GlobalHealth Lab | Snapshots
GlobalHealth Lab pairs faculty-mentored teams of MBA and other MIT graduate students with innovative enterprises on the front lines of healthcare delivery in Africa and Asia. To tackle challenges identified by each partner, GlobalHealth Lab develops customized projects in strategy, operations, marketing, and technology adoption. Student teams and their faculty mentors work from campus and on site in partnership with the staff, leaders, and communities who host each project. In 2013 and 2014, twenty-three collaborative projects put us in South Africa, Kenya, Zambia, Tanzania, India, Bangladesh, and Nepal. The images and captions that follow are a sampling drawn from student material and serve as snapshots of their amazing learning experience.
GS Memorial Plastic Surgery Hospital 2013 | Varanasi, India A private hospital whose charity-funded treatment of cleft lip and palate has helped tens of thousands, in 2013 GS Memorial sought ideas for expanding its services and geographical coverage. The team helped sharpen the organization’s strategy and management systems.
Founder Dr. Subodh Kumar Singh and his work were the subject of Smile Pinki, an Academy-Awardwinning documentary about a cleft lip child from a village who receives a free “miracle” surgery. Pinki is featured on the car. The four-story hospital is in the background.
Some of the hospital's records, stored in its accounting office. On site, the MIT team combed through years of patient records, gathered disparate data, and digitized paper forms to aid in analysis.
Beyond aesthetic issues, cleft lip and palate can cause infant malnourishment and speech problems. GSMâ&#x20AC;&#x2122;s two full time specialists provide speech therapy consultations before and after surgery.
GS Memorial sought to increase its burn services. Here, a surgery is underway to treat a burn victim who had traumatic scarring to the upper torso and left arm.
Dr. Subodh meets with the team in his office to discuss patient recruitment, using the moment to teach them about medical aspect of the project, the ancient city of Varanasi, and the culture of India.
Taking a break from their data collection and analysis, the team celebrated the springtime festival of Holi at the home of Dr. Subodh.
GS Memorial Plastic Surgery Hospital 2014 | Varanasi, India The next year, our GlobalHealth Lab project focused on guidelines for telemedicine clinics that could improve patient return rates and manage costs for the private and charity hospital, delving into detailed geo-data on patients and exploring their attitudes towards telemedicine.
The pharmacy at GS Memorial, where a high volume of care is delivered to both paying and charity-funded patients.
In Muzaffarpur, some distance from Varanasi, the team worked on a pilot telemedicine test to assess prospects for GS Memorial to implement the technology to screen and follow up patients.
The team interviewed patients both at the hospital and in the community after the telemedicine screening camp to learn about patient acceptance and willingness to pay for the service.
A young burn patient with her family at GS Memorial. The team explored how technology implementation could reduce overall care delivery costs, allowing the hospital to serve more burn victims.
Inside the operating room: An MIT team member, who was also a physician, joined Dr. Subodh to understand all aspects of GS Memorialâ&#x20AC;&#x2122;s comprehensive approach to patient care.
The challenge: wait times within the clinic. Serving 18 to 20 thousand patients per month, Retreat operates over capacity. Long wait times and a lack of updates lead to frustration amongst patients.
Retreat Community Health Centre 2013 | Cape Town, South Africa To help reduce on-site wait times in one of the highestvolume public community health centers in the Western Cape, MIT students worked closely with staff at all levels to generate a set of improvements that together helped save time, improve patient flow, and streamline paperwork. The team pinpointed the management of booked and unbooked patients as a major opportunity to improve patient and staff experience. An early indication of success: average time to triage was immediately reduced.
Triaging the â&#x20AC;&#x153;unbookedâ&#x20AC;? â&#x20AC;&#x201D; patients arriving without an appointment. Unbooked patients waited an average of two hours before even being seen by a triage nurse. This delay in reaching triage posed an impediment to patient safety.
A great deal of time could be lost in simply locating patient folders.
Booked patients, or patients arriving with an appointment, waited an average of 35 minutes before their first encounter with a staff member. Here is the processing of booked patients.
The first-ever Health Innovation Challenge Day: Retreat staff, the MIT team, University of Cape Town students and UCT Bertha Centre for Social Innovation brainstorm ideas to reduce wait times.
Improved triage processes developed by the MIT team and the clinic staff increase efficiency and decrease error.
Students generated many ideas for improving conditions at Retreat, including a dedicated window to answer questions for unbooked patients.
Like many public clinics in lowâ&#x20AC;&#x201C; and middle-income countries, clinical staff use paper to track patient care. Retreat maintains many thousands of folders of medical and visit information.
The Retreat pharmacy serves chronic and acute patients, supplies other facilities, and manages clinic supplies. Many hundreds of patients are served every day.
A recently-implemented order entry system ensured an electronic record of every prescription, but the role it played, among other factors, in contributing to pharmacy wait times was unknown. Students studied the flow of prescriptions and the processing times for each step.
Retreat Community Health Centre
The MIT team developed and tested a system for managing folders and prescriptions in the pharmacy that was inspired by the bins that staff used to manage medication supplies.
2014 | Cape Town, South Africa Our second project with Retreat focused on its pharmacy, where we aimed to help streamline operations to improve the delivery of essential medicine to its patients. The first step was an extensive study tracking the entire process, from patient arrival to dispensing. The team then pinpointed specific opportunities to explore in depth and generated a set of practical ideas they tested on site.
Some patients waited all day for the medicines they needed, and in some cases had to return a second day. Many had to miss a day of work to collect a routine refill, which could hamper their ability to adhere to needed treatment.
After two weeks working shoulder-to-shoulder in the pharmacy, the students had developed close relationships with the staff, and had come to appreciate the complexity and challenges of striving to serve hundreds of patients every day despite limited infrastructure and technology.
AMPATHâ&#x20AC;&#x2122;s staff and partners were essential collaborators for the students, especially when it came to interviewing community members about healthcare and family finances.
2014 | Eldoret, Kenya AMPATH provides health care for the poor at over 80 health centers in western Kenya. Our project aimed to help the non-profit and its collaborators, which included the public sector, refine the design and attributes of mobile-phone based health insurance for informal sector workers who otherwise have little access to needed hospital services. The team explored pricing options in depth, visiting many rural communities to conduct firsthand research.
The student team worked closely with AMPATHâ&#x20AC;&#x2122;s experienced staff at the collaborationâ&#x20AC;&#x2122;s Eldoret headquarters and in surrounding towns and villages.
Students compiled a vast amount of data from direct interview, which enabled them to develop a monadic pricing model drawing on methods they had learned in a specialized MIT Sloan pricing class.
The team benefited from working sessions with AMPATH leadership and staff.
Healthcare in Kenya is often delivered at the community level, in clinics and local hospitals. The teamâ&#x20AC;&#x2122;s work focused on making hospital care available to more.
Community members welcomed the team and generously shared their experiences and ideas. Some were very friendly!
Gradian Health Systems 2014 | New York and Zambia Gradianâ&#x20AC;&#x2122;s Universal Anesthesia Machine delivers safe anesthesia even if the power goes out or the oxygen tank is empty. To guide the organizationâ&#x20AC;&#x2122;s entry to the Zambian market, where its product could benefit many, the team surveyed the national healthcare landscape, identified potential customers, and refined a comprehensive market entry strategy. An effective approach to scaling up in Zambia could ensure that every machine delivers the maximum benefit to the country.
The team interviewed a wide range of stakeholders, from technicians to Ministry leaders, to understand the market and identify potential collaborators for Gradian.
Zambia has anesthesia machines, but needs more. Those that are in place may lack parts, supplies, or staff trained in their use and repair. The students aimed to avoid these pitfalls for Gradian.
The team visited many sites across the country, taking buses, cars, and short-haul flights to see hospitals first hand.
To understand the issues and the technology itself, the team watched surgeries and learned about the machineâ&#x20AC;&#x2122;s functioning.
Zambia faces a shortage of clinical training, which the team sought to understand as they examined how doctors, nurses, and clinical officers would learn about the machineâ&#x20AC;&#x2122;s use.
Like many others in GlobalHealth Lab, this team combined a wide breadth of skills, styles, and backgrounds, and like many of their peers, this team shared an intensely rewarding learning experience.
The Clinical Nurse Manager, Anila, searches through two months of ultrasound scans looking for one from the day before. Much time is spent looking for needed reports.
LifeSpring Hospitals 2013 | Hyderabad, India LifeSpring is a chain of maternity facilities providing highquality affordable health care to low-income women in India. In 2013, our third project with the company sought to optimize the role of its Clinical Nurse Managers, who lead many aspects of patient care at each hospital. The team conducted a detailed time and motion study, investigated differences across hospitals, and specified how the organization could more clearly define this critically important role and ensure greater efficiency.
Bowenpally Hospital, Hyderabad. LifeSpringâ&#x20AC;&#x2122;s facilities are located in low-income neighborhoods throughout the city, close to their target customers. The distinctive signs are the hospitalsâ&#x20AC;&#x2122; main advertising tool, strategically positioned in the neighborhood to direct customers to the local branch.
The team with a LifeSpring customer, who was in her third trimester. She had come with her mother to Chilkalguda for a pre-natal appointment. Many LifeSpring customers come to visits with multiple family members as attendants. Relatives play an important role in family planning and health care.
Sister K, nurse-manager at the Etwatwa clinic, at work in its treatment room. She is writing a prescription for a patient. Some basic medications and supplies were for sale in the clinic.
2013 | Johannesburg, South Africa Our second project with Unjani addressed the challenge of scaling up its network of small primary care clinics. The social business would need to increase patient volume and refine its pricing strategy. Our team researched franchise practices and interviewed dozens of staff, public workers, patients, and potential patients. The project culminated in strategic recommendations designed to optimize pricing, develop business owner skills, explore potential public-clinic collaborations, and increase patient awareness.
A spaza shop, or a small convenience store, in the community of Etwatwa. The team visited shops in each community, interviewing store owners to gain a better sense of the communityâ&#x20AC;&#x2122;s willingness to pay, as well as to understand what OTC medications were offered in each community.
The waiting area outside the Villa Lisa clinic. There was a significant queue at this clinic, which is a good sign for Unjani in terms of demand, awareness, and volume. However, the team discovered some patients had waited over three hours before being seen.
Grassroot Soccer 2013 | Cape Town, South Africa Grassroot Soccer uses soccer to educate and inspire communities to fight the spread of HIV/AIDS. To explore how SMS technology could extend GRS’s engagement with current and former participants, our team studied the mobile landscape in South Africa; researched how others used mobile phones to improve health outcomes; and met with staff and participants. The result: a strategy to bolster Grassroot’s efforts to educate youth about health, change behavior, and improve outcomes.
Football center in Khayelitsha, during a Nike Foundation focus group in collaboration with the Girl Project, an effort based on the belief that “girls are the most powerful force for change on the planet.” Nike Foundation is also considering how to leverage mobile technology for healthcare delivery.
Grassroot Soccer runs a variety of programs. Among the fastest-growing is Skillz Street, the only program focusing on adolescent girls. Adolescent girls are a critical segment to reach: at least 25% of South African girls were estimated to be HIV positive compared with 4% of boys.
To understand maternal outcomes, the team examined rates of C-sections, interviewing over 100 patients in person, conducting 80 hours of observations, and talking to over 30 staff.
Like all GlobalHealth Lab teams, the students constantly refined their thinking. They mapped out hypotheses, examined them in light of the data they gleaned, and zeroed in on useful frameworks.
Institute of Public Health with public facilities in Tumkur 2014 | Karnataka, India
The team collaborated closely with IPHâ&#x20AC;&#x2122;s Dr. Devadasan, benefiting from his deep knowledge of state and national healthcare systems and the key issues related to maternal health. They also worked with clinicians, policy specialists, and others from both IPH and a range of facilities in Tumkur.
In collaboration with IPH, a non-profit that aims to strengthen health systems, the team studied the experience of maternal patients in public hospitals to assess human resource gaps, operational bottlenecks, service alignment, and their effects. The recommendations were designed to improve patient pathways and improve outcomes and experience for pregnant women and babies.
To understand front line community health workersâ&#x20AC;&#x2122; needs and attitudes towards technology, students examined how they used their phones, for both work and leisure.
2014 | South Africa US-based social enterprise Dimagiâ&#x20AC;&#x2122;s software improves healthcare for the underserved in 30 developing countries. In studying users in four sites across South Africa, our team aimed to equip Dimagi to shift from providing its technology to enterprise partners to a new approach fueled by end-user demand. A pull model could enable Dimagi to innovate and better respond to community health workersâ&#x20AC;&#x2122; needs, creating a virtuous cycle of user-driven technology adoption.
The team traveled to four sites in three provinces to develop a first-hand view of the daily experience of community heath workers in both urban and rural settings, and their roles in the community.
Daily travel, meetings, and interactions with patients, families, and communities fill the schedule. Managing community health care includes assigning responsibilities and tracking follow up. When it came to acceptance of new mobile-based tools, the team saw potential that was not yet realized.
Shining Hope, or SHOFCO, supported an impressive range of activities, including income generation opportunities, a school, and more. The greens that these women prepared may end up in a Shining Hope school lunch or sold, to be eaten with the porridge-like ugali and some chili sauce.
Shining Hope for Communities 2013 | Nairobi, Kenya In the populous informal settlement of Kibera, SHOFCO tackles extreme poverty and gender inequity. Our team interviewed its clinic staff and patients and tracked patient flows, supply chains, and costs. They developed monitoring tools and other practical materials linked to key strategic issues they had identified: objectives, scope, internal organization, and external positioning.
The SHOFCO clinic. The organization sought to understand how it could improve the clinicâ&#x20AC;&#x2122;s operations so as to equip the organization for eventual expansion. Students examined specific improvements in clinic management and equipped the organizations with assessment tools.
Founder Kennedy Odede is an inspiration to many, including the MIT students who worked closely with him on both operational and strategic issues. The team left with a deep appreciation of all that Kennedy and his colleagues were accomplishing in Kibera.
Patient folders are color-coded to indicate the level of payment, as the hospital serves some patients at no cost and goes all the way to luxury service. Clinical aspects are identical for all patients.
LV Prasad Eye Institute 2013 + 2014 | Hyderabad, India L V Prasad provides comprehensive and equitable eye health services to tens of thousands patients per year at over 100 locations. Our first project applied a systems lens to the challenge of improving visit efficiency in outpatient eye clinics, by tracking patient flows and queue lengths by time of day, and examining differences across different clinics within the hospital. The team suggested specific steps for improving flows and reducing bottlenecks.
The next year, a follow-up project tackled appointmentkeeping. Visiting the communities they came from, the team interviewed 395 patients in-depth to understand the factors shaping their ability to arrive at appointments. The result was a detailed picture of perceived and practical barriers to appointment-keeping. These insights suggested potential innovations that could increase patient follow-up as well as operational efficiency. If patient flow is smoothed, system overload reduced, and operational efficiency increased, LVPâ&#x20AC;&#x2122;s many patients could benefit greatly.
A waiting room at the busy center of excellence in downtown Hyderabad. Patients typically forgo a full day of work for even a brief appointment, so many come early, which in turn exacerbates crowding and reduces efficiency.
Paying patients wait in an air-conditioned room with a television. The team explored how to improve the waiting experience for all patients, including those who must wait outdoors. In many respects, LVPâ&#x20AC;&#x2122;s operations and facilities are effectively organized and well run.
Could appointments and reminders rely more on SMS or mobile technology? The second project raised the question as it explored how to build a culture of appointment-keeping.
Traveling in Bangladesh can be an adventure. Bicycle rickshaw rides were a mainstay for local transport as the teams visited program sites.
BRAC Bangladesh-based BRAC is dedicated to empowering the poor through healthcare, microfinance, education, and legal services. Its health services reach 100 million people. In 2013, BRAC sought input on managing its partnerships. Informed by in-depth case reviews of past partnerships and dozens of interviews and discussions with BRAC leaders and staff, the students developed a framework, process, and tools to help BRAC to adopt a systemic, lifecycle approach for screening, evaluating, and managing partnerships to benefit the communities BRAC serves.
The teamâ&#x20AC;&#x201D;along with mentor Anjali Sastryâ&#x20AC;&#x201D;debates ideas mid-project, on the rooftop of BRAC headquarters in Dhaka, Bangladesh.
The first project sought to understand partnerships, including some that involved selling health commodities. The team studied the role of small shops and pharmacies in the markets that BRAC served.
2013 + 2014 | Dhaka, Bangladesh The next year’s project aimed to improve business strategy and operational models for its keystone Essential Health Care program to generate demand for its services, enhance operations, and refine marketing strategy. Improving the Essential Health Care program could benefit BRAC’s 55,000 embedded community health workers by raising their income and enable BRAC to address health needs of vulnerable people more effectively and efficiently.
BRAC is the world’s leading innovator in community-based development and connects access to capital, healthcare, education, legal rights, and more with individuals, families, and communities.
One of BRAC’s community health workers. She provides healthcare, health commodities, over-thecounter medication, and referrals as needed, household by household. BRAC’s cadre of these workers represents a vast asset that the second project examined strategically.
Since 2007, GlobalHealth Lab and related efforts have completed 70 practical projects designed to address healthcare delivery challenges with dozens of partners around the world:
AAR Health Services | Nairobi, Kenya AMPATH | Eldoret, Kenya Baobab Health Partnership | Lilongwe, Malawi BRAC | Dhaka, Bangladesh Cambridge AIDS Alliance/Cambridge Cares | Massachusetts CARE Hospitals | Hyderabad, India CARE Rural Health Mission | Andhra Pradesh, India Careworks HIV Managed Care Solutions | Cape Town, South Africa Carolina for Kibera | Nairobi, Kenya Centre for Infectious Diseases Research Zambia | Lusaka, Zambia ClickDiagnostics | Boston (project in South Africa) Connaught Hospital (with Surgeons OverSeas) | Freetown, Sierra Leone Daktari Diagnostics | Cambridge, MA (projects in Uganda, Botswana & Kenya) Dimagi, Inc | Cambridge MA (project in South Africa). Empowering Lives International | Kipkaren, Kenya G S Memorial Plastic Surgery Hospital and Trauma Centre | Varanasi, India Gertrudeâ&#x20AC;&#x2122;s Garden Childrenâ&#x20AC;&#x2122;s Hospital | Nairobi, Kenya Gradian Health Systems | New York, NY (projects in Tanzania & Zambia) Grassroot Soccer | Cape Town, South Africa. Himalayan Health Care | Illam, Nepal Institute of Public Health with Gubbi taluk hospitals | Karnataka, India International Committee of the Red Cross/Red Crescent | Boston (Senegal project) Joint Task Force-Haiti | US Military and Lincoln Labs (project in Haiti) Kampala Family Clinic | Kampala, Uganda KenCall | Nairobi, Kenya
Kyetume Community Based Health Care Programme | Mukono, Uganda L V Prasad Eye Institute | Hyderabad, India. LifeSpring Hospitals | Hyderabad, India Living Room International | Kipkaren, Kenya loveLife | Johannesburg, South Africa Mass Development Association | Dar es Salaam, Tanzania Mennonite Economic Development Associates | Dar es Salaam, Tanzania Meridian Medical Centres | Nairobi, Kenya Misoprostol Access Project | Indonesia Muthaiga Paediatrics Clinic | Nairobi, Kenya PSI-Tanzania | Dar es Salaam, Tanzania Shining Hope for Communities | Nairobi, Kenya Support for International Change | Arusha, Tanzania Sustainable Household Income Project/Family Treatment Fund via MGHHarvard-MUST Research Collaboration | Mbarara, Uganda Total | Accra, Ghana and Nairobi, Kenya Uganda Research Initiative (Mbarara University of Science and Technology and Massachusetts General Hospital) | Mbarara, Uganda Unjani (a project of RTT/Imperial Health) | Johannesburg, South Africa Up To Date | Waltham, Massachusetts (project on Lesotho and elsewhere) Village Reach | Mozambique Viva Afya and Valentis Health Care | Nairobi, Kenya Warmbaths Hospital | Bela Bela, South Africa Western Cape Department of Health: Lotus River Community Health Clinic and Retreat Community Health Centre | Cape Town, South Africa
Imagery ©2014 NASA, TerraMetrics. Map data ©2014 Google, INEGI
GlobalHealth Lab is part of the Groundwork Initiative for Global Health Delivery at Massachusetts Institute of Technology Sloan School of Management. It was founded by Anjali Sastry, PhD, a senior lecturer at the Sloan School. The initiative targets innovation at the front lines of healthcare delivery in lowresource settings, seeking to address challenges and to learn from successful innovators. In GlobalHealth Lab, students learn in the classroom and in the field about needs, opportunities, and effective action. We design every project to improve healthcare for who most need it, so that as we learn we also help advance practice and contribute useful knowledge that could spur wider innovation and improvement in healthcare delivery. Thank you to the hundreds of MIT students who have contributed to the effort, colleagues across MIT who have enabled it to flourish, domain experts at the Global Health Delivery Project and elsewhere who have taught us much, and our valued, inspiring supporters and advisors who have made this work possible. We are forever grateful to the dozens of amazing partner organizations who have collaborated with us over the years. To learn more and to support our work please visit: http://groundwork.mit.edu/
This content was developed by Anjali Sastry and Chris Rogacz, drawing directly on student materials from 2013 and 2014. Special thanks to Ariella Dagi, Kate Long, and Alison Prosek.