Health tech: appropriate over affordable

Home to some of the world’s best designers, engineers and clinicians, South Africa has the potential to make its mark as a central health innovation hub in the global south. This is the view of Sudesh Sivarasu, associate professor of biomedical engineering at the University of Cape Town (UCT), who believes that – using Frugal Biodesign – developing nations can solve their own healthcare challenges.

Sivarasu shared his insights into the process of designing appropriate healthcare technologies for local problems at the most recent instalment of Café Scientifique – hosted by UCT Research Contracts and Innovation (RC&I) and supported by leading intellectual property law firm Spoor & Fisher.

Advancing technology and access

The idea of designing intricate in-house healthcare technologies for low- and middle-income countries may seem somewhat counterintuitive. Many people might think there are ‘more important’ problems to solve first.

It’s widely understood, for example, that hospitals and clinics in these contexts – especially in rural areas – are understaffed. There is a lack of infrastructure – everything from roads that are unnavigable by ambulances to an absence of beds. Shouldn’t we focus on these issues and rely on donations of medical devices instead?

Currently, South Africa imports more than 90% of its health technologies.

These are just two of the common misconceptions around healthcare technologies in developing nations; ones that Sivarasu is happy to debunk.

Donations and imports: the antithesis to design

First, Sivarasu points out that medical devices cover a wide spectrum: from spectacles to medical-imaging scanners and everything in between.

“When it comes to medical devices, we easily get distracted by the complicated things like defibrillators, MRI machines, CT scanners – the super-spectacular technologies,” Sivarasu says. “But they’re not only that. They start with simple things like prescription glasses, measuring cups for medicines and even scales.”

Currently, South Africa imports more than 90% of its health technologies.

The idea that we can rely on donated or imported medical devices instead of designing our own to save costs, he points out, couldn’t be further from the reality playing out in most developing nations.

“In layman’s terms, for every R100 we spend on healthcare technologies, R90 goes overseas,” Sivarasu explains. “If a portion of this can be retained within the country through sustainable, local health technology innovations, we not only create jobs, but can also contribute to the country’s economic growth.

“We need to create this ecosystem of innovation.”

Furthermore, Sivarasu points out that close to 70% of all the donated medical devices in Africa don’t function. Not because of poor design, but because of a lack of maintenance.

“We don’t have spare parts locally available to repair these complicated technologies. We don’t have skilled personnel to prepare and operate these technologies,” he says.

Ultimately, Sivarasu believes that developing nations should be turning their attention to solving their own problems by designing technologies that are appropriate to their specific set of circumstances.

“We need to create this ecosystem of innovation.”

“With the fourth industrial revolution not being too far from reality, access to 3D printing and other cyber-physical systems may not be of reach even in rural Africa,” Sivarasu says. This could mean a level playing field and the potential for Africa to lead the way for the next generation of innovators by focusing on innovations that are appropriate, he continues.

Introducing Frugal Biodesign

Coining the term Frugal Biodesign, Sivarasu has based his approach on the Stanford Biodesign programme, which essentially takes the form of a multidisciplinary group of professionals solving a problem together.

While Sivarasu believes that taking this kind of bigger picture systems approach is the only way to reach a successful outcome with healthcare innovations, he adds that involving many stakeholders during the innovation phase is currently not feasible in an African context.

This is where the concept of Frugal Biodesign diverges from its Stanford roots and sets out on a new course by liaising directly with a clinician to establish a hierarchy of needs that a device should answer to.

“The clinician becomes the centre of the innovation,” Sivarasu says. “If you leave the clinician off the chain, you’re going to miss out on the end-user perspective.”

This is then followed by various stages of conceptualisation, intellectual property roll-out – where RC&I plays a crucial role – and, finally, commercialisation.

Real solutions for real problems

Sivarasu’s Frugal Biodesign has become one of the cornerstones of UCT’s sought-after MSc in Biomedical Engineering – Medical Device Design course.

Sivarasu believes that developing nations should be turning their attention to solving their own problems by designing technologies that are appropriate to their specific set of circumstances.

Each student is given a problem–solution pair, as established by Sivarasu through intensive consultation with a clinician. This means the students can move beyond the boundaries of academia and make a real-world impact through critical problem-solving and design.

Sivarasu’s postgraduate researchers have recently delivered some stellar innovations as a result.

In 2018, for example, Impulse Biomedical – a UCT spinout company set up by former students Giancarlo Beukes and Gokul Nair – was named the overall winner in the medical devices sector of the Technology Innovation Agency’s Global Cleantech Innovation Programme of South Africa for the Easy Squeezy asthma inhaler attachment. With its ‘bunny-ear’ design, the Easy Squeezy allows children and elderly patients to activate the pump easily using their whole hand, instead of struggling with two or three fingers as is the norm.

With about 10% of South Africa’s adults and 20% of its children suffering from asthma, this simple, 3D-printed device could be a game-changer for the most vulnerable sufferers.

It’s these kinds of successes that affirm Sivarasu’s overall philosophy. “It’s not the technology that’s going to dictate the solution; rather, it’s the problem that’s going to determine the solution through appropriate technologies. We should avoid the traditional pitfall of technology push.”