Fellows

Andres Rubiano Escobar and Nancy Ann Carney are fostering a new consciousness and system for integral trauma care though MEDITECH Foundation. MEDITECH is a research and educational organization dedicated to developing improved trauma care systems in Colombia and Latin America. Trauma and injuries are the leading cause of death in the economically active population (12 years to 45 years) in Colombia and other Latin American Countries. Injury prevention and appropriate trauma and acute emergency care are required in order to decrease death and disability in these patients. MEDITECH educates at all levels—right from community first responders to advanced medical providers—and conducts clinical research and develops protocols of care for centers with varying levels of resources. The goal is to identify and disseminate the most effective treatments for trauma in low resource settings. MEDITECH will move to a new era of promoting development of systems of care, introducing leadership training for health care providers and developing sustainable business models for emergency care volunteer groups in rural communities. MEDITECH is creating a new context, moving ahead with health-related (education, research, technology) public and private partners to introduce new cost effective interventions, and developing successful pilot models that demonstrate a pathway to influence health policy in order to change the system. 

Starting in Pakistan, Asher Hasan is providing quality, private health insurance to low-income workers in the emerging economies through an approach that distributes cost and social responsibility among several stakeholders affiliated with low-income beneficiaries. The exclusion of women in the workforce in both developing countries and mature markets has resulted in not only a massive loss of human potential but also loss of human life - especially in emerging countries such as Pakistan, where millions of people continue to lack access to quality, affordable healthcare. It is estimated that there are 50,000 qualified female doctors excluded from the health workforce in Pakistan and over 300,000 female doctors worldwide who are not participating (transitionally or permanently) in the global workforce. To tackle these market failures, doctHERs has developed a digital health platform that matches the underutilized capacity of female doctors (who would otherwise be excluded from the global workforce) to the unmet healthcare needs of underserved communities. The Globalizer process has helped to refine our strategy to focus on 2 key issues: (i) how to accelerate sustainable demand for our telemedicine-based services and (ii) how to create more value for the female doctors we are reintegrating into the health workforce. The Globalizer has also reinforced our commitment to scaling our model via corporate, academic and public-sector partnerships. 

More than 70 percent of people in Indonesia consider memory loss as a normal part of ageing, rather than understand it as a dementia symptom. Dementia is a neuro-degenerative disease affecting the brain, emotion, executive decision, thinking, behaviour and the ability to perform everyday tasks. Dementia affects 50 million people globally costing the US$ 1 Trillion in 2018, 23 million people with Dementia live in the Asia Pacific region, with 1.2 Million of whom in Indonesia. The figure is projected to reach 4 million in Indonesia with an estimated cost of US$ 2.2. billion (Alzheimer's Disease International Report, 2016).  To prevent people from Dementia Alzheimer and enable people to live well, Alzheimer Indonesia (ALZI) that was founded in 2013 with the purpose to improve quality life of PwD and caregivers in Indonesia, initiated a "Do Not Underestimate Memory Loss" campaign to raise awareness about the 10 warning signs of Alzheimer. The campaign and movement have increased visibility of dementia awareness and influenced the public - across generations. It has also influenced community based support groups to remain active and participate in the society to reduce risk, remain active and pursue a healthy lifestyle. The movement has influenced The Government of Indonesia to launch a Dementia National Plan in 2016, local government of Jakarta declared the city as a dementia and ageing friendly city in 2015 through an integrated support system of "purple troops" that are committed to provide information and solutions for families with PwD in the city and ALZI has become the go-to-source on all things related to dementia, the caregiver support group started in Jakarta has now grown to 12 cities in Indonesia. After the Globalizer process, the strategy and approach Alzheimer's Indonesia will take on is the establishment of a platform that will connect users to information, solution and a network of Care-Navigators. This approach will empower families and improved system diagnosis, care and treatment for PwD through an integrated Care-Navigation based approach. The platform aims to support users (families of PwD and caregivers) with holistic solution centred around  a Care-Navigator to best take care of their daily needs to live a healthy and good quality life. A Care-Navigator will identify what services are required, at the right place and the right time, thereby working as health care system integrator and coordinator for the individual, the family and the health system. Additionally, the Care-Navigator's role will work as part of the broader service system, looking to what other support is needed and available to support PwD and families (i.e. respite care, etc). The milestone: 1 million families will have access to Care-Navigators (via the platform-app) in 34 provinces in Indonesia by 2025. 

The use of mobile gaming for the dual purpose of education and entertainment is a new idea in India. Hilmi Quraishi is using mobile telephony to bring important public health messages to the masses. He envisages the widest and deepest reach through the mobile phone, the computer, and the internet—the technology tools of the future—to combat various health and other critical social problems by delivering useful knowledge products in the form of games. ZMQ is a global ‘Technology for Development’ social enterprise which identifies critical social problems of rural, poor and unreached communities; develops practical technology solutions; and implements them at the last-mile as a sustainable systemchange model by provisioning timely information and connecting communities with life-saving products & services. ZMQ’s ‘for-profit’ arm provides consulting on solutions for governments, international agencies, CSRs, NGOs and other development programs, making ZMQ a self-sustained social enterprise. One of ZMQ’s key innovations is MIRA Channel - an integrated mobile channel on maternal and child providing health communication, progress tracking and connecting rural women with public health services thus strengthening last-mile health system. MIRA has scaled in India, Uganda and Afghanistan; and now scaling to Senegal and Sierra Leone. MIRA has already impacted more than a million women, children and adolescent girls in last 3 years and have saved over 15 million dollars to the state. Taking the learning from Ashoka Globalizer, ZMQ is going for government adoption of MIRA in 1 Indian state and national adoption in Uganda and Afghanistan. Globalizer also helped ZMQ create sustainable business models through digital stories and IoT toys.

Marcos Lacayo is shifting Nicaraguans’ approach to their health from reactive to proactive. As of March, 2019, his organization, Estación Vital, has provided over 282,000 health evaluations to more than 64,000 users, only 20 percent of whom have health insurance. 

Marcos has found that, due to a lack of accessible health insurance and cultural traditions and habits, many Nicaraguans place a fairly low priority on their health, waiting to visit a doctor until their illnesses have progressed so far as to make treatment difficult – and sometimes impossible.  “With a lot of symptoms, people say, ‘It’s just a headache’. They don’t really think it could be something else,” said Marcos. 
 
Estación Vital creates a positive, preventative approach to health through kiosks in shopping malls that measure vital signs and weight, an alliance with Telefónica through which subscribers get daily text messages from physicians, and a mobile app.  With one kiosk currently in the Metrocentro mall in Managua, five more coming in malls throughout Nicaragua in the next year, and 40 to 50 kiosks planned to appear across Central America in the next five years, Estación Vital provides health education and prevention opportunities for the general public in a positive, upbeat environment.  Marcos also plans to offer low-cost health and life insurance and to add a membership program which will give access to many more health services, including appointments and home-care. 
 
Marcos remembers one woman who, prompted by concerning results from his kiosk, finally visited a doctor, after 10 years without seeing one, and discovered she had cancer. Luckily, it was still in early stages and could be treated.  “We created an alarm that forced this person to go to a physician and get examined,” said Marcos. 

Dr. Prasanta Tripathy is the cofounder of Ekjut (togetherness, in multiple Indian languages), a non-profit organization in India. Through a series of collaborative community based research trials, Ekjut and University College London established that Participatory Learning and Action (PLA) monthly meeting cycles facilitated by a trained woman from the rural underserved village and hamlet of districts of Jharkhand and Odisha states of India, can bring about reduction of newborn and maternal deaths. Replicability and sustainability of impact was also established. Findings were published in high impact medical journals such as The Lancet. PLA intervention consists of 4 phased meeting cycles (Phase 1- identifying and prioritizing newborn and maternal health problems by the communities, Phase 2- understanding causes and effects and finding feasible solutions, Phase 3 – acting on the solutions and strategies and Phase 4- evaluating together). PLA is an agile intervention leading to context specific solutions for savings lives. Dr. Prasanta and colleagues disseminated their findings widely. This resulted in the Government of India approving scale-up in 10 states of India through government frontline health workers called ASHAs in 2015. Grants from foundations and Governments are being strategically used for supporting governments in this scale up in more than forty thousand villages right now. Following the Globaliser program, Prasanta and the Ekjut team will have a clear 3-5 year road map on how to take the process forward for sequencing their work in addressing different clusters of problems such as child mortality, malnutrition, adolescent health and nutrition by applying the unique evidence based community capacity process of participatory learning and action (PLA). 

Every year, millions of people around the world suffer and die from conditions and diseases we know how to prevent, manage, and cure. Knowledge of effective interventions is growing, yet the ability to apply it broadly has not kept pace. Globally, almost four billion people could benefit from more widely shared best practices to address health and social concerns. Sanjeev Arora (represented today by colleague Oliver Bogler) and Project ECHO are changing the way knowledge flows. They use a collaborative education model where all teach and all learn, using guided practice, powered by technology and designed for measurement, that empowers health care providers to give better care to more people at the right place at the right time, often right where they live. Project ECHO does not care directly for patients. Instead, they dramatically increase capacity and access to best practice treatment in rural and underserved areas. Today, ECHO is being used by 200 centers in 29 countries to address over 65 diseases and conditions. Dozens of peer-reviewed studies have demonstrated the model’s strong positive impact on patients, providers, and entire populations and health systems. The ECHO Institute serves at the center of the ECHO community providing training and technical assistance to partners, replicating the model. ECHO Institute has the goal of touching 1 billion lives by 2025 and a strategy with four elements: 1) Pursuing growth focused on significant health concerns that are a strong fit with ECHO; 2) Achieving global scale; 3) Developing the ECHO Digital Platform; and 4) Improving the efficiency and effectiveness of the ECHO Institute.