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By Duncan Johnstone
Meeting healthcare needs affordably is truly a global challenge. Rapidly expanding populations, fast changing lifestyles and demographics all over the world make the issue manifold and complicated. Even in countries with well-developed healthcare infrastructures such as the UK, which has relatively straightforward access to care, affordability is not to be taken for granted. We are often reminded about the looming burden of an aging population and in tandem, the cost of addressing chronic disease. Increasingly, people expect to receive better and more complex treatments on a routine basis, and as such, affordability is, ultimately, a challenge faced by the entire population.
Healthcare is, of course, much more problematic in resource-poor regions of the world, where basics like clean water may be hard to come by, let alone a well-serviced hospital. This devastating state of affairs is reality for the majority of the world population. There is a major lack of skilled practitioners, a situation further aggravated by poor supply chains for medical equipment and slow rates of information diffusion. Good quality analysis of the overall healthcare system rarely exists, making it difficult to pinpoint issues to be solved and to quantify improvements once made. The problems are wide-ranging – does the person treating me have clean gloves, do they have any medical training, is there any record of my health, will someone monitor my treatment, is there any diagnostic equipment available at all?
It is in resource-poor settings that chronic disease catalysed by fast changing lifestyles will meet severely underdeveloped healthcare infrastructures in the near future. For chronic diseases such as diabetes, chronic obstructive pulmonary disease, and aggravators like hypertension, it is possible that high-quality affordable products produced for resource-poor settings could also be used in more developed countries.
In recent years technology has developed and spread at an astonishing rate and shows no signs of slowing down. If anything can keep up with the growth of healthcare demands it is this. Consider mobile phones, where 90% of the population now live within range of a communications mast [wbi.worldbank.org/wbi/content/behavioral-change-using-technology] and the worlds’ poorest communities are some of the most rapid adopters of unfamiliar technologies. Whilst at the same time in more developed nations the way data is processed into information is changing with the advent of cloud computing.
These are exactly the trends that a group of students and researchers from across the university have come together to use as an opportunity to improve healthcare through the Oxford Centre for Affordable Healthcare Technologies (OxCAHT). Technology can’t solve all the problems identified above, but it can improve some. I spoke to Sana Fathima, founder and co-director of OxCAHT, to find out more about the technologies they work on.
Sana Fathima is a 3rd year DPhil student at the Institute of Biomedical Engineering. She is founder and co-director of the Oxford Centre for Affordable Healthcare Technologies and is involved directly with a number of the technologies being developed at design and implementation stages.
What is the Oxford Centre for Affordable Healthcare Technologies (OxCAHT)?
OxCAHT is a multi-disciplinary, cross-professional centre dedicated to affordable healthcare technologies. Our core purpose is in developing innovative devices with significant market potential and the ability to impact healthcare systems across the globe. Device development is project based and led by students from across the university. We are also heavily involved in general student engagement through termly seminar series, workshops, industry-led events and internship opportunities.
What kind of devices do you work on?
We attempt to address the issues that must be solved to provide low-cost automated decision support in resource-poor locations, using the computational power readily available in billions of mobile phones and cloud computing environments. In this way we aim to harness the unprecedented opportunity that the ‘leap-frog’ effect of mobile phone usage presents for the delivery of healthcare to the most remote regions. In particular this includes; the design of low-cost robust instrumentation which is resistant to artefacts and noise typical of resource-poor locations, the development of secure interchangeable medical records accessible from a mobile phone, multiple-expert annotation of data, the employment of standardized medical nomenclatures and sustainability models for open source solutions.
How do you envisage these devices being applied in practice?
The provision of intelligent devices to the relatively abundant untrained or semi-trained workers around the globe allows for an integrated approach for capturing diagnostic data and enables experts to rapidly review and diagnose. Furthermore, the creation of large expert-labelled databases of context-specific medical data provides the opportunity to use the computational power of back-end clusters and mobile devices to provide automated decision support. In this way, it may be possible to scale up telemedicine from millions of experts to billions of autonomous agents.
We seek to use existing supply chains, rather than build new ones to integrate our technologies within communities. We also consider education, sustainability and human factors, and therefore partner with public & primary healthcare specialists, anthropologists and business entities.
What projects are running at the moment?
We work in 5 main areas that deal with major disease burdens globally: sleep and circadian rhythms, cardiovascular & respiratory diseases, perinatal, critical care, and Infrastructure for Health. Within these themes, teams currently work on 12 different projects including; a mobile blood pressure cuff, a neonatal apnoea monitor, a smart water pump, a low-cost heart sounds monitor, a mobile stethoscope, and a maternal-foetal monitor. All combine robust instrumentation interfaced with smart phones. We develop both the instrumentation and apps to drive them.
How successful are your devices?
Several of our projects have won international design competitions, and many are being approached by technology companies, healthcare delivery organizations, and industry partners looking to expand and incorporate mobile-based healthcare technologies into their development and access schemes. This list is quite long, and all the awards can be found on our website.
The devices we develop go through rigorous validation approached from a robust design and implementation perspective. We aim to keep the device cost as low as possible, averaging less than $10 USD. We also design in keeping with potential access to local supply chains for the manufacturing of these devices in order to create these low-cost sustainable devices.
What kind of people work at OxCAHT?
To us, innovating in healthcare requires not only relevant and distributable “smart” technologies but also a strong understanding of communities, practices, and human health behaviour. This can only come from interdisciplinary teams, and involvement from partners. While the bulk of our design teams include scientists and engineers, we also have strong involvement from the Said Business School, Department of Global Health, Department of Geography, Oxford University Engineering Society, and others.
Anyone with a passion for the field, and an interest in developing new strategies and technologies to deal with the inequities in healthcare access and delivery across the world are encouraged to get involved. Every background and thought is valuable to us, and we welcome all interested.
Want to get involved with Oxford Centre for Affordable Heathcare Technologies?
OxCAHT runs a number of healthcare projects throughout the year and are always looking for people from all backgrounds to join their project teams. For more information visit www.oxcaht.org and sign up to their mailing list.