Global Health Innovators Mobilize to Help Developing Countries Combat COVID-19

Assist International, one of four Grand Challenges Canada projects devoted to medical oxygen supplies, will increase capacity to supply additional oxygen as COVID-19-related demand increases. It will also provide equipment, such as ventilators, concentrators, pulse oximeters, and masks, training, and short courses in repairs and maintenance.

Novel, affordable ways to acquire medical oxygen, ventilators, masks and other critically-needed COVID-19 supplies and services are among 20 Grand Challenges Canada (GCC) innovations mobilizing to assist developing countries through the global pandemic.

In the past decade, the innovations received GCC support in several forms, including over $19 million provided by the Government of Canada, based on the criteria of “bold ideas with big impact” in global health. These project now offer critical resources, ideas and solutions for low-resource countries struggling to meet an acute need for affordable, locally-sourced products and services, most urgently:

  • Medical oxygen, ventilators and related training
  • Local manufacturing of personal protective equipment for health care workers
  • Life-saving information for hard-to-reach populations

“To overcome the unprecedented global health challenges presented by COVID-19, the world needs innovation and ingenuity. Over the past 10 years, Canada’s funding for Grand Challenges Canada has helped hundreds of innovative ideas become a reality. Today, some of those very ideas are saving lives by helping people prevent and respond to COVID-19 and other health challenges in developing countries,” says Karina Gould, Canada’s Minister of International Development.

GCC co-CEO Dr. Karlee Silver notes that “Innovation in global health means provisioning low-resource areas with needed goods and services that are better, faster and cheaper. Such solutions take time to develop, scale up, and evaluate as they transition to scale.”

With Canadian Government funding, we have supported a portfolio of solutions over the past 10 years that are particularly relevant to the developing world’s COVID-19 response. It is during times like these that the value of investment in innovation becomes most obvious.”

“Grand Challenges Canada is lending expertise and other support to the innovators as they focus on the pandemic, and several will receive additional funding as needed to help accelerate their response to COVID-19. Many others among GCC’s 228 active innovation projects are working to mitigate the fallout of COVID-19 on reproductive, maternal, newborn and child health services disrupted by pandemic control measures,” Dr. Silver adds.

“We have been guided by local governments’ needs, with locally supplied medical oxygen topping the list — a resource in tragically short supply and high demand throughout much of the developing world.”

The innovators leading these 20 solutions are based in 11 countries — Kenya, Uganda, Tanzania, South Africa, Brazil, India, Bangladesh, Cambodia, Australia, Canada and the United States — and operate in low-resource areas throughout Africa and beyond, from the Amazon to the Himalayas.

  • 4 projects provide medical oxygen
  • 2 produce rugged, battery backed-up ventilators
  • 1 is pivoting from affordable locally-produced sanitary pads to low-cost masks
  • 2 offer innovative diagnostic / imaging equipment
  • 7 support remote patient care, monitoring and essential products delivery
  • 1 supports mental health care
  • 2 support safe water, sanitation and hygiene
  • 1 supports at-home education

Oxygen

1) Assist International (USA)Assist International provides healthcare facilities with reliable, affordable medical oxygen supplies via local production plants and partners in over 40 hospitals in Kenya, Rwanda and Ethiopia. GCC helped Assist expand in Ethiopia, and supports its further geographical growth.The group will increase capacity to supply additional oxygen as COVID-19-related demand increases. It will also provide equipment, such as ventilators, concentrators, pulse oximeters, and masks, training, and short courses in repairs and maintenance.

Tele-monitoring and training provided via Project ECHO in Ethiopia, Tanzania and Cambodia will include new COVID-19 curricula for healthcare workers and technicians covering Intensive Care Units for both adults and newborns.

2) Hewa Tele (Kenya)

Hewa Tele Limited delivers reliable, cost-effective, life-saving medical oxygen to health facilities in Kenya that have little or no access to it otherwise, operating production plants in partnership with governments and hospitals. An associated NGO provides relevant training for healthcare staff.

Currently serving a population of 15 million with GCC support, Hewa Tele will now provide medical-grade oxygen to Nairobi’s COVID-19 isolation hospital, with a set of cylinders dedicated solely to that facility, and will gear up to meet the oxygen needs of a growing number of patients. Its expansion plans include hiring additional staff to facilitate 24-hour coverage, leasing more distribution vehicles, adding new oxygen cylinders to its inventory, and training health care staff to administer oxygen safely.

3) University of Alberta / Global Health Uganda Ltd. (Canada / Uganda)

GCC-supported University of Alberta researchers and their Global Health Uganda partners developed an easy-to-use “SPO2” solar powered system that turns ambient air into medical-grade oxygen with battery banks enabling uninterrupted service through the night and on cloudy days.

SPO2 systems include how-to “roadmaps” for local procurement, training, and maintenance of solar oxygen concentrators helpful to COVID-19 responses in remote, off-grid facilities or those without a reliable electricity supply.

Oxygen therapy systems are currently installed in 10 African hospitals (8 in Uganda; 2 in DR Congo), and the team is exploring partnerships to expand their reach to meet demand.

4) FREO2 Foundation (Australia)

The University of Melbourne’s FREO2 team, with support from GCC and the Saving Lives at Birth partnership, has created a rugged, low-cost medical oxygen system (OxyLink) that maximizes oxygen output, minimizes energy use, and can switch to backup power to bridge common short power cuts in low-resourced health facilities. Their Low-Pressure Oxygen Store System, meanwhile, helps facilities that often experience longer power outages, combining OxyLink with a novel oxygen storage technology.

With clinical trials complete and product field-testing underway, OxyLink systems may be particularly helpful in smaller facilities without access to oxygen plants or reliable electricity sources. The cost and power savings may also benefit regional hospitals and other larger facilities facing a surge in demand for oxygen therapy due to COVID-19, routine pneumonia cases, and other illnesses. Scheduled to debut commercially this fall, prioritizing low- and middle-income countries, FREO2 is working through complications to international roll-outs caused by travel restrictions.

Ventilators

1) Gradian Health Systems Inc. (USA)

This non-profit has established distribution and service networks providing and sustaining world-class medical equipment in facilities across more than 30 sub-Sahara African countries. Support from GCC and the Saving Lives at Birth partnership fostered Gradian’s validation and scale-up of a simulation-based training model being rolled out alongside installations of the ventilator.

The Gradian CCV (Comprehensive Care Ventilator) supports critically-ill patients in settings with unreliable supplies of power and oxygen, including temporary field hospitals being set up to manage COVID-19 patients in many countries. The ventilator can run for 21 hours on battery power, and its portability features enable single-ventilator use throughout critical care, including patient transport. Simulation-based training is a critical component of Gradian’s model, with teams of clinicians and bio-medical technicians providing remote and on-site training to healthcare providers.

Gradian has placed ventilators in Nepal, Sierra Leone, Kenya, and several other countries, conducted several remote trainings with clinicians, and is continuing to work with more health systems to build capacity for COVID response and other critical care needs.

2) OneBreath Inc. (USA / India)

With Stanford University intellectual property and GCC support, OneBreath has created an affordable ventilator for intensive care units, emergency rooms and ambulances. The device provides continuous respiratory support for all patients, from infants to adults, and is optimized for low-resource settings: affordable, portable and rechargeable, with an internal compressor that allows it to operate independent of compressed gas lines.

OneBreath anticipates its devices serving India soon and is seeking expedited regulatory processes (including US Food and Drug Administration approval) for a wider geographic rollout.

Masks

1) Saral Design Solutions Private Limited (India)

Saral’s “Swachh” is a fully-automatic, compact machine designed to produce low-cost, ultra-thin disposable sanitary pads through a decentralized manufacturing system. With GCC support, the company sells machines to local entrepreneurs and NGOs in India, and supports them as they operate their Swachh as a “business in a box.”

Saral has modified a Swachh machine to create 3-ply disposable surgical masks, adapting its ultrasonic sealing technology for non-woven materials to produce masks at a rate of 50-70 units per minute for less than US 6 cents per mask. Saral is partnering with a Mumbai-based auto firm to mass produce masks in their factory, to be distributed through Maharashtra Government networks. Saral will manufacture more machines and support existing sanitary pad machine customers pivoting to local mask production.

Diagnostics and imaging

1) Atomo Diagnostics Limited (Australia)

Atomo, with an early investment from GCC and the Global Health Investment Fund, created an innovative casing for rapid diagnostic blood tests. Originally developed for HIV diagnosis, the user-friendly devices enable home testing and testing in medical facilities without highly-trained healthcare workers. They will be deployed under a partnership with a French diagnostics company, NG Biotech, to detect COVID-19. Results from a drop of blood indicates within 15 minutes indicate whether a person is infected or been in contact with the virus.

The company will produce millions of the all-in-one, easy-to-use devices for professional and self-testing.

2) KA Imaging (Waterloo, Canada)

KA Imaging’s Reveal X-ray imager, created with an early investment from GCC, is an affordable, portable, low-dose, high-resolution device designed with tuberculosis, pneumonia, COPD, and lung cancer diagnosis in mind. Late-stage discussions with hospitals in different countries are underway on clinical trials to determine the efficacy of the imager in COVID-19 diagnosis.

Monitoring, information technology

1) WelTel Incorporated (Vancouver, Canada)

WelTel integrates virtual care and patient engagement, connecting remote outpatients with the healthcare system between clinical visits via their mobile phones. Public health agencies are using it to monitor and support COVID-19 cases and contacts in home quarantine. Patients respond to automated text messages sent via the Internet-based app; WelTel collects message data, using natural language processing and predictive algorithms, to inform healthcare providers and public health officials to priority patient issues.

WelTel’s system supports appointment scheduling and reminders, and broadcasts video or public health information on a secure patient portal. Proven in Rwanda, Kenya, Uganda, the USA and elsewhere, WelTel is adapting and deploying its platform for COVID-19 public health monitoring in Canada, the UK, Kenya and Rwanda.

GCC’s previous investment in the WelTel platform for HIV patients will be augmented to support COVID-19 response in Kenya and Rwanda. Its priority focus: pregnant women, young children and other vulnerable populations requiring enhanced healthcare monitoring while simultaneously avoiding COVID-19 exposure at healthcare centres. The WelTel program has formed the backbone of Rwanda’s national COVID-19 case-contact monitoring response and has already demonstrated benefit.

2) Praekelt.org (South Africa)

Praekelt.org has created MomConnect, a free WhatsApp-based text messaging platform to promote healthy pregnancies and infant care. Registered users receive biweekly advice tailored to each stage of motherhood, including clinical visit reminders and information on health services, with a feature allowing mothers to question Health Ministry employees, and to offer direct feedback on public health services.

A proven success scaling up nationally in South Africa, Praekelt.org has now introduced HealthAlert, a WhatsApp-based helpline disseminating accurate, timely COVID-19 information, with automated answers to frequently asked questions, relieving call centre traffic. Machine learning and its ability to understand natural language enable automatic triage advice and large volume conversations. Insights from real-time data support effective systems-level COVID- 19 decision-making.

South Africa has launched HealthAlert as COVID-19 Connect, while the World Health Organization has launched HealthAlert for WhatsApp globally.

3) TNH Digital Health Limited (Brazil)

TNH’s GCC-supported Vitalk mobile phone app provides highly-personalized, stage-based, interactive text messaging to pregnant women and new mothers, allowing healthcare providers and decision-makers to track development milestones and link women to care.

With private and public sector clients across Brazil and other countries, TNH is now using the platform and artificial intelligence to launch COVID-19 education and monitoring chatbots to facilitate patients getting treatment and case surveillance. The platform is being rolled out freely in Brazil’s Amazon state and, in partnership with municipalities across northeastern Brazil, is launching systems to be integrated with local community health efforts, with specialized COVID-19 content for pregnant women, as well as resources intended to reduce pandemic-related anxiety and stress.

Mental health

1) Friendship Bench Digital, Zimbabwe

Friendship Bench is an accessible, approachable problem-solving intervention offering cognitive behavioural treatment for common mental disorders beyond the psychiatrist’s office.

Developed in Zimbabwe with GCC funding, the Friendship Bench offers a proven, one-on-one therapy delivered by trained community health workers (“grandmothers”) on the grounds of municipal health clinics. Tens of thousands of people have been treated at 72 clinics in four cities across Zimbabwe since 2016, and studies have documented that Friendship Bench users are three times less likely to experience depression and four times less likely to have symptoms of anxiety. Transitioning to scale as part of Zimbabwe’s Mental Health Strategy for 2019-2030, the model has been applied in diverse contexts, including Malawi, Zanzibar and New York City. Partnered with Inuka Hero — an affiliated, SMS-based mental health support service also initiated with GCC support — the Friendship Bench program has been adapted for remote COVID-19 pandemic response, delivered free of charge via phone and SMS by trained non-professionals, enabling those in need to access effective, evidence-based psychological support while maintaining social distancing protocols.

Remote care and supplies

1) North Star Alliance East Africa (Kenya)

With high risk populations (i.e. truckers and sex workers) in mind, North Star Alliance has created a network of semi-mobile “Blue Box” facilities — shipping containers repurposed as health clinics situated along major transport routes in six sub-Saharan Africa countries.

GCC-funded programming includes multi-sectoral Crisis Response Teams to combat violence against sex workers, and an electronic medical records platform to follow and manage health data for highly-mobile, hard-to-track populations, and was already attracting attention of local governments for its ability to serve hard-to-reach populations.

North Star now serves a key role in minimizing COVID-19 transmission within high-risk demographics, supporting infection prevention and control and health education via the Blue Box facilities, while its cross-border electronic health records system may help monitor the health of frequent high-risk travellers. 

2) Friendship Bangladesh (Bangladesh)

Friendship Bangladesh’s model delivers comprehensive health care and education for isolated communities in northern and southern Bangladesh, with a strong focus, developed with GCC investment, on maternal, newborn and child health, and sexual and reproductive health.

The system includes community medical aides, satellite clinics and hospital ships to reach people living in complex, remote environments — populations particularly vulnerable to a rapid spread of COVID-19.

3) Healthy Entrepreneurs Uganda (Uganda)

Healthy Entrepreneurs’ integrated, end-to-end supply chain business involves a network of trained micro-entrepreneurs delivering affordable, reliable health products and services to rural women and children. Transitioning to scale with GCC support, the system offers soap, sanitizer, disinfectant, fever-reducing medications and other goods essential for containing COVID-19. IT is operating in Uganda, Kenya and Tanzania, and expanding into other African countries.

A telemedicine platform facilitated by the organization allows for remote triage, risk assessment and referrals for last mile populations / self-isolated homes. It will also promote COVID-19-related knowledge and awareness, preventing rumours and misinformation.

4) Karma Primary Healthcare Services Private Ltd. (India)

Karma Primary Healthcare Services facilitates access to reliable, affordable primary healthcare for the rural poor in four districts and two states in India. Over 100,000 people have been consulted at Karma’s nurse-assisted “e-Doctor” clinics, offering medicine, and diagnostic services in addition to remote doctor consultations. The clinics help prevent and address illnesses and promote good health, covering a range of medical concerns, including reproductive, maternal, newborn and child health services thanks to GCC support.

The service has been upgraded to help address COVID-19 by providing contact-less audio-video consultations and referrals, a phone helpline, and awareness campaigns, reducing the need for in-person engagement. This augments local government efforts and reduces the burden of healthcare facilities preparing for COVID-19 cases.

Water, sanitation, hygiene

1) Max Foundation (Bangladesh)

Through its Max Healthy Village Program, supported by a GCC investment, Max Foundation trains local NGOs to promote improved water, sanitation, nutrition and safe motherhood in rural communities in Bangladesh. Initial payments let NGOs adapt and implement interventions, incentivized by follow-on payments when results targets are met.

The Max Healthy Village program emphasizes accelerated water, sanitation and hand-washing efforts critical to a COVID-19 response, and, with its database of 400,000 mobile numbers for beneficiary households and community leaders, can facilitate quick dissemination of relevant, accurate health information to support behaviour change and decision-making in designated villages.

2) Water Sanitation Hygiene Enterprise Development Cambodia (Cambodia)

WaterSHED Cambodia’s “HappyTap Labobo” is the only commercial indoor / outdoor portable sink specifically designed for low-income settings, promoting hand washing — a critical tool in preventing COVID-19 contagion. HappyTap is an affordable, attractive hand washing station for use by anyone, including children. Produced in Vietnam and Bangladesh, it is available across Asia and expanding globally.

Educational services

1) Ubongo Learning Ltd. (Tanzania)

With GCC support, Ubongo locally produces culturally-relevant, multi-lingual, multi-media “edutainment” and other learning resources for young children and caregivers in Tanzania, Kenya and Uganda. TV and radio shows deliver engaging stories, animations and songs that teach children early numeracy, language and literacy, motor development, socio-emotional learning and good health / wellbeing, with complementary content and guidance for parents and caregivers to support home learning.

In light of COVID-19-related school closures across Africa, Ubongo is freely offering its library of TV and radio content, as well as public service announcements and educational videos to support health and hygiene.

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