Building the bridge across the (scale-up) valley of death

By Katie Clifford and Muhammad H. Zaman, Boston University

Cross-posted on The Practitioner Hub on May 31, 2017

Towards the turn of the last century, we witnessed the dawn of the internet age. Rapid developments in information technology, computing and the internet changed the way people in many countries lived, got their information and even did business. As the entrepreneurs and development experts recognized this potential in transforming lives, several new initiatives to increase access to computing and internet among low and middle income countries were launched. The mission of these various ventures across the globe became to provide a laptop to every child in the developing world to empower students through education and connectivity. The laptops were often brightly colored, ruggedly built, and slated to cost only $100 each or less. The technology was solid, supported by a wealth of R&D funding. Yet, upon roll-out of the initiative, complaints and concerns from local stakeholders started to echo around the world. There was rarely technical support provided for the technology, or training on how to effectively integrate them into the local educational system. Teachers were unsure how to use the laptops during lessons, and quickly became disenchanted by them. While children enjoyed the laptops, the laptops did not seem to facilitate learning for students – their primary goal. Without a contextually relevant scale-up strategy, focused on local partnerships and sustainable business models, laptops for low-income students was a great innovation that had minimal impact.

In the era of robust diagnostics, point-of-care tests and transformative hand-held devices, there is a similar danger in scale-up and impact, where great ideas make little impact in places where the need for new innovation is the greatest. It’s often easy to be charmed by the shiny new technology that holds tremendous promise to solve one global health challenge or another; however, unlocking that potential is just as critical as the R&D, and requires the same level of rigor and expertise.

USAID and its partners in Saving Lives at Birth are cognizant of this valley of death that connects the two peaks of early successes and the summits of impact. Great ideas need initial support, but also sustained partnerships to scale-up. The continued partnership of our PharmaChk platform with USAID reflects this commitment. We are cognizant that an essential component to our success in scaling-up our technological innovation is not just technological robustness; it is partnership, socio-cultural and economic understanding of the market and business models in places that have a high burden of disease and market structures that are different from the developed world.

Our journey with Saving Lives at Birth began in 2012, in response to the need for a simple, quantitative and inexpensive method of testing medicine quality in the field. USAID-supported R&D was conducted at our lab in the Boston University College of Engineering, where we have expertise in biomedical engineering, microfluidic technologies, and biochemistry. Five years later, we’ve prototyped a portable and simple to use “lab in a suitcase” that can test the quality of a drug in just minutes. We are in discussions with government regulators, ministries of health and hospitals in several countries who are excited about the technology and our partners in our success.

While excitement is indeed infectious, we are cognizant of the real goal – ensuring our technology gets into the hands of stakeholders who will use it to monitor and control drug quality in their settings. Saving Lives at Birth knows that there is no silver bullet and no well-trodden path here. As a result, they are able to provide customized support by connecting us with stakeholders across Africa, as well as institutions like VentureWell who are experienced in guiding social impact innovations to market.

In December 2016, as part of the mission to bridge the gap between innovators and users, we got a chance to learn about the complexity of impact in Kathmandu for a week-long transition to scale accelerator facilitated by VentureWell. During this week together, members of the Saving Lives at Birth and VentureWell teams continually challenged innovators on their assumptions and made suggestions on how to improve each team’s scale-up strategy. The accelerator workshop got us thinking about new markets where our innovation could have additional impact, as well as rethinking our future funding strategy and forcing us to define what really differentiated our product in the market. At the conclusion of the workshop, innovators were introduced to local public health leaders, who provided tremendous insight into what the roll out of each individual innovation may look like on the ground. The time spent at the accelerator was invaluable to the development of our current approach to scale-up with PharmaChk. It helped us think through our strategy, develop new business models and engage with new and exciting partners.

We know the road ahead is anything but easy. Payments, subsidies, continuous development and government support are aspects that need to be navigated for sustainable impact. However, with partners like Saving Lives at Birth, who recognize the importance of, and challenges associated with, transitioning to scale, we know we’ll have the guidance and resources necessary to bring our innovation into the world.

As we do our bit in moving towards equitable health for all, at all times, in all places, we are gratified that we have Saving Lives at Birth on our side to help us build a bridge across the scale-up valley of death.