The first time I walked into an under-resourced neonatal intensive care unit (NICU) in rural Rwanda, I was overwhelmed. Although I considered myself knowledgeable about the health care space from an organizational perspective, it was a completely different experience to see premature newborns being treated. Forty NICU visits, four months and three countries later, I gained a new appreciation for user-centered design in health care.
After graduation, I took the opportunity to delay the start date of a full-time consulting job for six months, move to Rwanda and complete a fellowship with D-Rev, a nongovernmental organization (NGO) that designs and licenses medical technologies for delivery to underserved populations in developing countries. My fellowship, which had three phases, focused on the development and delivery of a continuous positive airway pressure (CPAP) solution to treat newborn respiratory distress syndrome. First, I completed need-finding trips to over 30 hospitals throughout East Africa to conduct a market segmentation analysis to maximize D-Rev’s impact. Second, I completed a human factor study with the engineering team to test and receive usability feedback of our prototype from the end users. Finally, I met with international NGOs, ministries of health and distributors to streamline the supply chain in order to quickly get life-saving devices into the hospitals with the greatest need.
Being on the ground in East Africa was critical in shaping D-Rev’s launch strategy in the region. Here are my main takeaways:
- Go beyond the product and invest in the entire health care ecosystem: For many types of medical equipment, utilization is driven by the availability of training, repairs and consumables. These post-sale services are almost always offered through procurement contracts, rarely through donations. As a result, I saw closets full of top-of-the-line equipment that was donated with good intentions but couldn’t be used. For D-Rev to have meaningful impact, the entire ecosystem must be supported, either through increased investment in the region or deeper partnerships.
- Empower the nurses: Unlike in the United States, where the baby-to-nurse ratio is 1:1 and there are numerous neonatologists, in East Africa I visited numerous facilities where there were few doctors and the baby-to-nurse ratio was 15:1 or even 20:1. At these facilities, I saw firsthand how nurses were the major drivers in advancing health care in the region. Facilities where the nurses had full responsibility for the diagnosis and treatment of newborns had dramatically better outcomes. Therefore, D-Rev needed to design the CPAP device with a nurse as the primary user.
While in East Africa, I reflected on how my time at the UCLA Anderson School of Management had prepared me for this fellowship. These are a few of my thoughts:
- My D-Rev fellowship mirrored my Applied Management Research (AMR) project, in which my team collaborated with a Peruvian agriculture company on devising an optimal go-to-market strategy. Although the industry and region were different, the need-finding principles I used in my AMR project helped me greatly when visiting hospitals throughout East Africa.
- The Healthcare Business Association (HBA) was also instrumental in my understanding of the role D-Rev has in the larger health care ecosystem. At one of the HBA’s events, I had a discussion with the CEO of HealthBegins about the importance of the social and structural determinants of health.
- When I was trying to figure out how to help D-Rev scale up in the region, I remembered discussions from Professor Jennifer Walske’s Impact Creation Analysis class on how networked nonprofits maximized their impact by partnering with each other and mobilizing resources outside of their immediate control.
Overall, being able to go to East Africa and work with D-Rev was an absolutely amazing experience. Although I learned a lot about creating a launch strategy for a global health NGO, I was most inspired to see how nurses and doctors in East Africa are taking ownership of their problems and doing something about them. For example, Nurse Salome has become a specialist on respiratory distress syndrome and travels to hospitals throughout Kenya to increase other clinicians’ awareness and knowledge of CPAP devices, and Dr. Victoria is taking on newborn nutrition by creating the first milk bank in Uganda to serve the 40% of preterm babies who don’t receive breast milk. Yes, international aid is welcomed, but the narrative that this region is helpless is simply not true.