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AlertNet's top 20 big ideas that don't cost the earth

Source: Thomson Reuters Foundation - Fri, 7 Jan 2011 13:49 GMT
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(Corrects 2000 malaria death toll to 1 million, not 1 billion, in section 8)

What cheap, low-tech innovations could be used to improve the lives of the poor? Which potentially life-saving ideas have been knocking around for years but still aren't widely practised? What high-tech developments are in store for 2011?

AlertNet put these questions to dozens of experts and researchers in health, technology, education, water and sanitation. Based on their responses, in no particular order, here's a list of our ‘Top 20 big ideas that don’t cost the earth’.

1. Using paper to test for liver damage

2. TB treatment in a combined pill

3. Birth mat

4. Spreading the Kangaroo method

5. Low-cost infant incubator 

6. Promoting breastfeeding 

7. Using vinegar to fight cervical cancer

8. The bed net

9. Simple hand washing

10. Water mapping

11. Crisis mapping

12. Using mobile phones to improve health care

13. Using mobile phones to reward TB patients

14.  Free online master classes

15. A shoe for a shoe

16. Eyes on the prize

17. Single-use syringes

18. Marmite-inspired lanterns

19. Harnessing solar power

20. Dry toilets


1. Using paper to test for liver damage

It costs just a few cents and it's made of paper. In 2008, Harvard University Professor George Whitesides came up with a simple diagnostic test to detect liver damage, which is now being produced by U.S. nonprofit start-up Diagnostics For All (DFA). 

DFA has been targeting patients living in rural areas in developing countries who are receiving antiretroviral therapy (ARVs) for HIV/AIDS and tuberculosis. Some ARVs and TB drugs are toxic to the liver, causing liver failure in some patients. In developing countries, liver function tests for HIV/AIDS and TB patients are often non-existent.

The diagnostic test is roughly thesize of a postage stamp. It works by putting a drop of blood, urine or someother body fluid on it. The molecular chemistry that occurs results in changesof colour, from which a diagnosis can be made.

2. TB treatment in a combined pill

Tuberculosis, one of the world’s biggest killers, is responsible for the deaths of more than 1.7 million people every year, according to WHO

Although TB is curable, the drug treatment lasts at least six months and can involve taking as many as 16 different pills each day.

However, WHO says there is a cheap and more patient-friendly alternative - combination pills. TB drugs can be bundled together, meaning patients are more likely to complete the full course of treatment and take their medicine at the right time. One six-month course costs $20 to $26, and involves taking just three to four pills a day.

3. Birth mat

It can be difficult for health workers to measure blood loss after labour and delivery accurately enough todecide exactly when bleeding is excessive. Getting it wrong can mean women bleed to death.

Postpartum haemorrhage (PPH) is one of the leading causes of maternal mortality, accounting for around a quarter of all maternal deaths worldwide, according toWHO. 

Researchers are developing special absorbent mats that can be used to assess immediate blood loss after birth. Onemat already being used shows when a threshold of 500 ml of blood loss has been reached.

In addition, the Bill & Melinda Gates Foundation is funding research by Dr. Abdul Quaiyum in Bangladesh to test an inexpensive, biodegradable absorbent mat that can be placed under mothers who have just given birth. The mat can be weighed at regular intervals to measure absorbed blood, providing easy and early detectionof haemorrhaging.

4. Spreading the Kangaroo method

The Kangaroo method is a technique that allows mothers to keep babies born prematurely or with low birth weights warm and healthy. It costs nothing, can help save lives and reduces the need for expensive incubators.

The method includes wrapping the baby to a mother's chest to maximise skin-to-skin contact and exclusive breastfeeding. The technique also enables the mother's heartbeat to help the baby breathe regularly.

It was first introduced in Colombia in the1970s and is now used across the developing world, particularly in rural areas where electricity is scarce.

5. Low-cost infant incubator

Premature babies with low birthweights are unable to regulate their own body temperatures and are at risk ofhypothermia if not kept warm.

A new low-tech device, developed bythe non-governmental organisation (NGO) Embrace, offers an inexpensive way to keep babies warm.

It looks like a snug sleeping bag and has a pouch with a heat pack. And with a price tag of around $150, the baby warmer costs less than one percent of the price of a traditional incubator, which can reach $20,000.

“The device does not require constant electricity and is portable,” says Christina Chao, business development manager at Embrace.

After two years in the making, Embrace will launch the baby warmer early this year in India where it will initially be sold to doctors and private clinics.

6. Promoting breastfeeding

If every baby were exclusively breastfed from birth for six months, an estimated 1.5 million lives would be saved each year, UNICEF says.

Breast milk contains antibodies that help babies fight infections and contains all the nutrients, hormones and antioxidants needed for babies to thrive. Breast milk also protects babies from diarrhoea and acute respiratory infections and stimulates their immune system.

Yet despite the known benefits, only 22 percent of women in west and central Africa and 27 percent of women in South Asia breast feed their babies exclusively for the first six months, according to UNICEF.

7. Using vinegar to fight cervical cancer

Nearly 80 percent of invasive cancer cases occur in developing countries, which often lack proper screening programmes.

Yet all that's needed to detect early invasive cervical cancer is a trained eye, acetic acid - the main ingredient in vinegar - and a flashlight or halogen lamp, according to some scientists.

The idea is for a health worker to apply vinegar with cotton swabs on a cervix, and look for any areas that change colour. Damaged cervical tissue - such as pre-cancerous or cancerous lesions - turns white within minutes.

This back-to-basics method, known as ‘visual inspection with acetic acid’ (VIAA), costs about $1.60 a go, and is being billed as a low-tech way to help fight cervical cancer.

8. The bed net

While scientists are busy researching new vaccines against malaria, and developing fast and reliable diagnostic tests and innovative ways to repel malaria-carrying mosquitoes, the humble insecticide-treated net is still considered by many experts to be one of the simplest and cheapest ways to prevent the disease.

Mosquito nets, which cost around $5 per piece, have been key in contributing to the decline in malaria-related deaths, experts say. The number of deaths caused by malaria fell from nearly 1 million people in 2000 to 781,000 in 2009, according to the latest figures from the World Health Organisation (WHO).

But malaria still remains one of the world’s biggest killers, especially among children.

9. Simple hand washing

It may not sound like a ground-breaking idea but washing hands regularly with soap and clean water can save lives.

Handwashing with soap, especially before preparing food and after using the toilet, is one of the cheapest and most effective ways to prevent the infections that cause diarrhoea, which claims the lives of around 1.5 million children every year - more than AIDS, malaria and measles combined.

Proper handwashing alone can reduce the number of children dying from diarrhoea by 44 percent, research has shown.

Yet handwashing with soap is seldom practised and not always easy to promote. It is estimated that roughly 70 percent of people throughout the developing world do not wash their hands regularly with soap, the U.N. children's fund (UNICEF) says.

10. Water mapping

Known as the Water Point Mapper, this mapping tool developed by the NGO WaterAid is designed to provide communities with free information about water sources.

The tool plots the distribution of water services in rural and urban areas, as well as pinpointing contaminated water and places where water is no longer available. It also lets communities know the distance to the nearest clean water supply.

The system, which cost around 20,000 pounds ($30,880) to develop, aims to give local governments and water and sanitation experts the information they need to improve water supplies and help them identify where investments in water infrastructure are needed.

The Water Point Mapper, which is being used in sub-Saharan Africa, instantly converts water data into Google Earth-compatible maps that do no need complex GIS software or an internet connection to run, WaterAid says. The maps can then be saved as images and easily shared.

11. Crisis mapping

The growth of social networks, rising numbers of mobile phone subscribers and mapping technology are helping crowdsourcing to flourish as a tool increasingly used by aid workers to better plan and allocate resources on the ground.

Jen Ziemke, co-founder of the International Network of Crisis Mappers, says crowdsourcing can be used to create maps to identify places most in need of water, schools and clinics.

12. Using mobile phones to improve health care

With a third of all Africans now cell phone subscribers and users on the rise in India and China, innovators are keen to develop ways to use text messages and mobile phone applications to improve the delivery of healthcare in developing countries.

Monitoring patients and tracking their progress are constant challenges facing doctors and health workers in rural regions of developing countries. But mobile phones could help.

“2011 will undoubtedly be a big year for mobile health - tracking remote patient care, providing access to emergency services (including obstetric care), a new wave of diagnostic devices,” says Josh Nesbit, head of Medic Mobile.

For example, Medic Mobile has developed ‘Patient View', which claims to be the first system allowing patient records to be stored on mobile phones, and works anywhere where there is a mobile signal.

“This allows clinics to track care provided to thousands of remote patients, with updates from community health workers processed via SMS and mobile forms,” says Nesbit.

Meanwhile, the Bill & Melinda Gates Foundation is funding research to test a mobile phone-based vaccination registry that uses fingerprint scans to keep track of people who have received immunisations, with the aim of making vaccination programme seasier to run and more efficient.

Neil Pakenham-Walsh is co-director of Global HealthcareInformation Network, which is promoting the use of potentially life-savingand free information on mobile phones - from messages on the symptoms of childhood pneumonia to information about the correct mix of sugar, water and salt need to make a homemade treatment for diarrhoea.

“If every new mobile phone were preloaded with essential health information in the local language, this would go a long way to help realise our shared vision of a world where people are no longer dying for lack of knowledge,” Pakenham-Walsh says.

13. Using mobile phones to reward TB patients

Getting TB patients to complete a six-month treatment course can be difficult. Symptoms tend to go away after two months, and because of the unpleasant side effects of the drugs, many people lose the incentive to carry on taking them.

A team from the Massachusetts Institute of Technology (MIT) has come up with a way to offer patients cash incentives - such as mobile phone credit - for sticking to their treatment. It's meant to not only encourage more patients to complete their treatment but also to reduce costs by cutting out the need for health workers to make sure TB patients are taking their daily pills.

The programme, ‘X out TB’, was first piloted in Pakistan. In order to receive the cash incentive on their mobile phones, TB patients had to take a urine test which determined whether there were traces of TB drugs in their system. If so, the test revealed a code which could be sent via text message to receive a cash reward on their phones.

14.  Free online master classes

Sal Khan, a former Harvard graduate and hedge fund manager, believes world-class education should be available to anyone for free.

The son of immigrants from India and Bangladesh, Khan came up with the idea of free online lessons after his cousin was struggling in maths classes. He agreed to remotely tutor her. It was so successful that Khan decided to post the tutorials online.

It led to the Khan Academy, a free open source video library, with over 1,600 mini-tutorials and exercises on anything from algebraand the Napoleonic Wars to Newton’slaws.

Khan’s 10-to-15 minute tutorials are watched on average 70,000 times a day on YouTube. Since it was set up in late 2006, the site has received some 18 million visitors.

Could this idea of free quality online education be applied, for example, to training healthcare workers in their native languages in developing countries?

Vidar Jorgensen, chairman of the World HealthCare Congress  thinks so. “Using this concept in healthcare could make a real difference in training community health workers,” he says.

15. A shoe for a shoe

It’s estimated that roughly 40 percent of all parasites enter the body through the soles of bare feet.

Up to 1.2 billion people, many of whom are children in developing countries, are infected with intestinal worms, also known as soil-transmitted helminths (STH). Elephant disease, orpodoconiosis, is another common soil-transmitted illness that causes extreme swelling of the feet and legs.

Wearing shoes can help prevent suc hdiseases.

In 2006, when American Blake Mycoskie was travelling in Argentina he found that many children had no shoes to protect their feet. It inspired him to set up TOMS Shoes, an online retail company which matches every pair of shoes bought at TOMS with a pair of new shoes given to a child in the developing world. So far, over one million pairs of shoes have been donated.

16. Eyes on the prize

Providing people with the right glasses for as little as $4 can significantly raise productivity levels, improve quality of life and boost children’s school performance.

In many cases, poor eyesight can befixed just by wearing spectacles. But around 95 percent of sub-Saharan Africanswho need eye glasses do not own a pair. WHO estimates that poor eyesight costs at least $121.4 billion globally each year in lost productivity.

Yves Behar, a San Francisco-based industrial designer has developed robust, light and fashionable glasses for Mexican schoolchildren. The frame can be split in two halves, allowing children to mix and match the colour and shape of frames. He plans to distribute 400,000 free pairs every year to children in Mexico’s schools.

There are several leading NGOs also working to provide affordable glasses and eye tests in developing countries.

For example, U.S.-based VisionSpring trains villagers to carry out eye tests and sell low-cost glasses and eye drops in their communities. Villagers can earn $1 to $2 for every pair of glasses sold.

Adaptive Eyewear, a UK-based NGO makes low-cost adjustable glasses for Rwandans. The spectacles are filled with silicone oil, and with the help of a trained healthcare worker, users can adjust the power of the lenses using dials on the side of the frame.

17. Single-use syringes

One day in 1984, Briton Marc Koska came across a newspaper article about how dirty syringes were destined to be a major cause in the spread ofHIV/AIDS. Shocked by the finding, he gave up his aimless travelling around the world and took action.

The result was the K1 syringe. Costing just 5 cents a go (other syringes can cost up to $1 each), the K1 syringe isused in the same way as a normal syringe, but with a crucial difference - it can only be used once. After one use, the plunger locks in a barrel and breaks if forced.

Around 40 percent of injections worldwide are given with syringes and needles that are being re-used without sterilisation, causing an estimated 1.3 million deaths every year, WHO says.

The K1 syringe took just five minutes to design, says Koska, but 17 years to sell the first one. His big break came when UNICEF placed an order in 2001. Since then, some two billion have been sold.

18. Marmite-inspired lanterns

Homemade kerosene lamps are a hazard for millions of poor families in the developing world. Often made from household bottles, they can easily spill over and cause fires.

It’s estimated that around 300,000 people around the world die from accidental kerosene burns every year. In Sri Lanka, for example, about a third of all domestic burn cases are caused by unsafe lamps.

After years of seeing horrific burnsand deaths, Sri Lankan doctor Wijaya Godakumbura, embarked on a quest in 1992 to create a safer lamp

Based on the design of a Marmite bottle, he created the award-winning ‘Safe Lamp’. It is small and squat, with two flat sides, so it can’t roll and is strong enough not to break if dropped. A safe metal screw cap holds the wick, so the fuel does not spill if the bottle overturns.

Dr. Godakumbura found a factory prepared to manufacture the lamps cheaply from recycled glass. Since then, over 775,000 safe lamps have been distributed to homes in Sri Lanka.

19. Harnessing solar power

It costs under $8 to manufacture, is portable, and provides up to two hours of lighting for every one hour of chargetime.

Created by Plus Minus Design, the handheld solar-powered light, known as the ‘Solar Pebble’, aims to replace unsafe kerosene lamps widely used in rural Africa. It is powered by batteries that are charged from the sun through a small solar panel, and it can also be used to charge mobile phones and small electronic devices.

It is just one of many innovations using solar power intended to bring cheap light to homes, schools and hospitals in rural areas of developing countries. It’s estimated that over 500 million Africans have no access to electricity. 

Harnessing solar power to help the poor is a growing and dynamic field. Other innovations gaining ground include a blood transfusion service powered by three solar panels and a battery, and a solar-powered portable blanket that can provide light therapy to jaundiced babies.

20. Dry toilets

The so-called dry or waterles stoilet contains a toilet bowl that separates urine and faeces. A special air ventilation system helps to dehydrate and decompose the waste. Urine can then be reused as liquid fertiliser and faeces as organic fertiliser.

Across developing countries and rural areas where water and sewage systems are scarce, dry toilets are being billed as an ecological and inexpensive solution to save water and improve sanitation. In Namibia, for example, a low-cost dry toilet, known as the Otji toilet, is already being used.

"Dry toilets are gaining traction but there remains resistance - from those who think flushing is theonly way, or those who resist reusing human waste," says Nikki Shaw, technical adviser at the World Toilet Organisation

Dry toilets can go a long way in improving the hygienic disposal of human faeces, says Shaw, which in turn reduces the risk of people dying from water-borne diseases like diarrhoea.

“Dirty water kills 1.8 million a year through diarrhoea, and makes millions more people sick every year, and it is almost always dirty because it is contaminated by human faecal matter,” says Shaw.

But experts say clean water initiatives must go hand in hand with improving sanitation. “No amount of innovative, affordable water treatment products, however essential, will ever solve the problem - only safe disposal of human waste, i.e. safe sanitation plus good hygiene, will solve the problem,” says Shaw.


Idea 1. Diagnostics for all

Idea 5. Embrace

Idea 12. Reuters

Idea 16. Fuseproject

Idea 19. Plusminusdesign

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