A Paradigm Shift in Global Health

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the essential, accessible, acces sible, smart, integr integrated ated operating operating room

 A paradigm shift in Global Health Russell Gruen MBBS PhD FRACS

Esabelle Esabelle Yam BSc (Hons)

Professor of Surgery, Lee Kong Kong Chian Chian School School of Medicine Medicine;; Executive Director, NTU Institute for Health Technologies

Manager, Centre for Global Health, Lee Kong Kong Chian School School of Medicine Medicine

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Per i o d

St ag e

Fo c u s

15th century 1914

Colonial Conceptions of Health

Non-native Non-native diseases, Process of urbanization urbanization (crowded Mechanisms sms of oppressi oppression on (served the urban centers), centers ), Mechani interests of colonial powers) powers )

Early 19th century century - 20th century

Early Conceptions of Medicin Medicine e - Therape Therapeutic utic Revolution

Germ Theory, bacteriological paradigm dominatedresearch.

1955 – 1990 1990s s

Erad Eradic icat atio ion n Effo Effort rts: s: Mal Malar aria ia vs. Smallpox

Malaria - Suboptimal Suboptimal results achieved and emergence emergence of resistance resistance to DDT and anti-malarial anti-malarial drugs. Realisation Realisation that poor health systems were incapable of effectively implementing novel tools and providing adequate surveillance. Smallpo Smallpox x - eradicat eradication ion declar declared ed in 1980! 1980!

early 1970’s

Primary Primary Health Health Care Care - Shifts Shift in focus to socioeconomic socioeconomic status, status, distribution distribution of in Conventional Wisdom resources, a focus on health system development, and emphasis on basic health services.

1980s

Selective Primary Health Care

GOBI-FFF monitoring, oral rehydration rehydration therapy, therapy, GOBI - Growth monitoring, breastfeeding, and immunization (GOBI). Family planning, female female education, education, and food FFF - Family supplementation

late 1970s to mid-1980s

The Development Discourse

Development, Neoliberalism, and Structural Adjustment

2000s

Modern Global Health Challenges

Drug Resistance, chronic diseases, ageing populations

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Features of the ‘next paradigm’ 1. Driv Driven en by GBD GBD pri prior orit itie iess 2. Syste Systems ms-fo -focu cuse sed d as well well as ind indiv ividu idual al disea disease se & social determinants-focused 3. Facil Facilit ityy-bas based ed as as well well as com commun munit ity y and and healthworker-based 4. Tech Technol nology ogy-en -enabl abled ed to lea leapf pfro rog g devel develop oped ed economies 5. Sustain Sustainable able innovati innovative ve fina financi ncing ng as as well well as aid & public funding: business as part of the solution.

Heal t h Car Car e Fac i l i t i es

Scholz et al. BMC Health Services Research (2015) (2015) 15:183 15:183

Global lo bal Sur Surgery gery 203 2030: A Lancet Com Commi miss ssio ion n

Universal access to safe, affordable affordab le surgical and anesthesia care when needed

Lancet Commission in Global Surgery 5 Key Messages •

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5 bill billion ion people lack access to safe, affordable surgical and anaest anaesthes hesia ia care care when needed needed.. 143 million addit dditional ional surgic su rgica al procedures are needed each year to save lives and prevent disability disab ility.. 33 mill million ion indivi ind ividuals duals face catastrophic health expenditure due to payment for surgery and anaesthesia each year.

surgicall and anaesthesia anaesthesia services services is is Investment in surgica affordable, saves lives, and promotes economic growth. SURGERY IS AN INDIVISIBLE, SURGER INDIVISIBL E, INDISPENSAB INDISPENSABL L E PA PA RT OF HEALTH CARE. Dr Jim Kim, President, President, World Bank.

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The Global Surgery 2030 Movement Government, NGOs & Intergovernmental agencies; Collaborators in over 110 110 countries; Over 300 publications, abstracts & teaching cases Consensus on safety & quality standards Consensus on role of district level hospitals Global Indicators:  Acc  Ac c ess , Wor Wo r k fo r ce, Volume, Safety, Financial Protection Support for National Surgical Plans

Nation ti ona al Surgi Sur gical cal Pl Pl ans

6 Glo loba ball Surgic Surg ica al Ind ndic ica ato tors rs 1.The geographic accessibility of surgical facilities 2.The density of specialist surgeons, anaesthetists, and obstetricians 3.The number of surgical procedures per 100,000 population

4. Perioperative mortality rates 5. The risk of impoverishing expenditure when surgery is required 6. The risk of catastrophic expenditure when surgery is required.

Facili ci lity ty & Equipm Equi pme ent Chall halle enge ng es

Lack Lackin ing g Phy Physi sica call Infr Infra astru st ruct cture ure (% Hospitals)

So How? ow ? •

Wait for public hospitals to be rebuilt.

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Supplement with private hospital chains

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Upgrade equipment while doing necessary building repairs.

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Utilis Uti lise e exi existi sting ng modular hospita hospitall solutions solutions

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Utilise Utilis e compa compact ct mobile mobile surgi surgical cal solu solutions tions

Current Solutions are temporary, expensive, not scalable or irrelevant to local settings

Nex t Ge Generatio nerati o n Fa Fac ili il i tie ti es Component 1 –

Component 4 –

Physical Infrastructure

Technical Medical Equipment

Component 2 –

Component 5 –

Compound

Information Communication Technology

Component 3 –

Component 6 –

Supply & Utilities

Ventilation & Disposal System

A turn-key infrastructure, equipment and supply-chain solution that enables rapid prov provis isio ion n and and scal scalee-up up of sur surgica gicall capa capabi bili liti ties es at dis distric trict/ t/fi firrst-r st-ref efer errral hosp hospit ital alss thr through ough a prefab prefabrica ricated ted,, fully-eq fully-equipp uipped, ed, rapidlyrapidly-depl deploya oyable, ble, all-in-o all-in-one ne operatin operating g theatre theatre suite. suite.

Component 1  –

Physical Infrastructure

Game-Changing Construction Technique Prefabricated Prefinished Volumetric Construction

Video illustration of PPVC at work: https://www.youtube.com/watch?v=_bzFIT08NAc

Component 2  –

Distric Distr ictt & 1st-Re 1st-Referral Level Hosp Hospit ita als Integration and Capacity Building

Compound

Number of Hospitals in Myanmar: Type

National

Beds

1000+

State

300~500

District

100~200

Numbers

Remarks

3 NTU for 3Institute 4 Health 5Technologies 8

Township

~50

272

Station

5~10

0

Laparotomy, LUSCS Many have NO surgery

easiOR - Fullyully-e equipped theatre, theatre, Reception, operating room, sterilisation, storage, utilities & recovery rooms.

Component 3 –

Supply & Utilities

Green Green & SMART SMART Stable Energy, Clean Water and Gases Supply Data for Optimal Usage

Component 4 –

Technical Medical Equipment •

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Maximal Intraoperative Utility, Minimal Wastage

 Agreed procedures procedures that district district hospitals should provide Standardized, procedure-specific surgical instrument tray sets

Caesarean Delivery

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Standa tandardisa rdisation tion & Optimisation ptimisation

Laparotomy

Treatment open fractures

Data analytics for optimal consumables usage and minimal wastage, and for equipment maintenance feedback.

SMART SMART Hos Hospi pital tal

Component 5 –

IT-Enabled, Data-Rich

Information Communication Technology

Electronic Health Records Tele-Health Remote Diagnostics/Consultation endless possibilities…

Internet

Component 6 –

Ventilation & Disposal System

First irs t Installation in Myanmar yanmar Hinthada Ge Genera nerall Hospital 200-bed township hospital in the Ayeya Ayeyarwady rwady Delta, approximately four hours drive from Yangon 3 ea easiOR siOR surgi cal theatres theatres •

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North Okkala Okkalapa pa Hospita Hospitall •

1000+ bed teaching hospital on the outskirts of Yangon City 2 easiOR easiOR gene general/e ral/emergency mergency s urgery t hea heatres tres

Disruptiv isr uptive e technol technologie ogies s will help help hea health systems in in emerging mergin g econom ies leapfr leapfrog og develope developed d economi econo mie es

From: Health Systems Leapfrogging in Emerging Economies, World Economic Forum 2

 Al  A l t ern er n ati at i v e fi f i n anc an c i n g m o d els el s

Can Busi Bu siness ness Drive Driv e Development? Universal access to safe, affordable affordab le surgical and anesthesia care when needed

Contact on tact Details Details:: Prof Russell Gruen Executive Director, NTU Institute for Health Technologies Nanyang Technological University, Singapore.

[email protected]