Part III Medical Technologies
7.3 Discussion and Conclusion
human resources. The onus is on the patient to ensure completion of test and treat cycles. If a patient’s initiative is not supported in these journeys, chances are high that he/she opts out. Constructive counseling by providers about various aspects of diag- nostic tests and processes is necessary but not sufficient. Functioning relationships between providers are equally important (Engel et al.2015b).
While the system in South Africa does not foresee such an active role for patients in ensuring a POC continuum, it still relies on a patients’ ability to return to clinics on another day for either results (in the case of laboratory-based testing) or for follow- up testing and counseling sessions in the case of HIV. The examples of HIV testing showed that HIV patients also need to actively manage diagnostic processes to make testing fit their personal circumstances and make testing worthwhile for themselves (Engel et al.2017).
These profound differences between the diagnostic setup, offer very different con- ditions for POC testing. Although the promises that have been attached to POC testing easily lend themselves to view testing technologies as silver bullets, it matters how diagnostic processes are organized and made to work at POC. The results reveal how the material dimensions of diagnosis, such as the test platform, reagents, and supplies, the actors involved, their relations and the sociocultural context in which testing and diagnosis are happening are invariably interlinked (Engel et al.2015b). This means that simply focusing on one element, for instance, improving infrastructure or test platforms or relationships, is not sufficient. Those aspects need to be studied and tackled together. The contrasting results from India and South Africa further high- light that the settings and the tests have their own histories, assumptions, practices, and understandings inscribed in them. This means that by implementing tests suc- cessfully, both the setting, including its organization of the workflow, workforce, its infrastructure, interaction with patients, and standards, and the tests are being shaped and need to be adapted. Tools and (user) practices are being co-constructed (Oudshoorn and Pinch2003). Implementing diagnostic tests is thus a dynamic and ongoing process that requires continuous observation, analysis, reflection, iterations, and adaptations of tests and (user)-practices and -settings.
Such insights need to be taken into account when designing POC testing programs and technologies. Test developers, decision-makers, and funders need to account for these ground realities. They need to identify and involve users and various stakehold- ers in design, evaluation, and implementation processes. However, current global diagnostic design and development practices, research, regulation, and evaluation capacities do not do justice to the dynamic nature of these processes of making diagnostic tests work at POC.
Based on these insights, practitioners, donors, and test developers should make sure to
• Study diagnostic practices at POC and how devices are integrated into workflow and patient pathways before, during and after design and implementation of new products;
• Tackle jointly the relationships between providers and between patients and providers, infrastructure, testing platforms, and adaptive strategies of dealing with constraints;
• Examine the role, responsibility, and work of patients to ensure a POC continuum;
• Allow continuous observation, analysis, reflection, iterations, and adaptations of tests and (user)-practices and -settings; and
• Develop research capacity to assess and integrate these factors.
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Health Hackathons Drive Affordable Medical Technology Innovation Through Community Engagement
Aikaterini Mantzavinou, Bryan J. Ranger, Smitha Gudapakkam, Katharine G. Broach Hutchins, Elizabeth Bailey and Kristian R. Olson
8.1 Introduction
Successful medical innovation requires a process of co-creation among key health- care stakeholders including healthcare professionals, end users, scientists, engineers, and entrepreneurs (IDEO2015; Lee et al.2012; Prahalad and Ramaswamy2004).
This can be challenging especially in resource-limited settings where interdisci- plinary collaboration may be hampered by more pronounced professional, socioe- conomic, and age barriers (Sachs2003).
MIT Hacking Medicine, a group founded in 2011 at MIT, aims to energize the healthcare community and accelerate medical innovation by carrying out co-creation through health hackathons. These 1- to 3-day events bring together diverse stake- holders to solve pressing healthcare needs. The group has organized to date more than 40 health hackathons across 9 countries and 5 continents.
Aikaterini Mantzavinou and Bryan J. Ranger are co-first authors.
A. Mantzavinou (
B
)·B. J. Ranger (B
)Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA e-mail: [email protected]
B. J. Ranger
e-mail: [email protected]
S. Gudapakkam·K. G. Broach Hutchins·E. Bailey·K. R. Olson Consortium for Affordable Medical Technologies, Boston, MA, USA e-mail: [email protected]
K. G. Broach Hutchins e-mail: [email protected] E. Bailey
e-mail: [email protected] K. R. Olson
e-mail: [email protected]
© The Author(s) 2018
S. Hostettler et al. (eds.),Technologies for Development, https://doi.org/10.1007/978-3-319-91068-0_8
87
MIT Hacking Medicine first partnered with the Consortium for Affordable Med- ical Technologies (CAMTech) of the Center for Global Health at the Massachusetts General Hospital (MGH) in the fall of 2012 to organize a hackathon focused on afford- able medical technology for low- and middle-income countries (LMICs). Since then, MIT Hacking Medicine’s annual flagship event has featured a global health track in collaboration with CAMTech whose participants include students and health- care professionals from India and Uganda. The Hacking Medicine team has in turn joined CAMTech-led hackathons in India and Uganda. Engagement of the local com- munity in the process of healthcare disruption has led to multiple award-winning projects for better monitoring, diagnosis, treatment, and prevention of disease. Many of these solutions are translated from bench to bedside at remarkable rates aided by the CAMTech Innovation Platform and follow-up strategies that promote and track project development and progress. Sustainable business strategies for prod- uct commercialization and reverse innovation to bring cost-effective technologies to resource-rich settings are highly encouraged. The hacking philosophy applied to affordable healthcare, engagement of the local community engagement, and sup- port of novel ideas toward long-term sustainability hold great promise for creating low-cost medical solutions that can improve healthcare outcomes globally.