Since 2018, Creating Hope in Conflict: A Humanitarian Grand Challenge has provided proof of concept (Seed) and transition to scale (TTS) funding to 75 innovations intended for use with conflict-affected populations in over 20 countries. We embarked upon a learning journey to better understand how innovative products and processes could be tested and pointed towards scale in humanitarian settings, in order to help solve some of the most complex problems and barriers within the humanitarian sector.
This post is one of many SEED Stories: a series of blogs reflecting on what HGC-funded innovators have achieved and key lessons learned during the duration of their seed grant periods.
In the Democratic Republic of Congo (DRC), there is less than one physician for every 10,000 people, and even fewer doctors in rural and conflict-affected areas of the country. Rural health facilities lack sufficient staff to provide essential quality health care, and existing staff cannot access the necessary training and education needed to equip them with the tools to respond when unforeseen medical challenges, including new epidemic diseases, emerge. Medical expertise is typically concentrated in urban areas, and more complex rural cases require referrals involving lengthy travel for treatment. Rural residents are unable to access the quality of services needed for protection from frequently emerging health risks that result in disproportionate morbidity and mortality among already vulnerable populations.
How Iristick Tackled this Challenge
Given the shortage of skilled medical staff in DRC’s rural, conflict-affected regions, Iristick sought to connect frontline rural health providers with needed medical expertise that would otherwise be out-of-reach in these remote clinical settings. With the support of CHIC’s $250,000 seed grant from CHIC, Iristick, who designs, manufactures and distribute smart glasses, implemented these smart glasses as a means of remotely connecting frontline health care workers in three Rural Health Centres (RHCs) in Kingandu, DRC with medical experts at the Kingandu’s district hospital. Real-time guidance from doctors allowed for increased quality of care in diagnosing and monitoring patients. This was complemented by improvements in referral processes and emergency transportation of patients from hard-to-reach rural areas using a moto-ambulance service. This service enabled smooth hospital transfer of many complex cases that would otherwise have gone untreated due to the high costs and limited options for transportation to district hospitals upon referral.
Healthcare centre usage rates were assessed with qualitative data from semi-structured interviews. In December 2020, Memisa – a key partner – conducted 39 key stakeholder interviews to assess the utility and effectiveness of the innovation. In meetings with health centre and hospital staff, community leaders, patients, and staff from the health district office, Memisa found favourable and enthusiastic perceptions of the changes introduced through the innovation. Interviewees cited benefits such as the positive empowerment of healthcare staff, improved diagnostic services and healthcare decision-making, strengthened referrals to district hospitals, a reduction in unnecessary referrals, and increased community trust in local healthcare providers.
Quantitatively, there were a total of 629 successful calls through the CHIC-funded pilot phase, during which rural health clinic staff were effectively connected with doctors at the district hospital; these doctors provided remote medical expertise and live support during patient visits. The smart glasses also enabled remote training on the use of several rapid diagnostic tests for early detection of common diseases. The RHCs that implemented the smart glasses also saw steady increases of up to 60% in their monthly revenues, with an increase in the number of patients able to access doctors due to Iristick’s intervention. For example, Katenda RHC was promoted as a reference health centre, following its improved performance and assigned a permanent on-site doctor, which will extend benefits further.
While several technical challenges emerged, in part due to the lack of digital and technical literacy of RHC staff, these problems were progressively solved, and the overall perception of Iristick’s innovation was positive. The Iristick smart glasses, together with the new emergency transport modalities, have strengthened the local health referral system in the Kingandu district, resulting in a marked increase in the quality and accuracy of referrals for life-saving interventions. For the full results of this study, carried out in partnership with the Institute of Tropical Medicine in Antwerp, see a summary of Iristick’s innovation as published in Global Health Action.
Partnerships Built
Iristick has collaborated with several actors in the deployment and evaluation of their innovation. Memisa, a Belgian NGO that has long supported the Kingandu health district, led the formal project evaluation involving stakeholder interviews in the district about the perceived benefits of introducing Iristick’s smart glasses and moto-ambulance services within RHCs. Iristick also collaborated with a variety of technical partners including, but not limited to, Atom System, which installed and supported the satellite transmission system (very-small-aperture terminal, or VSAT) at the heart of the innovation. Several public actors provided further operational support, ranging from supervising the activities of the three health centres to coaching the medical staff on the use of smart glasses: Public Health Institute of Kinshasa, Division Provinciale de la Santé of Kwilu province; Équipe Cadre de Zone of Kingandu; and the district management team of Kingandu. Finally, throughout the project, Iristick worked closely with the local district health committee, composed of medical staff and traditional leaders, to foster greater community ownership, acceptance, and adoption of the innovation.
Lessons Learned
Some key lessons learned over the course of Iristick’s seed grant include:
- Close collaboration with local health and administrative authorities, and appropriate communication with community representatives, is essential to gaining local buy-in when introducing new health technologies.
- Ever-changing conditions in conflict-affected countries require mechanisms for rapid decision-making and information-sharing among project implementors.
- Technical and logistical access considerations are as important as medical ones when introducing new healthcare technologies in remote settings.
What’s Next?
To ensure the sustainability of Iristick’s innovation, particularly the functioning of smart glasses, technical challenges resulting from poor satellite connectivity must still be resolved. Due to the high concentration of electrical storms in the DRC, to maintain telemedicine solutions, the DRC government is planning to develop a local area network connection for all health districts. This project, however, was delayed amidst the COVID-19 response, and therefore other solutions are being pursued in the meantime. For example, Iristick is currently working to lower the required bandwidth for using the glasses, which could significantly decrease costs and technical barriers associated with satellite connectivity. Use of motorbike ambulances, meanwhile, will be expanded through the introduction of new routes for emergency patient transport to the district hospital. Funding has also been secured from the Japanese International Cooperation Agency and UNDP-Université de Sherbrooke Canada to deploy Iristick’s smart glasses technology in Ghana, Zambia, and Mali, building off lessons learned from the DRC pilot project.