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Brinnon Garrett Mandel: Finding a Path Forward in Global Health Innovation

Brinnon Garrett Mandel Jhpiego
December 11, 2014
“When patterns are broken, new worlds emerge.” — Tuli Kupferberg, American poet

Innovation shouldn’t be easy. It requires understanding and breaking through existing patterns — in technology, behavior, policies or market forces. Innovating life-saving solutions for the world’s greatest health challenges, whether they are products or services, is also not easy because the patterns are complex — and sometimes unknown.

But there are more and more individuals, organizations and companies from diverse backgrounds who are compelled to work together on global health technology by answering the call to innovate and enable a healthier world to emerge. That is inspiring.

At Jhpiego, a global health affiliate of Johns Hopkins University, we are working on a small portfolio of global health technologies. While we have considerable experience in the field of program implementation and working with health systems, we recognize the difference between a global health “need” and a market “demand” for a product, and what kind of evidence and data we need to advance our products to market viability.

Yet whether it’s the women and newborns who die needlessly during pregnancy or childbirth, the young children who suffer unnecessarily from preventable diseases, the increasing toll of deadly infectious viruses like Ebola, these are problems that can — and must — be solved.

Many entrepreneurs and technology developers are familiar with the “Valley of Death,” representing that overwhelming chasm between a proof of concept and a successful or viable product in the marketplace. Global health-technology innovators, driven to make a health impact, similarly have a long, arduous — and often opaque — journey to get from a concept to a life-saving solution. Many seasoned and new innovators confront a wall of obstacles even with seemingly simple product concepts. Many slam into the wall, while a few find their way up and over.

What exactly is this towering wall in global health-technology innovation that separates idea from impact? A successful global health product has to achieve evidence and confidence in the following three areas:

1. Technology performance and efficacy

Does the product work well in solving the problem for which it is designed? To demonstrate this, the innovator must conduct the appropriate research, obtain required regulatory approvals and generate enough evidence that the technology can perform in some of the harshest conditions or with limited infrastructure.

2. Market viability

Are there enough customers to convince someone to make and sell the product? In global health, the users of a product are frequently different than the choosers and payers, especially products designed for rural health facilities or community health workers. Understanding market dynamics, segments and potential demand — as well as distribution channels — is critical for any manufacturer or commercial partner to take the product on and develop a tenable business model.

3. Successful integration into health programs and services

An innovation is only successful to the extent it is embraced and used. How will the product get incorporated into services and public health programs, reaching more people and achieving health impact? Driving adoption of the innovative product will require understanding this environment and the decision-making around policies and guidelines for the product, how it will fit within service delivery platforms, and the risks and incentives for those involved in adopting a new product.

If only these all fit within nice tidy buckets. The reality is that global health-technology innovators are constantly triangulating across elements of these three buckets, often confronting chicken-and-egg scenarios.

The patterns of sequencing and interrelatedness are complex and variable, depending on the product and the system in which it will be used. The developer of a new screening device might be focusing design decisions and product requirements based on a community health worker, yet while those health workers might be the users and closest to the beneficiaries, they are not the customers. The commercialization or manufacturing partner wants confidence that there are customers before making and selling a new product. The developer needs to do more research to show the evidence and potential demand, but cannot do that without regulatory approvals. And so on. The wall does not only consist of funding, but also a jumble of confusing sequences and dependencies

Global health innovation should never be simply reduced to “new technology.” Processes and systems that strengthen the availability and accessibility of life-saving interventions are much more than gizmos. However, there are gaps in the affordability and appropriateness of technologies for some of the globe’s most challenged environments.

Investors, either donor agencies or private sector funding groups or philanthropic organizations like GE Foundation, are stepping forward and fueling a pipeline of promising innovative solutions — and engaging traditional, new and unusual players. Like other organizations or companies working in global health or product development we have found at Jhpiego that partnerships are the key to success, where shared value and complementary expertise can intersect to clarify the patterns.

Fostering partnerships and a shared investment to understand the patterns and build the ladder are important ways to overcome the wall for global health technology — and the return on that investment may be just as great as on individual products.

Top image: Courtesy of MCHIP/Kate Holt

Brinnon Garrett Mandel is the Director of the Innovations Program at Jhpiego, an affiliate of Johns Hopkins University, managing a portfolio of global health technology innovations and a team of bright engineers and public health clinicians, researchers, and practitioners. With a background in both public health and business, Mandel has worked in various roles at Jhpiego and in the private sector, with an interest in the intersection of global health, technology and business.


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