How Durable Design Can Save Lives

Many of these deaths are preventable through high-quality hospital-based care. But even routine devices such as syringe pumps and phototherapy lights that are crucial to achieve this level of care—and standard in most U.S. hospitals—are often inaccessible or difficult to use in low- and middle-income countries.

Developing medical devices that are suitable for these regions is no small feat—considering the devices must be affordable, easy to use, and functional in environments that might have extreme temperatures, high levels of dust, or frequent power outages.

To meet this need, a team led by Kellogg sustainability and social impact professors Kara Palamountain and Rebecca Kirby turned to an approach often employed by health agencies. Through field research and input from clinicians, NGOs, manufacturers, and researchers, they developed 15 “target product profiles” that detail the ideal specifications and cost requirements for producing newborn medical devices that are appropriately tailored for low-resource settings.

Since the researchers published the product profiles in 2020, many companies and NGOs have relied on them to create new devices or adapt existing technologies for low-resource settings. To date, thousands of these devices have been purchased and installed in hospitals throughout Africa.

“We have seen product developers adopt these profiles, and others have told us that they have referenced them and made changes to ensure their products meet the requirements,” Palamountain says. “It has shown governments how they can invest in newborn health and save lives.”

More broadly, leaders can use these product profiles, and the process the researchers used to create them, as a blueprint to address shortcomings in many other markets. By bringing together experts from both the supply and demand sides of a given market, “we were able to facilitate a healthy dialogue and bridge the gap where there previously may have been high transaction costs or information gaps,” Kirby says.

Defining needs

For their research, Kirby and Palamountain partnered with UNICEF and NEST360, an international alliance working to reduce preventable newborn deaths in sub-Saharan Africa.

The team’s collective goal was to support the United Nations’ plan to reduce newborn mortality rates to fewer than 12 deaths per 1,000 live births by 2030—which would avert potentially millions of deaths.

They began by reviewing WHO guidelines to identify which medical devices were most critical for small and sick newborns. In all, they identified 15 broad categories for devices that could help manage nutrition and drug delivery, treat jaundice, monitor and diagnose conditions, provide respiratory support, and check and control temperature for newborns.

“We didn’t worry about whether the product existed already or not,” Palamountain says. “For many of these categories, an adult version existed—like a glucometer for adult diabetics—but they did not have the right specifications for newborns.”

Then the researchers spoke with experts and conducted field observations to define the minimal and optimal characteristics for the effective performance of devices in each of the 15 categories. They took into account both environmental factors and human factors that might not exist in wealthier or more urbanized countries.

For example, they noted that oxygen concentrators must be able to function in areas exposed to high levels of dust. And that a newborn unit might not have enough nurses to take every baby’s temperature during each shift. “You might then design a thermometer that continuously measures the baby’s temperature and alerts the nurse through some visual cue that the baby is too cold,” Palamountain says.

They used this information to draft 15 target product profiles, each detailing features and technical requirements for the desired type of device. Then, they had more than 100 key stakeholders in newborn care in low- and middle-income regions—including clinicians, advocacy organizations, manufacturers, and technical agencies—review the drafts online and discuss them in an in-person meeting.

By the end of this process, the reviewers came to a consensus on 97 percent of the 668 performance characteristics highlighted in the 15 product profiles, from a device’s critical features to its price. In other words, most of the stakeholders eventually agreed on the vast majority of characteristics that these newborn medical devices needed to have.

“In many of these settings, there’s a lot of need and some demand,” Palamountain says. “And the healthcare device market is not as profitable in these countries. So you need a process like this to bridge the supply and demand, to show manufacturers what is needed and at what price point they need to be.”

Indeed, Kirby says that “it was challenging, at times, to achieve consensus on price because different geographies are more accepting of various price points.”

Price points can be difficult to establish since they include not only manufacturing, shipping, and maintenance costs for the medical devices, but also tricky trade-offs. For instance, in areas where outages are common, hospitals could request manufacturers add battery use as a feature to devices that require constant power, but that might considerably increase their price. Alternatively, a hospital could invest in a backup generator for the hospital that would allow it to purchase several more cost-effective devices without the added battery feature.

“These are the kind of trade-offs that different countries make,” Palamountain says.

Research with impact

The researchers’ target product profiles were published on the UNICEF website in April 2020 and have since been viewed more than 7,000 times as of 2023. Their work also recently received the “Academic Research with Impact” award from the Financial Times.

Now, over five years later, manufacturers and buyers continue to reference the profiles when developing or considering new devices. Device manufacturer Neopenda, for example, referenced several of the researchers’ target product profiles for its new vital signs monitor. Palladium International, working on behalf of the USAID Integrated Health Program, incorporated parts of several profiles into its offer to purchase training materials on caring for small and sick newborns.

In all, the researchers have identified 38 newborn medical devices—both new and updated—in 13 different product categories where manufacturers used the team’s recommendations.

Palamountain and Kirby continue to monitor the devices to evaluate their lifespan and to ensure that hospital technicians and bioengineers have the necessary training to maintain and repair them.

“We don’t just stop and say, ‘Here are the devices,’” Kirby says. “We want to make sure that the devices are actually useful and that the staff are trained properly. We want to make sure that we are truly making an impact.”

The ultimate measure of success will be whether the devices help reduce newborn deaths in these countries.

“But a true health-system approach is needed to hit the target,” Palamountain says. “We can’t hit the target if the hospitals don’t have the supporting infrastructure and human resources to use and support the devices, which is where the other parts of NEST360 and government collaboration come into play.”

Addressing gaps beyond healthcare

The project’s early success shows how strategic planning principles that may be intuitive in a business setting can be applied toward solving public-health challenges.

The researchers’ extensive and communal approach—in which they combined the insight of experts from many countries on both the demand and supply side of medical devices—could help address gaps in markets beyond healthcare, the professors say.

One of the keys to this approach is getting buy-in from stakeholders on both sides of a given product market—from manufacturers to users. In order to engage these groups well and translate what each side needs into a cohesive product, you need to be curious and humble, according to the researchers.

“You need to be a good listener and ask what might sound like ‘stupid’ questions,” Palamountain says. “You need to have good translators to understand the issues on each side. And MBAs in general are good translators who can coordinate across disciplines. Having someone like that running this process is invaluable. It is so inspiring to see the impact of the TPPs helping to save newborn lives.”