Global Health Innovation at Work: A New Approach to Cancer Screening

Innovation is the buzzword of the decade. Touted by government officials, corporate and civic leaders and entrepreneurs, the word has become a stand-in for anything cutting edge or trend setting.

But for those of us working in the field of global health, innovation is the driving force behind transformational change that can propel the most promising solutions to the world’s relentless health challenges.

Innovation in global health is more than scientific breakthroughs and engineering feats, and shiny new technology — it means offering health providers in impoverished and remote communities the opportunity to save lives with safe, effective and affordable healthcare interventions.

That’s the essence of the innovation behind the “single visit approach” (SVA), a strategy for cervical cancer prevention pioneered by Jhpiego, a global health affiliate of Johns Hopkins University.

For most women in the developing world, screening for cervical cancer is rare, resulting in over 270,000 women needlessly dying every year from what is a preventable and treatable disease. The SVA is a low-cost method that uses simple vinegar to screen and offers same-day cryotherapy treatment, all at a fraction of the cost of the traditional PAP smear and saving the time and expense of making another trip to the clinic.

SVA is saving lives in 22 countries around the world where Jhpiego has supported cervical cancer prevention programs. In Tanzania, Julietha Makyala, a 37-year-old mother of three children, decided to take advantage of a free cervical cancer screening. She and 13 other women screened that day at a health facility in Njombe tested positive for precancerous lesions and were able to receive treatment quickly and safely during the same visit.

That kind of impact is exciting and energizing, but what about the millions of women who aren’t as lucky as Makyala? The success of the cervical cancer “screen and treat” programs in preventing women like Makyala and others from dying unnecessarily from cervical cancer depends on something quite simple: cryotherapy equipment that works, is affordable and empowers the healthcare workers in the outer corners of health systems worldwide to treat the women whom they screen and among whom they identify pre-cancerous lesions.

Yet in many countries, cryotherapy equipment that is cost-effective, robust and efficient for the single visit approach remains a bottleneck. It was this reality that prompted a team from Jhpiego and Johns Hopkins University Center for Bioengineering Innovation and Design to develop CryoPop — a new, inexpensive cryotherapy device that is portable and cost-effective.

Let’s take a moment to walk in the shoes of a nurse in rural Tanzania, Antonia Masinga. Like most healthcare workers in developing countries, Masinga’s job is demanding; and like the rest of us, she takes pride and ownership in the ability to do her job well and deliver life-saving healthcare to her community.

Her health clinic would like to start its own SVA cervical cancer program in her district, but the one piece of cryotherapy equipment they have cost a lot, so they could only buy one or two. One of them is now broken, and the cost and complexity to get it fixed has rendered it a dust collector in the corner of her clinic.

Now, when women come in to get screened, if Masinga detects a pre-cancerous lesion, she often has to refer the women elsewhere to get treated. As they walk out the door, Masinga worries that the woman will go home and her lesion will progress without getting treated, a missed opportunity and a tragic reality.

CryoPop is designed for people like Masinga, but costs a fraction of existing cryotherapy devices. It is also more robust and uses CO2 more efficiently — a gas that’s available wherever anyone drinks Coca-Cola. That means we will be able to see and treat more women at a lower cost to the health system.

In advanced product development stage, the CryoPop team has spent extensive time with users and clinical experts from all over the world. In addition to empowering healthcare workers like Masinga and making successful cervical cancer prevention and treatment programs a reality for women and families regardless of where they live, it turns out that CryoPop could also be an attractive alternative for clinical providers in developed or emerging markets in Asia, Europe, and Latin America. CryoPop has the potential to close the gap in cervical cancer prevention and treatment.

Developing technology for global health is not easy, with —even the simplest technologies facing a challenging course to move from idea to impact. CryoPop is simple, but transformational — empowering frontline health workers who are committed to providing quality, life-saving care to the women who need it most. And with the help of partners like the GE Foundation, we are closer to bringing this change about.

It is up to us to find the intersection of innovation, global health need, and engineering and scientific breakthroughs to deliver on the promise of global health technology.

Brinnon Garrett Mandel is the Director of the Innovations Program at Jhpiego, an affiliate of Johns Hopkins University, managing a portfolio of global health technology innovations and a team of bright engineers and public health clinicians, researchers, and practitioners. With a background in both public health and business, Mandel has worked in various roles at Jhpiego and in the private sector, with an interest in the intersection of global health, technology and business.


Brinnon Garrett Mandel

How Ethiopia is Scaling Midwifery to Save More Mothers, Newborns

Addis Ababa- In Ethiopia there are 4.9 million pregnancies each year of which 84% take place in rural areas. Here in Ethiopia, where the vast majority of women deliver at home, only 32% of maternal, newborn and child health needs are being met by midwives according to the newly released State of Midwifery Report. That is troubling for a country that is making noticeable strides to save its women…

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These photos are from the WHO/Jhpiego (Johns Hopkins) manual. NSFW (or babies).

Needless to say, these kinds of “adverse events” are dismissed as “rare” risks of cutting off part of an infant’s dick— and rarely enter into the “informed consent” discussion with parents.  This isn’t written for parents, though, it’s a  document aimed at the male circumcision “research” and IMPLEMENTATION industry.

The disparity in the number of health care workers between the developed and developing world is having an unintended consequence on pregnant women.

A WHO study released last year revealed that the global health workforce is short more than 7 million workers. That number will likely worsen to a deficiency of more than 12 million workers by 2035.

The shortage is most acute in certain regions of the developing world.

“Unfortunately it’s not only about the numbers, it’s about the distribution,” Julia Bluestone, chair of the Frontline Health Workers Coalition, said on HuffPost Live. “That means we have a much greater proportion of doctors, nurses and midwives posted in urban or more affluent areas. Whereas the urban poor or folks who live in rural or remote areas are much less likely to see a skilled provider or a nurse or a midwife.”

Bluestone, who is also a senior technical advisor at Jhpiego, saw the consequences of these grim statistics firsthand while traveling abroad.

“In Ghana, when we were visiting midwiferies five hours outside of the capital, [one woman was] the only midwife in that primary health post and served hundreds of women,” she told HuffPost Live. “She is always the one on call. She’s always the one on duty.”

Watch the full conversation about the shortage in health care workers here and here.

Sign up here for Live Today, HuffPost Live’s new morning email that will let you know the newsmakers, celebrities and politicians joining us that day and give you the best clips from the day before!
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Day 247: Jhpiego

Who We Are

Jhpiego is an international, non-profit health organization affiliated with The Johns Hopkins University. For 40 years and in over 155 countries, Jhpiego has worked to prevent the needless deaths of women and their families.

Jhpiego works with health experts, governments and community leaders to provide high-quality health care for their people. Jhpiego develops strategies to help countries care for themselves by training competent health care workers, strengthening health systems and improving delivery of care.

Jhpiego designs innovative, effective and low-cost health care solutions to ensure a level of care for women and their families. These practical, evidence-based interventions are breaking down barriers to high-quality health care for the world’s most vulnerable populations.

Mission and Values

Jhpiego is dedicated to improving the health of women and families in developing countries.

From our origins as technical experts in reproductive, maternal and child health, Jhpiego has grown to embrace new challenges, including HIV/AIDS, malaria, cervical cancer prevention and urban health—reflecting the increasing interconnectedness of global health. We take the latest knowledge in science and technology, apply it to develop practical, low-cost health care solutions and make them available from home to hospital, village to city.

Jhpiego assists countries in confronting and addressing health needs for women and their families. We do this by educating and preparing front-line health workers (doctors, nurses, midwives and community health workers) with evidence-based skills and techniques to deliver quality health care. Jhpiego believes that because many people cannot reach needed services easily and expeditiously, services must be made available to people where they live and in their community.

To meet that need, Jhpiego designs and implements effective, low-cost, hands-on solutions that can be delivered by a community health care worker in a home or by a doctor or a nurse in a hospital. We support and are working toward integrating treatment services and health interventions for different illnesses so women and families can be treated for several conditions in a convenient place at one time.

We build local capacity to strengthen health systems through advocacy, policy development and performance improvement approaches. Jhpiego’s ultimate goal is sustainability—leaving behind a well-prepared network of health care professionals and a strong foundation that they can build upon when we move on.

Jhpiego: A History

Responding to the Changing Needs of Women and Families Worldwide

Since its founding in 1974, Jhpiego has been innovating to save the lives of women and families worldwide. From the first day, Jhpiego has been asking the question: How can we make lifesaving services available and accessible to the people who need them—all over the world?

Dr. Theodore M. King, an early innovator and champion for women’s health, was the moving force behind the founding of Jhpiego, an affiliate of Johns Hopkins University. In the early 1970s, King recognized the need to make physicians, nurses and administrators from developing countries aware of reproductive health breakthroughs, such as laparoscopy (a procedure used to inspect internal reproductive organs for infertility or to provide contraception by closing off the fallopian tubes) and modern contraceptives. Originally known as the Johns Hopkins Program for International Education in Gynecology and Obstetrics, the organization was funded through the United States Agency for International Development (USAID). Under King’s leadership, as a founder, trustee and later president of Jhpiego for 14 years, the organization conducted a steady stream of programs throughout the developing world.

How Did We Get from There to Here?

Early on, Jhpiego established itself as a leader in reproductive health training. Beginning in 1974, Jhpiego held training sessions on family planning/reproductive health for doctors and nurses in the USA In 1979, Jhpiego started its first in-country training programs in Tunisia, Brazil, Kenya, Nigeria, Thailand and the Philippines. From 1987 through 2004, Jhpiego conducted three global Training in Reproductive Health Projects, funded by USAID. Beginning in 1993, Jhpiego published learning materials on long-acting family planning methods.

Over the years—to respond more effectively to the needs of individual countries—Jhpiego became increasingly field-based and established its first field office in Kenya in 1993. Today, Jhpiego has field offices in more than 30 countries worldwide. Similarly, Jhpiego’s programming areas have expanded to meet changing needs in the field. In addition to family planning and reproductive health, Jhpiego now has expertise in maternal and child health, infection prevention and control, HIV/AIDS and infectious diseases.

Jhpiego’s work has also expanded to address reproductive health policy and guidelines and to support health systems strengthening. For example, in 1996 in Brazil, Jhpiego launched a performance and quality improvement approach, now known as Standards-Based Management and Recognition (SBM-R), which has since been implemented in 30 countries. SBM-R empowers health workers and facilities to improve the performance and quality of their services by providing them with the tools and methods they need to make decisions, solve problems and innovate at the local level.

Innovations in Training Methods and Technologies

In 1986, Jhpiego pioneered a competency-based training (CBT) approach that emphasizes learning by doing. CBT focuses on how the participant performs and promotes the trainer’s ability to encourage learning. Jhpiego also introduced the use of anatomic models for “humanistic training.” To minimize risk to clients, learners first practice on models until they achieve competency. In 1995, a clinical training skills manual—the cornerstone of Jhpiego’s training approach—was published. Using a systematic “training of trainers” approach, Jhpiego has created a global network of qualified physician, nurse and midwife trainers.

As early as 1984, Jhpiego collaborated with the University of the West Indies to deliver reproductive health courses, via satellite, to six islands in the Caribbean. In 1987, Jhpiego sponsored a global meeting on reproductive health education and technology with the World Health Organization (WHO) and introduced computer-assisted instruction to simulate clinical situations in several of its US-based courses. In 1995, ReproLine, an online source for reproductive health information, was launched. Today, Jhpiego continues to explore new learning technologies: mobile phones in Afghanistan, a computer-based learning management system in Ethiopia, computer-based training in Ghana, a distance learning program in Zambia.

Practical Solutions for Low-Resource Settings

Since the 1992 publication of its international reference standard Infection Prevention for Family Planning Service Programs, Jhpiego has been at the forefront in promoting evidence-based practices that can protect health care professionals, staff and clients from potentially life-threatening infections. To this end, Jhpiego has tested and introduced practical, low-cost infection prevention procedures that can be implemented effectively in settings with limited resources.

In developing countries, cervical cancer remains the leading cause of cancer deaths among women. In 1995, Jhpiego began research with the University of Zimbabwe to find a low-cost alternative to the Pap test that could make cervical cancer prevention a reality in low-resource settings. Based on the results of this research, Jhpiego helped form the Alliance for Cervical Cancer Prevention in 1999 and received funding from the Bill & Melinda Gates Foundation to expand its cervical cancer program. Since that time, Jhpiego has developed and piloted the single visit approach in which women are screened and treated during the same visit.

In 1995, Jhpiego began addressing HIV/AIDS and its integration with family planning services. Six years later, Jhpiego began work in HIV voluntary counseling and testing with a USAID-funded project in Jamaica. In 2002, Jhpiego received its first funding from the U.S. Centers for Disease Control and Prevention (CDC) for work in HIV/AIDS and, the following year, developed a global learning package on prevention of mother-to-child transmission of HIV—with CDC, WHO and university partners—to enable global scale-up. Also in 2003, Jhpiego began work on male circumcision for HIV prevention in Zambia. In 2008, Jhpiego developed a global learning package on male circumcision for HIV prevention with WHO and UNAIDS.

The Way Forward

Jhpiego’s role in maternal and child health has expanded dramatically over the years, increasing its emphasis on nurses and midwives as primary care providers. From 1998 through the present, Jhpiego has led three of USAID’s global flagship programs: the MNH Program, followed by the ACCESS Program—both of which focused on maternal and newborn health—and currently the Maternal and Child Health Integrated Program (MCHIP), an expanded program that focuses on maternal, newborn and child health.

Jhpiego’s dedicated teams of technical experts—in the areas of global learning; family planning/reproductive health/cervical cancer; maternal, newborn and child health; monitoring, evaluation and research; health systems strengthening; HIV/AIDS and infectious diseases; publications; and knowledge management—are renewing their efforts to pursue and disseminate practical, low-cost innovations that can make significant contributions to the health of women and their families.

As Jhpiego moves forward, its staff will continue to respond to changing needs in the field, and they will continue to ask: How can we save more lives?