GHF: Smart Sanitation, NTDs and eHealth solutions

ES1-3: The fortune in our toilets. Digital Health Breakthroughs & The Smart Sanitation Economy 

Around the world, 2.3 billion people do not have access to basic sanitation and 892 million people practice open defecation. David Shimkus and Alexandra Knezovich led an engaging discussion this morning on innovation in the sanitation sector. These figures present a global issue that concerns safety, dignity, and health. While many organizations in the humanitarian sector have funded and installed toilets in rural areas, often these sanitation facilities go unused, unaccompanied by behavior changes in local populations. The Water Supply and Sanitation Collaborative Council, represented in this roundtable discussion by David Shimkus, works with governments to collaborate on projects in rural areas around the world.

Alexandra Knezovich, representing the Toilet Board Coalition, discussed several ongoing projects her organisation is involved in. The Toilet Board Coalition collaborates with entrepreneurs as well as multi-nationals to scale up sanitation businesses and develop new economies. The toilet economy, circular sanitation economy, and smart sanitation economy allow a range of stakeholders to contribute to the goal of clean water and sanitation, while benefitting their respective businesses as well. This model will ideally serve as a sustainable solution to developing both better sanitation as well as improved local economies. The circular sanitation economy is mutually beneficial to human and environmental health as it includes innovative uses for waste. Waste can contribute to energy, water recovery, agriculture, animal feed, or even, as NASA demonstrated in the ISS, into plastic materials that can be 3D printed into products and goods.

 

WS04: Noma, A Rare Tropical Disease in the Digital Age: Old Difficulties, New Tools?

The Digital Stethoscope: Beyond Listening

The challenges of diagnosing pneumonia in primary care facilities, especially in low resource settings was discussed. The panel concluded these as the most prevalent challenges in both diagnosis and device development :

  • Standardising methods of measurement among health care workers
  • Establishing what assistive devices, including applications are best based on available evidence
  • Determining what would be the gold standard for measuring the respiratory rate
  • Financing, scaling and implementation of a diagnostic tool.
  • Focusing on solutions that are not merely innovative, but can also meet the current Global Health demands of economic and environmental sustainability.

 

WS09: Cyberattacks and hospitals: what are the issues? 

Problem of cybersecurity in the field of health is increasing. There are three key elements within security; confidentiality, availability and integrity of data. The exposure to risk is far greater, due to more connections, more mobile technologies, more cloud interactions, and the increased value of personal and eHealth information. Unfortunately in the cybersecurity sector, healthcare lags behind. This leads us to the question of guidance or regulation? According to Chana O'Leary from OpenSky Corporation, USA - the problem with regulation is that the manufacturer would just 'check the security box' , and would thus consequently stop the process of constant improvement regarding security processes. Opting for guidance would not curb the process of security innovation, but rather encourage it.

In many western countries, cyberattacks are recognised as threats, but not yet considered as a top priority. Will the first death-directly related to cyberattacks, be the wake-up call needed? 

 

WS02: What digital tools to develop chronic wound care in resource-limited countries? 

Wounds in developing countries are mostly linked to NTDs, insects/snakebites, infections but more recently, also diabetes and foot ulcers. The main problems are low quality care and low level of knowledge on how to treat wounds, the answer is not necessarily a fancy and expensive dressing, but better training. Great progress was achieved in wound healing knowledge during the last 30-60 years but it is still often not applied in developing countries.
The 6 basic principles are:
1. Evaluate and correct the wound cause and the patient's general condition.
2. Maintain a moist wound environment.
3. Protect skin from any trauma.
4. Promote a clean wound bed without infection.
5. Control the peri wound limphedema.
6. Prevent and correct secondary disability.
 Dr. Sophie Delagne. MSF. 
MSF uses telemedicine platform Collegium Telemedicus and already has more than 40 networks established. It provides expert advice in low-resource settings in English, French and Spanish, 24/7, with a median response time of 5 hours.
Wounds are suitable for telemedicine because they are visual, and images can be easily transferred.

WS01: Diabetes and E-health solutions in resource-limited settings: gadgets of real opportunities for quality of care?  

Financial constraints and equity and quality issues with access to diabetic care: however are digital tools really the answer?

Diabetes is a complex disease, which requires round the clock care. “Therapeutic education” centred around patient self-care, should be at the core of prevention and treatment, however this has to date still been poorly developed: in LEDCs and MEDCs alike.In Mali, a project has developed mobile e-learning: Info Ado. The interactive and fun “gaming”solution aims to help diabetic children and their parents and teachers understand and deal with their condition. The plus sides are that the app is engaging, available in local languages and internet connexion isn’t required. However the platform still requires a smartphone and isn’t adapted to children of all ages nor illiterate children. Cost wise, it also remains expensive for telephone operators. Questions further remain with as to how to politically involve ministers of health at the government level. Although Mali does have a national diabetic policy, numerous countries do not and remain stuck in the infectious disease conundrum.

Costs of diabetic devices may be brought down through implementing a more punctual use in a clinic setting, as opposed to daily use at home. Other free app innovations are also coming out on the market such as Webdia which calculates the amount of insulin in your daily meals – allowing for a more sustainable, hassle-free care without costly devices. MOOCs are also available online. Needless to say, such approaches, although innovative, do not replace face to face care with a medical professional. Overall, in a diabetic setting, tech may not always be the answer. It is certainly no panacea and financial concerns remain. In the long run, partnerships (North-South, but also South-South) should be encouraged, and crucially, health systems in chronic care should be strengthened.

 

Written by Sylvia BasterrecheaLacye Groening, Shem ReeceMorgane Justine GuexAlexandra Egorova, Mia Clausin and Nefti-Eboni Bempong