Bringing Care to the Front Door 

By Sandy Garçon, PSI

Amid a changing funding landscape, global health stakeholders are looking for innovative and cost-effective ways to deliver consumer-centered healthcare, both inside and outside hospital walls. Thanks to emerging medical and digital technology, there is an unprecedented opportunity to deliver quality health solutions directly to the consumer.

From personal diagnostics to mobile technology, these new classes of products and services are making it from the traditional clinic to the household, helping bring care closer to the people who need it most.

Consumers in the least developed parts of the world can now become more actively involved in their own healthcare. The following five innovative solutions are shifting control directly to health consumers’ hands for greater health outcomes.

SAYANA® PRESS

The first ever “do-it-yourself ” injectable contraceptive, Sayana® Press combines a lighter dose of the drug Depo-Provera and a needle into an easy-to-use cartridge. Injected just under the skin, Sayana® Press requires minimal training, making it especially suitable for administration by community-based workers—rather than by doctors and nurses. It can even be safely and easily self-administered, where authorized. What’s more, it’s tiny, doesn’t require assembly, and is easily disposable.

Changing the Game
An estimated 214 million women in developing countries would like to delay or prevent pregnancy but are not using any method of contraception. Because of its unique contraceptive delivery technology—compact, discreet, easily transportable, and no refrigeration required—Sayana® Press can be provided in low-resource, non-clinic settings. And with three months of contraceptive protection per dose, the product calls for less frequent clinic visits, further increasing women’s autonomy.

The Last Mile
Funding from the Bill & Melinda Gates Foundation and the Children’s Investment Fund Foundation is making Sayana® Press available for US$0.85 per dose to qualified purchasers in over ten countries. Current efforts are underway to unlock new market opportunities.

HIV SELF-TESTING

Much as home pregnancy tests put more information directly in the hands of women, HIV self- testing (HIVST) is helping people learn their status in a way that works for them: on their own terms—using either a blood-based or oral fluid self-test kit—at a place and time of their choosing, and with a return of results in minutes.

Changing the Game
Three out every 10 people living with HIV worldwide are unaware of their status. HIVST empowers those who may be deterred from learning their status and getting care. Fear of stigma and discrimination, lack of privacy, lack of time, as well as the distance and cost of transportation to the nearest health facility are often cited as reasons. Expanded HIVST use can contribute to reaching first-time testers, people with undiagnosed HIV or those at ongoing risk in need of frequent retesting. This will help address poor coverage particularly among men, youth, key populations (i.e., sex workers and men who have sex with men) and other hard-to- reach groups.

The Last Mile
Regulatory obstacles remain in many countries. Countries must adopt national guidelines and frameworks, with rapid scale-up and implementation. Plans must include continuous evaluation to identify the most sustainable, equitable, and cost-effective approaches for HIVST distribution.

DAPIVIRINE RING

First developed for contraceptive use, vaginal rings are a promising tool for HIV prevention. The self-insertable, flexible silicone ring provides sustained-release of the antiretroviral drug dapivirine locally to the site of potential infection during the time that it’s worn. Designed to be changed monthly, the ring reduces women’s risk of acquiring HIV by more than half.

Changing the Game
Existing prevention methods have not done enough to stop the spread of HIV among women. Pending regulatory approval, the dapivirine ring would provide women with the first discreet, easy-to-use, and long-acting prevention option. Expanding women’s options increases the likelihood of identifying a solution that works in the context of their lives, so that they can stay protected.

The Last Mile
Preliminary results from the open label HOPE and DREAM studies are showing protection levels up to 54%, alongside higher rates of adherence. The next step is regulatory approval and guidelines from the World Health Organization. Research is also planned to evaluate the ring’s safety in pregnant and breastfeeding women. Further research has already begun on a dual-purpose ring to provide women three months of protection against HIV and unintended pregnancy.

TIKO

Think frequent flyer miles, but for health- seeking behaviors. This program, created by Triggerise, rewards consumers for accessing health services and products, just as they would be for booking a flight or shopping in certain retail stores. Consumers earn “TIKO Miles” at participating public and private facilities for each milestone they reach in the healthcare system.

Changing the Game
A solution designed for cash- starved, informal markets, TIKO aims to reduce the financial and supply barriers to accessing care. TIKO virtual currency can be redeemed for goods and services that consumers and their families need—ranging from groceries, to mobile credits, to hair salon appointments. Along with incentivizing consumers to receive health services, people in cash-strapped communities have more disposable income, which they can use to make personal purchases at local businesses, injecting that money back in the local economy.

The Last Mile
Currently active in 11 different markets, the TIKO ecosystem connects the local healthcare system, providers, and local shops to a broader network. With a scalable model that works across both geographies and interventions, the customizable reward-based scheme adapts to the unique needs of each community.

“NEXTGEN” BED NETS

The latest innovation in the fight against malaria is a durable long-lasting insecticide-treated bed net (LLIN) with multiple modes of action, including fast action against mosquitoes and additional efficacy against insecticide-resistant mosquitoes. This new type of LLIN product will remain effective for at least three years.

Changing the Game
Vector control has a been a key contributor to the progress against malaria worldwide. But the use of one class of insecticide (i.e., pyrethroids) in LLINs has led to growing resistance in malaria-carrying mosquitoes. Second generation bed nets are a direct response to the spread of pyrethroids resistance in many areas, particularly sub-Saharan Africa.

The Last Mile
The arrival of next-generation nets will require not only the technology, but also the political commitment and funding to enable scale-up in the countries with the greatest need. Countries with known resistance will require support with demand creation and distribution of next-generation LLINs through campaigns and continuous distribution channels.

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