What do the photos of a Dengue mosquito, a 3D-printed microscope and a wooden foetal stethoscope have in common? All are part of ‘open health’ projects, no joke. Makers, health professionals and patients in open health initiatives are putting their knowledge together to develop innovative, individual and openly available solutions to healthcare problems. Here, people are viewed not just as patients but as integral parts of the health system. And it’s about time.
The healthcare system is not doing well: it is becoming increasingly dominated by commercialisation and by closed, proprietary business models. Healthcare solutions are often industrially manufactured, mass-produced and patented. Underfunding, the dismantling of the welfare state and aging societies are also burdening the healthcare systems of Western societies. Which is why there is a growing gap between people who can afford high-quality, usually private services, and those who can’t even get their basic needs covered by standardised solutions.
In developing countries, according to a WHO report, more than 400 million people worldwide have no access to vital health services such as obstetrics or clean drinking water. There, people with disabilities or chronic diseases are in the weakest position: health care is rarely accessible, financially unviable, or it does not meet their needs.
The right to health is supposed to be one of the measures of the Sustainable Development Goals (SDGs) which are going to tackle these circumstances. The SDGs stipulate that by 2030, everyone should have access to healthcare systems, clean water, air and sanitation facilities. The question of how this objective might be achieved without binding political and economic obligations, remains unanswered.
One part of the solution might be located in healthcare systems accepting bottom-up principles and open innovation processes. Indeed, the concept of open innovation that Henry Chesbrough developed at the beginning of the 21st century is slowly gaining traction in healthcare. The idea is that innovations should no longer be developed behind closed doors in labs and companies, excluding patients or other target groups. Patients can be included in order to achieve better results through participation and iteration.
For example, as early as 2012, the European Alliance for Personalised Medicine (EAPM) recommended the development of ‘open innovation’ frameworks which are open to participation at specific points, so that healthcare providers can fulfil the various requirements of patients. And there has long been a number of open health projects that have given patients a new, active role rather than treating them as passive recipients of assistance services.
Because researchers have expanded the post-war definition of health. Since 2011, health has also come to mean “the ability to adapt and self manage in the face of social, physical, and emotional challenges.” This turns people into actively qualified prosumers, and breaks with the idea of the passive recipient of health services. Health becomes a subjective feeling requiring individual solutions instead of industrial standards.
- What’s That? Open Health?
In order to involve patients and innovators, new technologies can also help. With the advancement of digital technologies, patients, campaigns and independent, innovative entrepreneurs can exert an increasing amount of influence.
Experts such as Joyce Lee, a doctor who analyses design thinking models from the patient’s point of view, are proclaiming to healthcare stakeholders “it is time to embrace not only mobile technology and social media for achieving innovation and transformation inside the healthcare ecosystem.”
- The Maker Net
In addition to open software and open data, Open Health projects are becoming increasingly relevant in the field of home-made medical devices and products. The maker movement operates under the DIY principle. And more and more makers are focusing on social, ecological and health issues. Prostheses for people in developing countries can be produced with 3D printers, NGOs such as FieldReady have been providing emergency relief with 3D printers in natural disaster zones for years.
In 2016, the MakerNet initiative was founded by Field Ready, the economic development companies Civic, CoStruct, and the maker spaces Gearbox and Kumasi Hive. MakerNet seeks to promote local manufacturing, as well as optimising delivery and value chains. To this end, they connect individuals or organisations in need of solutions with makers and local manufacturers. The pilot project of MakerNet is currently being launched in Kenya, with the collaboration of the young Kenyan Michael Gathogo. Gathogo is a typical maker: he has taught himself many manufacturing techniques, but he is neither a doctor nor an engineer. Even before his time at MakerNet, Gathogo was tackling local problems with home-made solutions. One of his inventions is a smart vest for the passengers of motorbike taxis: brake lights light up on the back of the vest, even if the actual brake lights of the motorcycle are broken, which is often the case in Kenya.
For the pilot stage of MakerNet, Gathogo has brought together local hospitals and health professionals with the makers, in order to develop solutions for hardware needs in the local healthcare system. One of the project’s successful results is the repair of a broken oxygen gauge at St. Patricks Hospital in Kenya. A new device would cost about 550 dollars. But it was only a connecting screw that was broken. Design, 3D printing and repair ended up costing about 40 dollars. They also printed new connecting tubes out of resin for broken suction units from the Maria Maternity Clinic and Nursing Home in Kayole. Instead of spending 350 dollars on spare parts, the repairs cost about 50 dollars.
The use of local means of production and labour is part of the MakerNet concept: after they had printed a plastic prototype of a 3D pinnard horn (a foetal stethoscope) and tested it in local hospitals, they had the cylinders (which are used to listen to the heartbeat of unborn babies through the mother’s womb) produced out of wood by a local carpenter. The clinics gave positive feedback: the wooden pinnard horns worked better than the plastic prototype. The process developed by MakerNet created an inexpensive product using local resources and a short value chain.
MakerNet cooperates with AB3D from Kenya: for several years, this maker company has been manufacturing 3D printers out of eWaste. The printers make medical equipment, such as syringe tips. Their new project is a printed microscope. Veterinary facilities and hospitals in Kenya are already using them, with better results than with the available models, which are imported and dependent on spare parts.
Such open health projects, which are connected with the maker scene, aim to lower the costs of medical devices, and avoid supply shortages. Furthermore, for Tarek Loubahni, independence and self-sufficiency are also important. His Glia project manufactures medical devices in Gaza. Together with the Al-Shifa Hospital, he developed a stethoscope that costs just 30c US to produce, and is to be made available as an open source design, without restrictions. In 2012, when the military conflicts flared up in Gaza again, there were not enough stethoscopes. So Loubahni set out to produce the simple yet vital devices with a 3D printer.
Meanwhile, in Ramallah, Samer Shawar, operator of the Vecbox Hackerspace, developed a 3D-printed prosthesis that works with integrated machine learning technology and is able to detect muscle movements. In this manner, all movements can be adapted individually to the patient’s motor skills and nerve structures.
- Healthcare 2030 – the question of the relationship between the private and public sectors
Health is one of the priorities of the SDGs. But the development goals won’t be achieved without creative, innovative approaches. Only when governments and administrations overcome their dependence on equipment manufacturers and pharmaceutical companies will the assistance provided by citizens and patients become more significant. This applies for both underdeveloped and industrialised countries.
Looking ahead to the year 2030, we are faced with the question of whether public and private players in healthcare will cooperate more closely, or whether healthcare will be delegated to the private sector?
This complex conflict can be seen, for instance, in the case of the flare start-up. Celebrated in the press as one of Kenya’s most successful and innovative companies, it’s really nothing more than a sort of Uber for hospitals. Since there is no central emergency number in Kenya, two Americans founded flare to fill this service gap with a private company. As such, the business model – as with many other start-ups and innovation projects – is simply a response to deficient or absent government services.
But where are we heading with these kinds of ambulances? If flare is able to show the state that an ambulance service is possible, the private company could be bought by the state. But movements in the other direction are more likely: that the governmental duty of transporting the sick gets privatised. That governments will not even attempt fulfil their obligations in the first place.
So how could open health projects improve public services instead of replacing them? It would be useful if, in the future, all hospitals had maker facilities, making it possible to repair machines quickly and cheaply, or to develop solutions on a case-by-case basis. This would require the political will to implement open innovation guidelines, to involve innovators and patients in research processes – and not just at the testing stage, but from the very beginning of the development process.
Of course, some critical questions crop up as well, for example, regarding quality control, liability and warranties. What happens if the 3D-printed umbilical cord clip doesn’t work? This has implications for various ethical and legal questions that are yet to be resolved. Which is understandable, since we are only beginning the evolution towards more open health. The initial examples sound promising, but at the same time, there’s are a significant amount of factors to resolve. How can DIY health approaches be integrated into existing healthcare systems? How can the solutions be scaled? And when do top-down and bottom-up approaches in healthcare complement each other? These questions will have to be addressed if we want to use innovative solutions and modern technologies to create opportunities for people to help themselves.