of Jayson Marwaha (MED’s Founder & Co-Executive Director), Han Sheng Chia (Co-Executive Director), Jason Shum (Tech Director), Seth Akers-Campbell (Biomedical Engineering Specialist) and Yao Liu (Development Director).

About the Hult Prize

The Hult Prize is a start-up accelerator for social entrepreneurship, which brings together the brightest college and university students from around the globe to solve the world’s most pressing issues. The annual initiative is the world’s largest student competition and crowd-sourcing platform for social good. MED’s team was selected from more than 10,000 applications received from over 350 colleges and universities in over 150 countries.

Ahmad Ashkar, CEO and Founder of the Hult Prize, attributes the success of the competition to the shift in the global economy and the millennial generation’s refusal to live in a world with inequality, “We are giving entrepreneurs from around the world a platform to innovate and revolutionize the way we think about servicing the poor.”

Following the regional finals, one winning team from each host city will move into a summer business incubator, where participants will receive mentorship, advisory and strategic planning as they create prototypes and set-up to launch their new social business.  A final round of competition will be hosted by the Clinton Global Initiative at its annual meeting in September, where CGI delegates will select a winning team, which will be awarded the US $1 million prize by President Bill Clinton himself.

The Search for MED’s Next Student Leaders is on! Apply to the MED Fellowship Today.

MED Fellowship Application We are excited to be launching the MED Fellowship—a one year program run in partnership with Brown University’s Social Innovation Initiative (SII) and School of Engineering. The fellowship, kindly supported by accounting firm JCK Shum Leung Luk & Co. and our partners from Brown is designed to develop MED’s next generation of leaders.

SII and the School of Engineering have been valuable partners for MED. Over the years, SII has played a key role at in nurturing socially-minded leaders with a keen entrepreneurial sense. Brown’s School of Engineering has been providing MED with deep expertise needed to solve some of the developing world’s toughest problems. MED’s executive directors will benefit immensely from mentorship by faculty and staff from both institutions.

Two positions are available for the first year, please download the attached MED Fellowship Power Point and MED Fellowship Application Form for more.

Benefits:

  • USD 5000 to be broken up the following ways:
    • USD 3500 for summer travel and personal use
    • USD 1500 for venture expenditure, at the discretion of the fellow
  • Extensive mentorship from faculty and staff of SII and School of Engineering
  • Immense networks from MED, SII and School of Engineering

Position & Requirements:

  • 2 Positions are available
  • This is minimally a 1-year position, Jan 2013-Jan 2014
  • Time spent on MED averages 15 hours/week
  • There is an option for extension, with a possible extension of funding
  • Applicants cannot be seniors
  • Fellows must be able to travel for a minimum of 7 weeks to field country in summer 2013
  • Fellows must be regular members of Brown’s SII network
  • Fellows must take PPAI 1701Q Leading Social Ventures for credit in the Spring

Application Process:

  • Dec 25-29             Skype with Hans/Jayson to learn more
  • Jan 11-22              Skype with Hans/Jayson to learn more
  • Jan 22                      Application Submission Deadline
  • Jan 22-29              Interviews
  • Jan 30                      MED Fellow selected

About MED International:

  • MED International aims to increase the availability of medical equipment for patients in resource poor hospitals of the world
  • We leverage deep engineering and computer science expertise at Brown University to deliver appropriate technological solutions for underserved populations
  • We are the only social enterprise on campus blending engineering, computer science and social entrepreneurship to deliver healthcare solutions for the developing world

Contact

Hans            hschia@medinternational-us.org

Jayson        jmarwaha@medinternational-us.org

You’re Invited!

HeartBeats InvitationUPDATEDCome join MED International for an evening of musical delights, as faculty members and the Bear Necessities serenade the audience for a good cause.

Heart Beats is a mixer supporting MED International’s work to increase the availability of medical equipment in Zanzibar, Tanzania. The event features short updates from MED’s Co-Executive Directors and karaoke performances by the most popular professors on campus.

Sponsored by MED International and Karaoke Club with funding support from the Late Night Fund, Campus Life, and the Bio-Med Community Health Department.

MED Sends Instructor to Zanzibar

P1020791

MED International is excited to announce the hire of Kevin McCracken who will serve as our Biomedical Engineering Instructor in Zanzibar. From March to August 2013, Kevin will train eight technicians from Zanzibar’s Ministry of Health to maintain medical equipment. Kevin has almost thirty years of experience in the field and volunteered with MED last summer. During a short three weeks, Kevin restored life-saving medical equipment valued at US$50,000 for under $75 in total.

Kevin’s teaching approach will focus on innovative methodologies that have been shown to repair 66-76% of equipment in resource-poor hospitals. He will teach these repair skills in at Zanzibar’s College of Health Sciences and work alongside the technicians in the state’s largest hospitals. We are confident that he will be a valuable asset and warmly welcome him on board.

MED Repairs $50,000 Worth of Equipment

 

Over the course of 3 weeks this summer, the MED team with the help of biomedical engineers Mr. Kevin McCracken and Ms. Cathy Weitenback repaired a total of $50,000 worth of medical equipment in Mnazi Moja Hospital, Zanzibar. The 22 pieces of equipment returned to service included 6 infant incubators, 2 ultrasound machines, and 4 suction machines. Most of the repairs only cost US$75, with the exception of 2 units that required costly spare parts, demonstrating that life saving equipment can be repaired at relatively low costs.

 

The repair of 6 infant incubators increased the number of functioning incubators in Mnazi Mmoja’s Neonatal Department by four-fold. Previously the department only had 2 infant incubators running efficiently and the lack of functional equipment posed life-threatening risks to premature infants. Since the department could only accommodate a limited number of infants, they often had to share an incubator. The nurses would also improvise means to keep the infants warm, wrapping them in blankets and creating makeshift hot water bottles. The department now has 100% incubators to functioning effectively.

Keynote Address at Biomedical Conference

Dr. Sira Mamboya, Deputy Minister of Health for Zanzibar, delivering her keynote speech for the EWH Summer Institute Conference in Arusha, Tanzania. Left to Right: Mr. Juma Hamad (Chief Engineer, Ministry of Health, Zanzibar), Mr. Jayson Marwaha (Co-Executive Director, MED International), and Dr. Sira Mamboya (Deputy Minister of Health, Zanzibar).

Last Saturday, August 18, Zanzibar’s Deputy Minister of Health, Chief Engineer, and one of the Co-Executive Directors of MED International gave the keynote speeches for a biomedical engineering conference held in Arusha, Tanzania, by US-based nonprofit Engineering World Health. The conference was held both for EWH’s stakeholders and participants of their Summer Institute program in Tanzania. EWH Executive Director Melissa Beard and Summer Institute Coordinator Ben Fleishman were at the conference and had invited the three from Zanzibar to speak.

In their addresses, Dr. Mamboya, Mr. Hamad, and Jayson shared many of the challenges of hospital equipment maintenance in resource-poor settings. They also met with Melissa and Ben to explore ways in which the Zanzibar Ministry of Health, MED International, and EWH could support each other in the future. Ben, EWH’s Summer Institute Coordinator, will be visiting Zanzibar at the end of August to continue the conversation with the Ministry, its public hospitals, and its healthcare engineering team.

The Summer Institute in Arusha is an annual program held by EWH that gives engineering students from the US the opportunity to work in hospitals in the developing world. The students spend one month taking seminars in electrical and biomedical equipment and then spend their second month repairing equipment in one of a number of partner hospitals near Arusha. Research conducted by EWH members has shown that up to 85% of equipment in hospitals in the developing world can be fixed for under 200 USD per hospital and with just basic repair knowledge. As such, 2 students are sent to each partner hospital, complete an inventory of the hospital, are given a spare parts budget of 200 USD, and report back at the end of the month on the number and types of machines repaired. MED International also adheres closely to this philosophy, which is why it invests largely in building basic repair and troubleshooting capacity amongst hospital technicians.