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Saving Lives at Birth:

A Grand Challenge for Development

Innovation Catalogue 1


Saving Lives at Birth: A Grand Challenge for Development




The Problem

The Challenge

Our Timeline




The Impact

The Pipeline






Drugs & Pharmaceuticals





Approaches & Services

Innovation Pipeline

Index of Innovations

Saving Lives at Birth Partners


Saving Lives at Birth: A Grand Challenge for Development

The Problem

Every two minutes, a woman dies in childbirth. The onset of labor marks the start of a high-risk period for both mother and baby that does not ease until at least 48 hours after birth. We have many powerful tools such as skilled attendance at delivery; emergency obstetric and newborn care; parenteral administration of drugs; blood transfusions; kangaroo care for newborns; early initiation of breastfeeding; hygiene; and rapid diagnosis and early treatment of infections. However, these interventions are not always available to the women and children who need them. As a result, an estimated 2.6 million stillbirths, 2.7 million neonatal deaths and 303,000 maternal deaths occur globally each year, signaling a major gap in interventions specifically around childbirth and the early postnatal period – a time when mothers and babies are most vulnerable and global progress in reducing mortality has been particularly poor. This gap in interventions is particularly acute in developing countries and for women who are disadvantaged.


Global Causes of Maternal Death



Indirect Causes

Hemorrhage Hypertensive Disorders

Other Direct Causes


Abortion Complications


14% 8%


Underlying Causes for Maternal Death

Unintended pregnancy

Non-communicable diseases



Source: Say L et al. 2014; USAID 2015

An estimated 2.6 million stillbirths, 2.7 million neonatal deaths, and 303,000 maternal deaths occur globally each year. Saving Lives at Birth: A Grand Challenge for Development

Global Causes of Child & Neonatal Deaths 13%




Neonatal Diarrhea




Other Conditions


5% 7%


Causes of Neonatal Deaths

24% 35%

Complications from preterm birth

Other Pneumonia

Intrapartum-related Sepsis/meningitis





5% 9%


1% 2%

More than 80% of neonatal deaths are in preterm or small for gestational age babies in high burden countries.

Source: WHO 2014


Saving Lives at Birth: A Grand Challenge for Development

The Challenge

Identify and scale groundbreaking solutions. Time and again, specific scientific, technological and operational breakthroughs have transformed insurmountable development challenges into solvable problems. To accelerate substantial and sustainable progress, United States Agency for International Development (USAID), the Government of Norway, the Bill & Melinda Gates Foundation (BMGF), Grand Challenges Canada, UK’s Department of International Development (DFID), and the Korea International Cooperation Agency (KOICA) joined together to launch Saving Lives at Birth: A Grand Challenge for Development. Saving Lives at Birth calls on the brightest minds across the globe to identify and scale groundbreaking approaches to save the lives of mothers and newborns in poor, hard-to reach communities around the time of birth. The partnership seeks innovative ideas that can leapfrog conventional approaches in three main domains: technology, service delivery, and demand—to empower pregnant women and their families to practice healthy behaviors and be aware of and access health care during pregnancy, childbirth and the early postnatal period, especially the first two days. 9

Our Timeline: To over 100 innovations

1st Global Call Launch Launch of Saving Lives at Birth: A Grand Challenge for Development March 9, 2011 in Washington, D.C.

Partnership Announcement U.S. Agency for International Development (USAID) Government of Norway Bill & Melinda Gates Foundation Grand Challenges Canada The World Bank



$50 million Overall commitment of by partners for solutions

DevelopmentXChange First annual DevelopmentXChange in Washington, DC

24 awards announced

Saving Lives at Birth: A Grand Challenge for Development

2nd Global Call

3rd Global Call



Second annual DevelopmentXChange in Seattle, WA

Third annual DevelopmentXChange in Washington, DC

15 awards announced

22 awards announced

Xcelerator Announcement USAID/The Lemelson Foundation/ BMGF/VentureWell form partnership to accelerate Grand Challenge innovations to impact

Partnership Announcement UK’s Department for International Development (DFID) joins Saving Lives at Birth

Over 3,500 ideas submitted from over 100 countries, identifying over 100 game-changing solutions.

4th Global Call DevelopmentXChange

5th Global Call DevelopmentXChange

6th Global Call DevelopmentXChange

Fourth annual DevelopmentXChange in Washington, DC

Fifth annual DevelopmentXChange in Washington, DC

Sixth annual DevelopmentXChange in Washington, DC

30 awards announced

19 awards announced

16 awards announced



$50 million Additional $50 million dedicated to the sourcing and acceleration of innovations

Partnership Announcement Korea International Cooperation Agency (KOICA) joins Saving Lives at Birth


Saving Lives at Birth: A Grand Challenge for Development

The Impact

These innovations are saving thousands of lives. Saving Lives at Birth has built a rich pipeline of diverse maternal and neonatal health innovations from all over the world. The innovators come from a range of organizations —including non-profits, universities, and private enterprises—and from all over the world—such as Australia, India, Kenya, Nigeria, and the United States. Many work in partnerships that bring together diverse expertise and skillsets, fostering creative and sustainable solutions. Many of our investments are already having an impact as they begin to scale. To date, Saving Lives at Birth innovations have benefited over 1.5 million women and newborns, saving nearly 10,000 lives. Together, as a collective whole, this community of innovators will catalyze substantial and sustainable progress to address this Grand Challenge for Development.


Saving Lives at Birth innovators are working around the world

1.5 million

Saving Lives at Birth: A Grand Challenge for Development

women and newborns benefit globally from Saving Lives at Birth Innovations


lives saved—and counting—around the world


Saving Lives at Birth: A Grand Challenge for Development

The Pipeline

Diverse innovations from all over the world. This catalogue highlights a selection of promising ideas in our portfolio of innovations including drugs, diagnostics, devices, nutritional interventions, practices and cross cutting approaches that address roadblocks in prevention and treatment of maternal and neonatal health.

Portfolio of Innovations


New or refined medical device, tool, or contraceptive


Diagnostic or screening device



Method of providing access to essential nutrients to mom and/or baby

New or refined service delivery or demand-creation model


Reformulation and/or improved access to a new or existing drug



Saving Lives at Birth: A Grand Challenge for Development



Augmented Infant Resuscitator (AIR)

Bempu Temperature Monitoring Band

Feedback delivery mechanism for healthcare professionals performing newborn resuscitation

Novel, simple, low-cost band to prevent neonatal hypothermia



Mbarara University of Science and Technology, University/Research Institution

Bempu Health Private Limited, Non-profit

Location Mbarara, Uganda Oxygen depriving events cause up to 1.8 million newborn deaths and stillbirths every year. Most of these deaths are preventable by early effective initiation of resuscitation at birth. However a significant proportion of the best trained health workers fail to resuscitate babies at birth and those that do experience rapid skills decay. The Augmented Infant Resuscitator (AIR) is a tested add-on device that objectively monitors quality of infant resuscitation, logs resuscitation quality data, and provides actionable real time feedback to health providers on resuscitation quality. The AIR device is designed to improve and maintain resuscitation skills of front-line health workers, strengthen quality improvement efforts and save lives. Experts estimate that a 20% reduction in time to effective ventilation may reduce adverse events (death or neurological impairment) by 25-48%. Country of Impact Uganda

Location Bangalore, India Hypothermia and infection are among top health challenges facing newborns in low and middle income countries. Regular temperature monitoring is an effective means of detection and prevention of hypothermia but in our extensive field research, but newborn temperature monitoring is rarely practiced in under-resourced clinics and uneducated homes. After vetting the need with over 75 pediatricians and filtering through several proposed solutions, Bempu Health has developed Bempu, a novel, simple low-cost newborn temperature monitoring wristband. The band intuitively alerts a mother in case of hypothermia, enabling her to take early action. Bempu is more affordable and reliable than the current standards of care (hand touch, axillary thermometry) because it continuously monitors a child for up to two months in the clinic or home. Within 10 years, Bempu aims to protect 25 million newborns cumulatively and 7 million per year thereafter worldwide, seeking to be the standard of care for neonatal temperature monitoring. Country of Impact India




Portable, high-intensity phototherapy to treat neonatal jaundice

High-performance apnea monitor for newborns

Organization Little Sparrows Technologies, For-profit Location Winchester, Massachusetts, USA Brain injury and death from severe neonatal jaundice is a preventable global health tragedy. Despite the relative simplicity of the cure, blue light phototherapy, rapid deployment of this treatment in rural, low resource areas of India has proven to be logistically challenging due to high equipment cost, distribution difficulties, and unreliable line power. Little Sparrows Technology has developed Bili-HutTM, a novel phototherapy device designed to improve access to jaundice treatment in low resource areas. The Bili-HutTM meets the specific needs of the previously unreachable, low-resource areas without reliable electricity that have the highest mortality from jaundice. Country of Impact India

Organization William Marsh Rice University, University/Research Institution Location Houston, Texas, USA Each year, more than 13 million babies are born prematurely in the developing world. Approximately 67% of babies of these neonates experience apnea of prematurity – a recurring condition in which they suddenly stop breathing. When detected immediately as is done with constant patient monitoring in high-resource settings, apnea can be easily corrected by simply tapping the infant’s foot or back. However, if apnea is not detected and corrected immediately, it can lead to death or severe cognitive impairment. BreathAlert is a simple $25 battery-powered monitor that both detects and automatically corrects episodes of apnea. An alarm function notifies a nurse to intervene only if the vibration does not restore breathing. BreathAlert offers a low-cost way to monitor and treat apnea of prematurity in low-resource settings, simultaneously improving premature babies’ outcomes and reducing nurses’ workload. Country of Impact Malawi

It is estimated that BreathAlert could ultimately eliminate apnea-related mortality and morbidity in at least 2.9 million babies per year.

Saving Lives at Birth: A Grand Challenge for Development



An electronic alternative to paper partogram to rapidly assess and respond to complications during labor

An electricity-free oxygen concentrator

Organization Jhpiego Corporation, Non-profit Location Baltimore, Maryland, USA Vigilant labor monitoring with the paper partogram has proven to be an inexpensive and pragmatic way to reduce both maternal and newborn mortality and morbidity; it also can promote logical human resource allocation, facilitate clinical supervision and support record-keeping. Despite these benefits, use of the paper partogram in developing countries is neither widespread nor uniform, because it is static, time consuming and difficult for frontline providers to manage in busy settings. The E-Partogram offers key solutions to these challenges. It is an easy, affordable tool to record clinical observations, predict complications and obtain problemsolving support, including from distant senior-level clinicians. The E-Partogram could positively transform safe childbirth by enabling front-line providers to more rapidly assess and respond to labor complications and receive crucial guidance to save the lives of women and newborns. Country of Impact Kenya

Organization The University of Melbourne, University/Research Institution Location Melbourne, Victoria, Australia Pneumonia is the leading cause of death in children under five worldwide, accounting for about 950,000 deaths every year. Oxygen is an essential medicine for treating pneumonia. However current systems require reliable electricity – something unavailable to 1.6 billion people worldwide. Consequently more than 99% of all pneumonia deaths occur in low- and middle-income countries. FREO2 is an electricity- free oxygen concentrator ideally suited for deployment in tropical or mountainous regions with proximity to flowing water. The oxygen generating capacity of FREO2 rises with the increased demand commonly observed during the rainy season in tropical regions. Country of Impact Worldwide

Based on 2016 statistics from the World Health Organization there are over 200,000 health facilities that require oxygen. It is estimated that FREO2 could be used in over 10,000 clinics worldwide.


Hemafuse A handheld, mechanical device for intraoperative autotransfusion of blood Organization Sisu Global Health, For-profit

Icterometer and Newborn Health Mobile Phone Application Community-based case management of premature and jaundiced newborns



Baltimore, Maryland, USA

The Brigham and Women's Hospital, University/Research Institution

In Africa, $3 billion is spent on blood and there is a severe blood shortage. Sisu Global Health created Hemafuse as an alternative to donor blood for cases of internal bleeding from pregnancy complications and trauma. Hemafuse manually salvages, filters, and recycles blood from an internal hemorrhage back to the patient. This device replaces current manual practices of autotransfusion and augments the use of donor blood in surgical practices. The relationships and systems Sisu develops with Hemafuse will be used with other portfolio products to scale in Africa and across emerging markets. The Hemafuse is handheld, electricity-independent, locallyaffordable tool designed be a safer, faster replacement. The device is syringe-like to manually suction and filter the blood for transfusion in a sterile, closed environment; decreasing risk of clots and of infection and promises to decrease the mortality of women. The development and sale of this device while prove a unique service implementation strategy to deliver low-tech devices to the areas that need them most. Country of Impact Ghana

Hemafuse could be used to reduce hospital costs and save lives in 290,000 surgeries that are performed each year in Ghana. In Africa, the addressable market is about 20 million cases.

Saving Lives at Birth: A Grand Challenge for Development

Location Boston, Massachusetts, USA Preterm birth affects 15 million babies every year and is the leading cause of under-five child mortality, and jaundice is one of the most common neonatal morbidities. Frontline health workers may effectively manage newborn illnesses using guidelines such as the WHO Integrated Management of Childhood Illness; however, current protocols do not adequately address management of small infants (preterm or low birth weight) or neonatal jaundice. Simple, low-cost tools may enhance health worker performance by improving the identification and case management of small, sick and/ or jaundiced infants. The Brigham and Women's Hospital is 1) developing a mobile phone application for a comprehensive newborn assessment to identify and manage small and sick newborns, and 2) designing and validating a simple “jaundice ruler� (icterometer) to improve the accuracy of screening for neonatal hyperbilirubinemia. These tools have the potential for impact, sustainability and scalability given their simplicity, low cost, use of human-centered design principles, and partnerships with key local and international maternal-neonatal health stakeholders. Country of Impact Bangladesh



An obstetric device to prevent birthing infection

Postpartum uterus trainer for intrauterine device simulation

Organization Novate Medical Technologies, LLC, For-profit Location New Orleans, Louisiana, USA

Organization Jhpiego Corporation, Non-profit Location Baltimore, Maryland, USA

Lack of healthcare infrastructure and unsanitary birthing conditions are thought to result in over 500,000-950,000 infection-related infant deaths per year, and it is recognized that the unhealed umbilical cord is an important conduit for local and invasive infections during this period. Currently, birthing kits contain string or other plastic clamp devices and metal blades that are contaminated or improperly reused in an estimated 50% of births while causing healthcare provider injury due to unprotected sharps and uncontrolled blood or amniotic fluid exposure in 40-50% of deliveries. InfaClip is a nonreusable obstetric device that simultaneously cuts and clamps the umbilical cord, focused on addressing neonatal mortality due to umbilical cord infections while reducing unintended blood borne pathogen exposure during the birthing process. InfaClip also makes the birthing process more efficient and intuitive, through a novel technology manufactured entirely of plastic polymers to ensure cost-effectiveness and safe use while preventing reuse. Promoting clean delivery is effective in averting 20-30% of newborn deaths due to infection. InfaClip will further reduce neonatal mortality while protecting vital healthcare providers for women and children worldwide. Country of Impact

Despite efforts to reinvigorate use of the postpartum intrauterine device (PPIUD) as a way to prevent adverse maternal and newborn health outcomes due to poor birth spacing, PPIUDs are underutilized due to lack of provider confidence, client mistrust of the method and systemic conditions that limit the number of providers trained. Current PPIUD training models are expensive, heavy and not designed to simulate a variety of uterine positions. Training approaches relying on conventional models are limited to large, group-based training requiring health workers to leave their sites for long periods. Jhpiego and Laerdal Global Health address these challenges by demonstrating the efficacy and potential of a new PPIUD simulation model and a self-paced, blended learning approach through field-testing among trainers, providers and clients at facilities in Pakistan in collaboration with key stakeholders. Jhpiego expects the new PPIUD model to be ready for rapid scale-up at facilities in Pakistan and to be introduced in other postpartum family planning programs around the world. Country of Impact Pakistan



MOYO Fetal Heart Rate Sensor A human energy-powered fetal heart rate monitor Organization Laerdal Global Health, Non-profit Location Stavanger, Norway The burden of stillbirths and birth asphyxia is estimated to account for 2 million perinatal deaths annually, 98-99% which occur in low and middle-income countries. Laerdal Global Health’s low-cost Fetal Heart Rate (FHR) monitor, MOYO, and its training program will help providers measure FHR faster, automatically and more accurate to make timely obstetric responses when detecting fetuses at risk. Expanding the use of MOYO to referring hospitals and dispensaries will help detecting fetuses at risk earlier and improve referrals. Training antenatal care providers and using MOYO at antenatal visits, will improve the antenatal follow-up, build trust with providers and help encourage mothers to deliver in a safe environment. MOYO can be worn by the mother to continuously measure FHR, and will issue an alarm if FHR is abnormal according to guidelines. Country of Impact Tanzania

NIFTY Cup A Neonatal Intuitive Feeding TechnologY for preterm infants who have difficulty breastfeeding Organization PATH/ Laerdal Global Health, Non-profit/For-profit Location Seattle, Washington, USA The World Health Organization and United Nations Children’s Fund recommend hand expression of breast milk and use of a small cup to feed newborns with breastfeeding difficulties in low-resource settings, yet no standard infant feeding cup exists. Devices currently used in high-resource settings are impractical and unhygienic in settings that lack clean water and electricity; nonspecific or improvised items (e.g., small medicine cups) are used worldwide but can be an inefficient for feeding, unsafe, and too small to express milk into. The NIFTY cup is a simple, safe, easy-to-clean, ergonomic, and affordable tool designed to optimize the efficient hand expression and feeding of breast milk to newborn preterm infants and other infants with breastfeeding difficulties. In May of 2016, PATH and Laerdal Global Health announced a collaboration to bring a feeding cup to low and middle-income markets based on the NIFTY cup design co-developed by PATH, the University of Washington School of Dentistry, and the Craniofacial Center at Seattle Children’s Hospital. Country of Impact

With earlier detection of abnormal fetal heart rate followed by appropriate obstetric interventions, the fresh stillbirth rate could be reduced with 40% and an expected reduction of asphyxiated newborns by 30%.

Saving Lives at Birth: A Grand Challenge for Development


For various medical reasons, there are 9 million babies born in Africa and South Asia every year that have difficulties breastfeeding.

Odon Device™ A safe and easy assisted vaginal delivery device to reduce negative obstetrical outcomes Organization Becton, Dickinson and Company/WHO, For-profit/ Public International Organization Location Franklin Lakes, New Jersey, USA

increase the risk of infection. Furthermore, these interventions are often not available in many low-resource settings. The Odon Device™ is potentially safer and easier to apply than forceps or vacuum extractor for assisted vaginal deliveries, and a safe alternative to caesarean sections in settings with limited surgical capacity and human resource constraints. With continued safety and feasibility testing, the Odon Device will be the first innovation in operative vaginal delivery since the development of forceps centuries ago and vacuum extractor decades ago. It has the potential to improve intrapartum care in developed and developing markets around the world. Countries of Impact

Approximately 10% of pregnancies experience prolonged or complicated second-stage of labor; 9% of maternal mortality is attributed to prolonged or obstructed labor; and 24% of neonatal deaths and 45% of stillbirths are due to intrapartum complications. Additionally, without proper intervention, severe complications may arise such as post-partum hemorrhage, perinatal asphyxia and fistula. The risks and complexities associated with current devices for assisted vaginal delivery may inhibit utilization; increase cesarean sections, add cost, and

Argentina, South Africa, Kenya

Innovation Can Come From Anywhere: Odon Device™ The idea came to Jorge Odón as he slept. Somehow, he said, his unconscious made the leap from a YouTube video he had just seen on extracting a lost cork from a wine bottle to the realization that the same parlor trick could save a baby stuck in the birth canal. Mr. Odón, an Argentine car mechanic, built his first prototype in his kitchen, using a glass jar for a womb, his daughter’s doll for the trapped baby, and a fabric bag and sleeve sewn by his wife as his lifesaving device. Unlikely as it seems, the idea that took shape on his counter won the enthusiastic endorsement and strategic partnership of the World Health Organization and Becton, Dickinson and Company. With the Odon Device, an attendant slips a plastic bag inside a lubricated plastic sleeve around the head, inflates it to grip the head and pulls the bag until the baby emerges. BD intends to launch the Odon DeviceTM in more than 50 countries, and the device is expected to impact 10 million births around the world.


PharmaChk Rapid detection and screening platform for substandard and counterfeit medicines Organization Trustees of Boston University, University/Research Institution Location Boston, Massachusetts, USA Each year, millions of people are exposed to substandard and counterfeit medicines, leading to more than 100,000 preventable deaths and the emergence of drug resistant pathogens. Current regulatory strategies for medicines control include: packaging inspection which fails to identify substandard drugs, thin layer chromatography (MiniLab) testing which is difficult to perform and only provide qualitative results, and high performance liquid chromatography testing, which is very expensive and requires a trained staff in a laboratory setting. PharmaChk offers a cost-effective and quantitative alternative to current technologies that can be used in the field with just minimal user training, and which additionally offers analysis on kinetic release behavior. A tablet is dropped into a vessel, where it is disintegrated and mixed with light-emitting probe, which binds to the active pharmaceutical ingredient in the medication. By capturing the light emitted from the bound probe and comparing it to a reference, PharmaChk can tell the user exactly how much active ingredient is contained in the tablet. The technology is of significant value in the developing world as a cost-effective and reliable tool for local health authorities and other stakeholders to better safeguard the efficacy of their pharmacopeia, and to greatly improve maternal and neonatal health outcomes. Country of Impact Ghana

Poor quality medicines are estimated to account for $75 billion out of a $962 billion global pharmaceutical market, exposing millions of people to poor quality medicines and causing over 100,000 preventable deaths every year. In Africa, Latin America, and Asia, estimates indicate that 10–30% of drug sales are poor quality out of the $230 billion pharmaceutical market. Saving Lives at Birth: A Grand Challenge for Development

PIERS on the Move Smart phone platform to accurately identify risk and guide home-based health care Organization

Contraceptive Implant Assistive Device Task-shifting device for the administration of subcutaneous contraception

University of British Columbia, University/Research Institution



University of Michigan, University/Research Institution

Vancouver, British Columbia, Canada


Every day, 750 pregnant women, 7200 fetuses, and 8200 newborns die - almost uniformly from preventable causes. These causes of stillbirth and newborn death include complications of labor, infection and congenital heart disease. The PIERS on the MOVE mobile platform aims to further the creation of an integrated mHealth application that first triages, and then guides initial management of, all the leading causes of maternal, fetal and newborn deaths. The University of British Columbia is now developing an additional feature to the existing PIERS on the MOVE application which focuses on hypertension, to create a user-friendly diagnostic tool for pregnancy hypotension. Country of Impact Worldwide

Ann Arbor, Michigan, USA Worldwide, more than 100 million women have unmet contraceptive needs. Access to long-term contraceptives (such as IUDs and subcutaneous implants) is significantly limited in rural areas of low- and middle-income countries due to lack of infrastructure and trained medical personnel to perform the administration. Currently, costly and challenging to deploy training programs are the primary methodology by which access can be increased. University of Michigan is developing assistive devices aimed at making insertion and removal of subcutaneous contraceptive implants simpler, safer, more accurate, and more consistent. Deployment of these technologies to community healthcare workers could enable the administration of long-term contraception by a large cadre of providers and increase access to this life-saving contraception in rural areas. Country of Impact Ethiopia

Based on studies that have gauged interest in Ethiopian women’s preferences for contraception, there are currently 1.5 million women who want access to contraceptive implants. Extrapolating the analysis to sub-Saharan Africa, suggests that there are 6.5 million women who would use contraceptive implants if they had access.


Postpartum Intrauterine Device Inserter

Multi-use Intrauterine Device Inserter

A dedicated IUD inserter for postpartum women

Reusable IUD inserter for easier and safer procedures

Organization Population Services International/ Stanford Program for International Reproductive Education and Services (SPIRES)/ Pregna International, Non-profit/University/For-Profit Location

Organization Bioceptive, Inc., For-Profit Location New Orleans, Louisiana, USA

Washington DC, USA Globally, there has been huge surge in institutional deliveries and increasing demand for postpartum insertions particularly in developing countries. Currently, there is no dedicated inserter available for immediate postpartum intrauterine device (PPIUD) insertion similar to what exists for interval insertions. Providers are using forceps for PPIUD insertions whereby the IUD is taken out of the conventional inserter manually and grasped with forceps before it is placed at the uterine fundus. The PPIUD inserter has been introduced with longer thread, hence it is visible after insertion in postpartum uterus. It comes “ready to use� in sterile packaging and is directly inserted through cervix to place at uterine fundus, and therefore does not require any instrument or manual touch. This easy-to-use device could accelerate PPIUD usage, which would further contribute to improving maternal, neonatal, and child health development goals. This innovation targets the women seeking immediate post-partum contraception and provides them with a convenient, easy-touse, safe and affordable option for family planning while they are already in the hospital setting. Country of Impact India

Saving Lives at Birth: A Grand Challenge for Development

The discreet intrauterine device (IUD) is one of the most applicable Long-acting Reversible Contraception (LARC) methods for global use due to its long term of use, high efficacy, and minimal user effort. Yet, IUD access is frequently limited because the insertion procedure is complicated and only carried out by highly trained physicians. Bioceptive has developed a novel, reusable, sterilizable IUD inserter that makes the procedure simpler and intuitive and allows any healthcare worker to confidently insert an IUD with minimal training, thus using improved technology to overcome existing barriers to service delivery. This device can empower women with effective family planning options, increase contraceptive prevalence worldwide, and help countries move towards a balanced contraceptive method mix. Bioceptive aims to expand access to LARC for the estimated 222 million women around the world with an unmet need for modern family planning resources. Country of Impact Bangladesh

Pumani bubble Continuous Positive Airway Pressure (bCPAP) System A low-cost bCPAP to reduce deaths from respiratory distress Organization

During the period of 2015-2030, it is estimated that 14,648 neonates will be treated with the bCPAPs at government facilities in Malawi. Scaling bCPAP to district hospitals across the African continent could save the lives of an additional 178,000 neonates each year.

William Marsh Rice University/3rd Stone Design, University/For-Profit Location Houston, Texas, USA Acute respiratory infections are the leading cause of global child mortality. In the developing world, oxygen therapy is often the only treatment option for babies suffering from respiratory distress (RDS). Without the added pressure of bubble Continuous Positive Airway Pressure (bCPAP), babies struggle to breathe and can suffer serious complications, and frequently death. A stand-alone bCPAP device can cost $6,000, too expensive for most developing world hospitals. The Pumani is a low-cost, high-performance bCPAP system that has been shown to significantly improve the survival of neonates with RDS by delivering therapeutic pressures and flows comparable to bCPAP systems used in the United States. An economic analysis proved it to be highly cost-effective according to WHO international guidelines, and its robust design requires minimal maintenance. The Pumani bCPAP has demonstrated the potential to improve survival rates due to neonatal RDS by 49% and has impacted the lives of over 2,000 neonates who have received bCPAP treatment since 2012. Country of Impact Malawi


SimPrints Biometric System A low-cost portable biometric scanner and software Organization SimPrints Technology Ltd., For-profit Location Cambridge, UK Community health worker visits during the pre-natal period can save lives, yet only 39% of expecting mothers received the WHO-recommended four health worker visits before giving birth. Accurate patient identification is currently a significant bottleneck in tracking and verifying health worker visits. In many developing countries patient medical records are paperbased, difficult to access, and prone to loss/damage. Existing mHealth technologies are similarly limited by vulnerabilities in misidentification such as common community names or unknown dates-of-birth. SimPrints obviates these concerns by identifying patients through their unique fingerprints in a portable, cheap and time-efficient manner. This technology additionally provides managers with new tools for verification and GPS mapping that current mHealth technologies lack. SimPrints builds open source software and biometric hardware to empower mobile tools including a low-cost fingerprint scanner that can instantly link a mother to her health records anytime, anywhere. It empowers health workers to identify patients and drive continuous service delivery improvements. This tool could help ensure that 221 million pregnancies every year do not fall through the cracks and instead receive adequate antenatal care. Country of Impact Bangladesh

Saving Lives at Birth: A Grand Challenge for Development

Simulation-based Training Model for Cesarean Sections Cesarean section skills training model Organization Operative Experience, Inc, For-profit Location Elkton, Maryland, USA A major cause of maternal and neonatal death and severe disability in developing countries is the lack of trained medical providers to perform emergency cesarean sections in cases of obstructed labor. Due to the shortage of doctors, many underserved countries rely on midwives and clinical officers to provide obstetrical care. These providers are not trained to perform cesarean section. A low-cost method for training them to safely do this operation could reduce maternal/fetal mortality and devastating, non-lethal obstetrical complications such as recto-vaginal fistulas. Operative Experience, Inc. has pioneered unique, simulation-based methods to teach major surgical operations and currently trains military physicians and combat medics in critical trauma procedures. Operative utilizes their methods to teach healthcare providers in underserved areas to perform emergency cesarean sections. Country of Impact Worldwide

Every Second Matters Uterine Balloon Tamponade System (ESM-UBT™) A next generation uterine balloon tamponade device to treat postpartum hemorrhage Organization Massachusetts General Hospital, University/Research Institution Location Boston, Massachusetts, USA Postpartum hemorrhage (PPH) is a leading killer of pregnant women worldwide. In resource-poor settings, especially in rural areas, many women lack access to quality, assisted delivery by skilled birth attendants and are, therefore, at high risk for suffering injury or death consequent to PPH. Uterine balloon tamponade (UBT) has been shown to be an effective technique to treat uterine hemorrhage in developed countries but has not been widely examined in resource-poor settings. Massachusetts General Hospital is rolling out and evaluating a next-generation UBT device to arrest maternal hemorrhage in Kenya and Sierra Leone, where maternal mortality statistics are alarmingly high. The UBT will be deployed as part of a best-evidence package of training, commodities, and checklists related to the treatment of PPH. This system will also include cutting-edge cell phone technology that will facilitate UBT referral tracking and documentation of patient outcomes. ESM-UBT TM could soon become a required item in every health facility and in every midwife's tool kit worldwide.

XStat Mini-Sponge Applicator for Obstetric Use A novel agent for management of postpartum hemorrhage Organization Oregon Health & Science University/RevMedix, University/For-profit Location Portland, Oregon, USA Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in low-income countries. The majority of these deaths occur outside the health care system, and so an intervention that could be used in any setting and with minimal training could save lives. This device utilizes pre-packaged, environmentally stable, compressed medical sponges soaked with a hemostatic agent and administered by a light-weight applicator. The sponges, once deployed, exert uniform pressure to address multiple sources of bleeding and are easily removable. Country of Impact Worldwide

Countries of Impact Sierra Leone, Kenya



Photo Credit: 2015 Sujan Sarkar

Saving Lives at Birth: A Grand Challenge for Development



Iron Fortified Tea

Quadruple Fortified Salt

Iron fortification of tea to prevent iron deficiency in pregnant women

Simultaneous delivery of iron, folic acid, vitamin B12, and iodine to pregnant women

Organization University of Toronto, University/Research Institution Location Toronto, Ontario, Canada Iron deficiency is a major contributor to maternal death. Improving the health of women through iron fortification of a universally consumed food vehicle will result in significant saving of lives at birth. Tea is universally consumed in South Asia; however iron forms complexes in tea, reducing bioavailability, and thus thwarting earlier fortification attempts. The University of Toronto has developed a way to make tea viable as an iron fortification vehicle through a spray-encapsulated iron premix that will be attached to tea leaves, and released into hot water during brewing, without altering the tea's sensory attributes. Iron will be encapsulated in enteric coating to prevent formation of non-bioavailable tannin complex in the stomach, the coating will dissolve in the small intestines to expose a high bioavailability

Organization University of Toronto, University/Research Institution Location Toronto, Ontario, Canada Globally, 56 million, or approximately 40% of all pregnant women, suffer from anemia, which is mostly due to iron deficiency. The deficiency of iron, folic acid and vitamin B12 in the diet is a significant contributor to maternal mortality and birth defects in the developing world. Iodine deficiency, a major cause of nervous system and cognitive development problems, is now addressed by salt iodization for 70% of the world. The University of Toronto is developing a technology for adding iron, folic acid and vitamin B12 to iodized salt, using equipment readily available in salt producers' plants. This will provide 100% of the iodine and 30% of the iron, folic acid and vitamin B12 daily requirement through the normal use of cooking salt in the household

self-emulsifying iron delivery system. The encapsulation and

Country of Impact

microemulsion protects iron in the stomach and enhances


absorption in the lower GI, while using tea as the fortification vehicle to ease adoption of this innovation. Country of Impact India

At the cost of $0.10 per person per year, quadrupled fortified salt has the potential to impact 1.6 billion people who are severely affected by these multiple micronutrient deficiencies, decreasing anemia by 35% .


Lucky Iron Fish™ Cooking additive tool to prevent iron deficiency Organization Lucky Iron Fish Inc, For-Profit Location Guelph, Ontario, Canada Iron deficiency is a global health problem affecting more than 3.5 billion people, primarily women and children in the developing world. Compliance with iron supplement programs is often low and rates of iron deficiency anemia continue to trouble certain populations. The Lucky Iron FishTM is a simple health innovation that can provide a portion of the daily required iron intake. Cooking with this inexpensive but carefully formulated and tested cast iron fish adds iron to food or drinking water and the Fish is reusable for up to five years. This is a simple, effective solution with no observed side effects to this serious health and economic condition and the goal is simply to “put a fish in every pot” and change the face of health. Country of Impact Cambodia

A Culturally Relevant Solution: Lucky Iron FishTM In Cambodia, women can be anemic due to iron deficiency in their diets, causing premature labor, hemorrhaging during childbirth, and impaired brain development of their babies. Usually obtained through red meat or other iron-rich foods, a small chunk of iron added to water in the cooking pot can release a life-saving iron supplement, but attempts to persuade mothers to do so were unsuccessful. On a 2008 study mission in Cambodia, University of Guelph researcher Chris Charles thought of creating a piece of iron, shaped like a local river fish, which is believed to bring good luck and fortune. His simple idea succeeded beyond all expectations; women happily placed the Lucky Iron FishTM in their cooking pots and, in the months that followed, anemia in the village fell dramatically. A Lucky Iron FishTM is small enough to be stirred easily, but large enough to provide about 75% of daily iron requirements.

Saving Lives at Birth: A Grand Challenge for Development


Lactoferrin To Correct Iron Deficiency in Pregnancy A new approach to correct iron deficiency early in pregnancy Organization The University of Sydney, University/Research Institution Location Sydney, Australia The current paradigm of using iron supplements (and folic acid) targeted at pregnant women often fails, in part because of the side effects, which are a strong barrier to use of the supplements early in pregnancy, and also because maternal inflammation blocks absorption and effective utilization of iron. Lactoferrin is a safe, naturally occurring iron-binding protein found in high concentration in body secretions including milk. It offers an exciting new approach to correct iron deficiency early in pregnancy, prevent low birth weight, preterm delivery and reduce neonatal deaths. It has few side effects, facilitates absorption of iron, and reduces maternal inflammation to enhance the utilization of iron giving it the potential to rapidly restore iron status in pregnant women, even in populations with high burdens of infectious diseases. Bovine lactoferrin supplements can be manufactured by local pharmaceutical companies from imported raw materials and marketed at an affordable price. Given the presence of a large dairy industry in Bangladesh, it is also possible that lactoferrin could be produced locally further reducing the costs of the supplements. It has the potential to be an efficient solution for correcting iron deficiency in pregnancy accelerating the decline in neonatal mortality globally. Country of Impact Bangladesh


Approach & Drugs & Service Pharmaceuticals Cover Page

Photo Credit: Save the Children

Saving Lives at Birth: A Grand Challenge for Development



R E F O R M U L AT I O N A N D / O R M E T H O D T O A C C E S S T O A N E W O R E X I S T I N G D R U G


of Health to accelerate scale-up with the goal of mainstreaming chlorhexidine in all districts nationwide. The use of chlorhexidine has replaced traditional harmful traditional practices of umbilical cord care and as a result is saving approximately 8,000 newborns in Nepal.

JSI Research & Training Institute, Inc., Non-profit

Country of Impact



Low-cost antiseptic for umbilical cord care

Boston, Massachusetts, USA In Nepal, as in many developing countries, two in 100 newborn babies die before they are one month old. Newborn infection is the leading cause of neonatal death. 45% of deliveries occur at home and the cord is often treated using substances like turmeric prouder, mustard oil, or even cow dung. Chlorhexidine is an extremely low-cost, easy-to-use topical antiseptic that is effective against gram positive and gram negative bacteria, as well as some viruses, including HIV. It has been proven to be effective in reducing bacterial colonization on the skin and umbilical stumps of newborns. JSI's innovation is to use chlorhexidine to prevent newborn infections by 68% and deaths by 23%. They are working within the Nepalese Ministry

Scaling Impact: The Use of Chlorhexidine In a pilot study in Nepal, the promising impact of umbilical cord cleaning with chlorhexidine was proven to reduce the risk of overall neonatal mortality by 24% . Recent studies in Pakistan and Bangladesh show similar reductions in mortality (between 20% and 40%) and cord infection. Few interventions have shown such promise for rapidly reducing newborn mortality in developing country settings. In recent years, chlorhexidine has been added to WHO’s Essential Medicines List and is now considered one of 13 life-saving commodities by the UN. Because of its impressive results, Nepal is seen as a living university of chlorhexidine implementation and one to replicate. Twenty country delegations have visited the JSI team in Nepal to learn lessons in scaling this promising cord care antiseptic. It is expected that 25 countries will introduce chlorhexidine in the next few years. At full scale in the developing world, the use of chlorhexidine could save over 300,000 lives a year.


Every Second Matters— Ketamine (ESM-Ketamine™)

Inexpensive Preeclampsia Treatment

Use of ketamine anesthesia for emergency cesarean section

New uses for old, generic drugs in treatment of preeclampsia



Massachusetts General Hospital, University/Research Institution

Queen's University Belfast, University/Research Institution



Boston, Massachusetts, USA

Belfast, UK

Lack of access to anesthesia services is one of the primary barriers to accessing emergency and essential surgery. As a consequence, currently, large regions of the world have zero to one percent caesarean section rates. In Kenya alone, there are large regions where the caesarean section rate is 1% or less and in fact, Mandera County has a reported maternal mortality ratio of 3,375 (the highest in the world). The ESM-KetamineTM package is an affordable rescue solution, defined as a bounded package including a five-day training program for non-anesthetist midlevel and above providers, wall charts, pocket check-lists, and an ESM-KetamineTM kit. Preliminary data suggests an enormous potential for impact with scale.

Preeclampsia is a disease without targeted treatments. Traditional drug discovery in pregnancy is lengthy, costly, and highly risky, deterring the biopharm industry. Queen's University is establishing a cell-based assay to screen clinicallyavailable, mostly generic and inexpensive, drugs that may have a therapeutic effect on preeclampsia. The drugs to be screened are chosen as relatively safe to pregnant women based on FDA labels; most of them are already on pharmacy shelves in developing countries, being used for diseases other than preeclampsia. Finding new uses of old drugs will benefit pregnant women immediately especially in developing regions, shifting standard practice from the resource-consuming "reactive surveillance-based model" to effective treatment.

Country of Impact Kenya

Saving Lives at Birth: A Grand Challenge for Development

Country of Impact Worldwide

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality. Every year, an estimated 140,000 mothers die as a result of uncontrolled bleeding after giving birth, with over 1.5 million more surviving but with debilitating anemia or other health challenges. The gold standard therapy for the management of PPH is an oxytocin injection, but this degrades in hot climates unless refrigerated and requires injection-trained personnel.

Inhaled Formulation of Oxytocin

Inhaled Formulation of Oxytocin

Highly heat-resistant and non-invasive form of oxytocin

A low cost, needle-free, and non-refrigerated powder-form of oxytocin to treat post-partum bleeding

Organization The Mintaka Foundation for Medical Research, Non-profit



Monash University, University/Research Institution

Geneva, Switzerland

Location Melbourne, Victoria, Australia

The Mintaka Foundation has found a dry powder formulation which is 100% stable over 72 weeks at 40°C, 75% relative humidity and lends itself to highly efficient delivery system using an inhaler and distributed through a wider range of birth assistants. Country of Impact Worldwide

Monash is developing an innovative heat stable, simple to use, dry powder oxytocin inhaler that is safe and equally effective as the current injection product. This approach simplifies oxytocin administration to allow task shifting to lower tier healthcare workers and removes the requirement for refrigeration prior to use. As a result inhaled oxytocin offers the potential to dramatically expand access to a high quality oxytocin product within communities of high need and will likely bring substantial improvements in maternal mortality and morbidity. Country of Impact

With 52 million births occurring each year without skilled care and 60 million births taking place outside of facilities, inhaled oxytocin presents an opportunity to deliver significant impact in maternal care. Inhaled oxytocin has been independently assessed as having the potential to save 146,000 lives over a period of 8 years. Substantially greater improvements can be expected in maternal morbidity as for every maternal death an estimated 20-30 women suffer pregnancy-related near-misses and/or disability.



Pratt Pouch A model for expanding Infant Nevirapine Prophylaxis using an anti-retroviral pouch

Tetanus Toxoid Microneedle Patch


Novel tetanus toxoid vaccine delivery for pregnant mothers and children

Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)/Duke University, Non-profit/University


Location Washington DC, USA

Emory University, University/Research Institution Location Atlanta, Georgia, USA

Annually, 120,000 HIV-exposed infants are born in Uganda with nearly 16,000 becoming HIV-infected through transmission from their HIV-positive mothers during pregnancy, delivery, or breastfeeding. Antiretroviral prophylaxis given from birth to six weeks of age can dramatically reduce the risk of transmission, yet 68% of HIV-exposed infants do not receive critical nevirapine (NVP) prophylaxis in Uganda. The Pratt Pouch, a foilized, polyethylene pouch (similar to a ketchup pouch) designed and proven to safely store NVP doses, offers an innovative way to expand NVP coverage. The Elizabeth Glaser Pediatric AIDS Foundation and its partners are introducing and scaling up the Pratt Pouch in antenatal care, delivery, and postnatal care services in Uganda. Integrating this technology into existing services will simplify dosing and ensure all HIV-positive women have access to infant NVP. The easy-to-use pouches will empower women to immediately initiate NVP after delivery and encourage them to deliver in a health facility or bring their infants for postnatal care within 14 days. Country of Impact Uganda

In the past 15 years, neonatal tetanus cases have dropped by 87% but the total tetanus cases have decreased by less than 50%, with the disease still prevalent in 28 countries claiming 200,000 neonatal lives and 3,000 maternal lives per year. The current vaccine formulation is tetanus toxoid mixed with an adjuvant (Alum), administered in the deltoid muscle with needle and syringe. Emory University and Georgia Institute of Technology have developed a cold chain-independent dissolving microneedle patch (MNP) for skin vaccination of unadjuvanted tetanus toxoid. The skin represents an ideal vaccine delivery target because of large numbers of immunologically active cells that boost the adaptive immune system, eliciting robust and long-lived immune responses at least as good as the commercial intramuscularly injected adjuvanted vaccine. This technology aims to substantially enhance universal tetanus vaccination in countries where trained personnel is limited, increasing safety and patient compliance and improving administration logistics due to cold chain independence and small size of the patches. The MNP delivery platform can be used for a wide array of vaccines and thus is a very attractive solution to expand vaccination coverage, given that the vaccine market share in developing countries (80% of the world population) is less than 20%. Country of Impact India

Saving Lives at Birth: A Grand Challenge for Development


Photo Credit: 2015 Arturo Sanabria






Point-of-care bilirubin measurement device

A Point-of Care Assay for Plasma Bilirubin



William Marsh Rice University, University/Research Institution

Bilimetrix SRL, For-profit



Houston, Texas, USA

Trieste, Italy

Neonatal jaundice affects approximately 24 million newborns each year, and is especially common in premature babies and, if left untreated, can result in severe, untreatable brain damage. In high-resource settings, tools to measure serum bilirubin levels are readily available, but have proven too expensive and complex to implement widely in low-resource settings. BiliSpec is a low-cost battery-powered reader designed to immediately measure serum bilirubin levels from a small drop of whole blood applied to an inexpensive, disposable paper strip. The reader can be manufactured at low volume for less than $100 and the per-test cost of the lateral flow strip will be less than $0.10 with results being available after approximately one minute after spotting. BiliSpec combined with low-cost blue light phototherapy could greatly reduce the morbidity and mortality associated with neonatal jaundice in low-resourced settings.

Hyperbilirubinemia and Acute Bilirubin Encephalopathy (ABE), although preventable, continue to be highly prevalent in most low- and middle- income countries. Current bilirubin assays are done in hospitals or facilities and are not affordable. Bilimetrix has developed the Bilistick System, an affordable point-of-care diagnostic assay able to measure total serum bilirubin (TSB) concentration on the blood of newborn infants and promptly diagnosis neonatal hyperbilirubinemia. It is composed of: 1) Bilistick reader, a portable rechargeable battery reflectance reader; 2) Bilistick test strips, test strips with a cell-plasma separator coupled with a nitrocellulose membrane, both encased in a plastic cassette; and 3) Bilistick sample transfer pipettes, used for loading the appropriate volume of blood on the test strip. This innovative solution provides key stakeholders with a low cost and effective solution to monitor neonatal jaundice can contribute to substantial reduction of the prevalence of ABE in these countries. Studies show that combining public awareness and appropriate parental training for the identification of neonatal jaundice signs, plus proper medical training and availability of tools like Bilistick System, could help eradicate ABE and guarantee the health and future of thousands of newborns all around the world.

Country of Impact Malawi

The improved early detection of neonatal jaundice could impact an estimated 24 million babies born each year and prevent the deaths of 114,000 most of which occur in sub- Saharan Africa.

Saving Lives at Birth: A Grand Challenge for Development

Countries of Impact Egypt, Nigeria

Gene-RADAR® Nanotech platform Point-Of-Care HIV Diagnostic Device for the Prevention of Mother-To-Child Transmission (PMTCT) Organization Nanobiosym, Inc, For-profit Location Cambridge, Massachusetts, USA Mother-to-Child Transmission (MTCT) of HIV infects approximately 230,000 infant infections worldwide each year. Access to viral load (VL) testing is a major barrier to effective monitoring of anti-retroviral treatment (ART) and prevention of mother-to-child transmission of HIV (PMTCT) programs in Rwanda and other resource limited settings. Given the costs, plus the need for highly trained personnel, electricity, running water, and complex sample transport networks to run VL tests on traditional molecular diagnostic machines, VL testing can take up to six months in many sub-Saharan African countries. Nanobiosym’s portable, easy to use, Gene-RADAR® platform, winner of the prestigious 2013 XPRIZE, leverages the breakthrough science of nanobiophysics to transform the way diseases are diagnosed and bring the power of an integrated reference laboratory to the patient and healthcare provider where ever they are located. The Gene-RADAR® solution provides gold standard results in real time without the need for running water, electricity, trained personnel, complex sample preparation, and costly overhead infrastructure. The GeneRADAR® HIV VL test allows providers to rapidly and accurately measure patients’ response to ART, ensuring adequate and timely response to ART, reducing MTCT of HIV to their child in-utero, at birth, or during the breastfeeding period, saving thousands of lives.

mChip Frontline mobile diagnostic for HIV and syphilis Organization Columbia University/Junco Labs , University/For-profit Location New York, New York, USA The lack of obvious specific clinical symptoms for HIV and syphilis means that accurate diagnostic tests are crucial to stopping the transmission of these sexually transmitted infections (STIs) diseases. To respond to the lack of rapid, easily accessible and easy-to-use diagnostic tests, Columbia has built and tested a novel low-cost, front-line diagnostic testing device, also known as “mChip” that enables simultaneous detection of HIV, syphilis, and anemia at the point of care. mChip was initially implemented in Rwanda as a model for scale up in other developing countries. Country of Impact Rwanda

Country of Impact Rwanda


Preeclampsia affects approximately 2-8% of all pregnancies and is a leading cause of maternal mortality, especially in developing countries. The current standard of practice for preeclampsia in the developed world is to monitor blood pressure and urine protein content; however, this practice is not specific, requires multiple visits, can fail to diagnosis asymptomatic patients, and is compromised in patients with preexisting chronic hypertension or kidney disease. Automated diagnostic systems for detection of blood biomarkers with higher accuracy and better predictive values are commercially available. Unfortunately, these systems are feasible only in resource-rich settings; no low-cost solution currently exists for diagnosis of PE/E. Instead, blood pressure and proteinuria screening serve as surrogate markers of risk for developing PE/E. As a result, the risk of dying from PE/E is approximately 300 times higher for a woman in a developing country than for a woman in a developed country.

Point-of-Care Diagnosis of Preeclampsia

Point-of-Care Diagnosis of Preeclampsia

Multiplex, point-of-care test for predicting preeclampsia risk

Novel biomarkers in a lateral-flow test Organization

Organization Becton, Dickinson and Company, For-profit Location

PATH, For-profit Location Seattle, Washington, USA

Research Triangle Park, North Carolina, USA BD is developing a novel, low-cost, point-of-care (POC) test for detection of preeclampsia in developing countries by combining clinically validated preeclampsia biomarkers with an enhanced nanoparticle-based platform that is ideally suited for multiplexed biomarker detection. The ability to integrate a combination of biomarkers into a POC multiplex assay offers the potential to provide a diagnostic test that is robust, inexpensive, and rapid with superior sensitivity and specificity. With an effective diagnosis and treatment of preeclampsia, approximately 500 mothers per day could be saved. Country of Impact Worldwide

PATH has identified three promising urine-based biomarkers from published proteomic studies; the first project activity will be to develop these three urine-based biomarkers into three respective ELISA for proof-of-concept validation and technology transfer to lateral-flow assays. Also, PATH has engaged with two developers who have novel blood-based biomarkers in developed ELISA; they have conducted small, pilot clinical validations, and the resulting data shows promising sensitivity, specificity, and correlation to PE/E outcomes. PATH’s second project activity will be to transfer the developers’ assays into lateral-flow assays. The third activity will be to evaluate the analytical performance of all the assays, the results of which will be a decision point for further work. The fourth project activity will be to continue and/or initiate discussions with manufacturers and clinical investigators regarding potential clinical and commercialization activities. Country of Impact Worldwide

Saving Lives at Birth: A Grand Challenge for Development

The Urine Congo Red Dot (CRD) Test A low-cost paper-based urine test for early diagnosis of preeclampsia Organization The Research Institute at Nationwide Children’s Hospital/ GestVision, University/For-profit Location Columbus, Ohio, USA The Research Institute at Nationwide Children's Hospital has provided novel evidence that the urine of preeclamptic women is highly enriched in misfolded proteins. Based on this evidence, they developed the Congo Red Dot (CRD) as a diagnostic and clinical prognostic tool for preeclampsia. This innovation takes advantage of basic science findings, translating it in innovative manner toward development of low-cost paperbased diagnostics with potential to decrease maternal and fetal mortality worldwide. Countries of Impact Bangladesh, Mexico, South Africa

It’s All in the Details: Congo Red Dot Test Dr. Irina Buhimschi’s team at the Research Institute at Nationwide Children’s Hospital developed the Congo Red Dot test, which mixes Congo red dye with a sample of a pregnant woman’s urine to detect if she has preeclampsia. The team tried more than 400 kinds of paper to find the one that produced the best result—which turned out to be the same type of paper used to make mailing labels. Trials in South Africa validated this claim; the plain paper delivered the same, if not better, results than more sophisticated paper. It was this finding that led the team to refine the test to work more quickly, simply and cheaply for limited-resource countries. With this simple diagnostic, women can be referred to a higher level of care where the fetus can be monitored and other interventions can be tried to stabilize the pregnancy for as long as possible. 45

Point-of-Care Diagnosis of Active Syphilis A finger-stick based rapid test to eliminate congenital syphilis Organization Burnet Institute, University/Research Institution Location Melbourne, Victoria, Australia Congenital syphilis affects more newborns than any other infection, with many infants dying within the first year of life. Treatment of syphilis is simple and inexpensive, but diagnosis of active syphilis is challenging, requiring venous blood collection, laboratory equipment and trained staff, which hampers implementation and thus delivery of potentially life-saving treatments. The primary outcome of this study is the successful development of a point-of-care syphilis test with comparable sensitivity and specificity to available rapid syphilis diagnostic tests, and the ability to accurately distinguish between active and past treated infections. This test could result in immediate access to diagnosis and significantly increased syphilis treatment uptake, thereby improving maternal and neonatal health outcomes and reducing stillbirths. Sustained impact will be achieved through the existing partnership with a major global supplier of current syphilis diagnostics and by meeting WHO target product profile to promote uptake. Country of Impact Worldwide

Saving Lives at Birth: A Grand Challenge for Development

Point-of-Care Diagnosis of Bacterial Neonatal Pneumonia Thermal images on Smartphones Organization Massachusetts General Hospital, University/Research Institution Location Boston, Massachusetts, USA Pneumonia is still one of the two most common reasons that children under age 5 die every year around the world. There is no reliable way to diagnose pneumonia if chest X-rays are not available, and chest X-rays are rarely available in resource-limited settings where most of the deaths from pneumonia occur. MGH's innovation is to use a thermal camera attached to a health care worker’s own smart phone, to map variations in heat (natural infrared radiation) across the baby’s lungs. Focal “hot spots” that occur on one side of the lung, but not the other, often correlate closely with bacterial pneumonia diagnosed by chest X-ray and laboratory data – the smartphone images can be interpreted by the health care worker or by an app (one is in development). This technology is simple, cheap, easy-to-use and, since it works with the health care worker’s own smart phone, it has outstanding potential for sustained impact in the diagnosis of pneumonia, earlier treatment and reduced mortality. Country of Impact Pakistan

Tuberculosis and HIV Diagnostic Point-of-care diagnostic of tuberculosis and HIV for mothers and newborns Organization Unima, For-profit Location Jalisco, Mexico Tuberculosis is one of the top five causes of death for women aged 15 to 44 and over 95% of deaths related to this disease occur in low- and middle- income countries. It is also the leading cause of death for people with HIV. Currently the diagnostic for tuberculosis is a long and expensive process which requires specialized laboratories and personnel and therefore decreases the possibility of a timely diagnostic for a large part of the population in the developing world. Unima developed a point-of-care diagnostic technology which allows most people, even without technical training, to screen tuberculosis and HIV patients directly at the point of care, without the use of lab equipment, in less than 15 minutes and under $1 per test. This technology is based in a chimeric recombinant antibody printed in a paper device which generates a visual reaction which is evaluated by a smartphone app. It has the potential to increase the access to a timely diagnostic and decrease costs related to the control of this disease in low- income countries. Country of Impact Mexico


Approach & Approaches Service & Services Cover Page

Saving Lives at Birth: A Grand Challenge for Development


A Loyalty Program for Mothers A sustainable, barcode—based incentive system to encourage ANC attendance Organization University of Nairobi, University/Research Institution Location Nairobi, Kenya The lack of antenatal care visits and skilled attendant deliveries contributes to high rates of maternal and newborn death. With the goal of reaching every pregnant mother and/or neonates, The University of Nairobi has created a sustainable barcodebased incentive system that encourages “loyal health visits.� The Mother and Child Wellness Loyalty Card applies quick response (QR) codes to track ANC attendance and reward mothers with discounts on essential livelihood items, thereby creating demand for both health and livelihood services. This project is targeting 2,000 mothers to complete full ANC visits (up from 1.0 to 4.0 visits) and increasing babies delivered by a skilled attendant up from 5.8% to 90%. Country of Impact Kenya

N E W O R R E F I N E D S E R V I C E D E L I V E R Y O R D E M A N D - C R E AT I O N M O D E L

All Babies Count (ABC) A quality improvement approach that provides supplies and onsite clinical mentorship Organization Partners in Health, Non-profit Location Boston, Massachusetts, USA WHO estimates that two-thirds of newborn deaths could be prevented if effective health measures were provided during birth and in the first week of life. In Rwanda, 91% of births take place in health facilities, yet 46% of neonatal deaths still occur on the first day of life when these newborns are likely at a facility. To change this, Partners In Health (PIH) developed a health-system capacity-strengthening model called All Babies Count (ABC) - an integrated, low-cost approach that boosts demand for antenatal and delivery services by improving patient satisfaction through patient-centered care. ABC is an intensive 18-month change acceleration process that (i) equips health workers with essential supplies; (ii) provides on-site, regular clinical mentorship to improve delivery of evidence-based interventions; and (iii) launches learning collaboratives to promote data utilization for continuous improvement. All Babies Count is scaling to seven district hospitals and the 64 health centers in their catchment areas reaching more than 1.3 million people. PIH will train 300+ healthcare providers, serve over 55,000 women, and reduce neonatal mortality by 33%. Country of Impact Rwanda


Building and Sustaining Capacity of Frontline Health Workers Prevention and management of postpartum hemorrhage and neonatal asphyxia Organization Jhpiego Corporation, Non-profit

Collaborative Communitybased Technology Integration of community support services with mobile and telemedicine technology to increase demand and access to quality prenatal care services Organization Africare, Non-profit



Baltimore, Maryland, USA

Dakar, Senegal

Uganda’s maternal mortality rate is estimated to be 430 per 100,000 women with roughly one third of deaths due to hemorrhage. Furthermore, the newborn mortality rate is 27 per 1000, most of whom die due to failure to breathe at birth. While there have been efforts to improve the outcomes for women and newborns on the day of birth, these efforts typically utilize traditional training approaches that build capacity on a small scale, often negating providers at the periphery, and as a result, there remain challenges to building widespread capacity and saving lives on a larger scale. Jhpiego has used an integrated approach to build capacity of all providers using a low-dose, high-frequency approach that keeps providers on site at facilities and encourages sustainable, ongoing learning through regular team-based, clinically- embedded simulation and practice. Between 2013-2014, Jhpiego trained over 602 health care providers and saw reductions in postpartum hemorrhage by 17%, retained placenta by 47%, and a 34% reduction in fresh stillbirths and 62% reduction in newborn mortality within 24 hours. At scale, this approach could be a cost-effective, sustainable, wide-reaching way to build the confidence and skills of providers to save the lives of women and newborns on the day of birth. Country of Impact

Senegal has one of the highest mortality rates with 370 maternal deaths per 100,000 live births, and neonatal and infant mortality rates at 47 and 55 per 1,000 respectively. These high mortality rates are due to poor access to health services. To increase demand for and access to quality maternal and neonatal services for women living in hard to reach areas of Senegal, Africare developed an innovative model that integrates community based support services with mobile and telemedicine platforms. Maternal Care Support Groups are used to deter the cultural practice of hiding pregnancy status till late in the second semester and reduce delays in seeking prenatal care. In addition, Africare and Dimagi built a mHealth system to support timely data collection by community health workers. By recording pregnancies at an early stage and using mobile messaging, community nurses/midwifes can facilitate access to care, identify at risk pregnancies, and make recommendations regarding delivery by skilled birth attendants at a health facility. With AMREF, Africare uses an innovative telemedicine platform to provide distance training and technical assistance to community health workers to treat and/or refer. This innovative technology platform, combined with community services, will bring prenatal care services closer to 303,920 women in rural Senegal, allowing for early detection of potential problems and quick referrals to centers equipped to manage emergency obstetric care.


Country of Impact Senegal

Saving Lives at Birth: A Grand Challenge for Development

Community-Based Health Insurance and Quality Improvement An approach to increase access to affordable and quality health care for low-­income families

Empowering Islamic Leaders for Improved Health Capacity building for maternal, neonatal and child health Organization


development Research and Projects Centre, Non-profit

PharmAccess Foundation, Non-profit



Kano City, Nigeria

Amsterdam, the Netherlands With a population of 177 million, Nigeria has 2% of the world population yet 14% of the global maternal deaths. Child mortality rates show that 128 per 1000 lives do not reach the age of 5 years compared to the global average of 51 per 1000. Poor quality of health care, lack of investments, high medical costs and poverty contribute to a vicious cycle of low supply of and demand for health care that reinforce soaring maternal and child mortality and disease levels. This project is a public-private partnership which uses an innovative, holistic approach to pool risks and resources (including government spending, out-ofpockets expenses and private investment) towards setting up a viable health insurance system, which addresses both the demand for, and supply of health care for low-income countries. This innovation will improve the accessibility, affordability, and quality of maternal and child care for low-income expecting women, mothers, and children through the complementary initiatives of (a) educating communities about maternal and child health through community outreach, multimedia, and mHealth; (b) enrolling women and children in community-based health insurance; and (c) quality upgrading of healthcare facilities in Kwara State, Nigeria. Country of Imact Nigeria

Misconceptions on the Islamic precepts on reproductive, maternal, newborn, and child health (RMNCH) informs the knowledge, beliefs and practices of health providers in Muslim Majority Northern Nigeria states. Yet, there are no interventions for in-service health providers addressing misconceptions and religious beliefs on RMNCH. This is a key inhibitor to the uptake of RMNCH services, donor-funded interventions for women and men of reproductive age, and on pre-service training of health providers. Current standard of practice of health promotion through counseling to change health- seeking behavior is seldom conducted in public facilities due to the high patient volume and limited knowledge of providers on religious barriers to RMNCH. dRPC recognizes the knowledge gaps of health providers on the Islamic perspective of RMNCH and seeks to address it by connecting providers with Muslim Scholars. The health providers then counsel clients on the position of Islam on MNCH services. This unique intervention of mainstreaming correct Islamic precepts on RMNCH into the pre-service and in-service training programs of health providers in Muslim majority areas is scalable through catalyzing curriculum reform to on-going training programs funded by donors and government agencies. Country of Impact Nigeria

In Nigeria, the total addressable market for this model is 600,000 people, including 60% of the rural population earning less than $1.50 a day.


mHealth for Safer Deliveries

Postpartum Empowerment

Phone-based tool that supports screening, counseling, and follow-up care for pregnant women and their infants

An integrated approach driving demand and delivery of high quality, low-cost postnatal services Organization

Organization D-Tree International, Inc, Non-profit Location

Jacaranda, For-profit Location Kenya

Weston, Massachusetts, USA In Zanzibar, 1 in 220 women die during childbirth and 1 in 10 infants die before their first birthday. "More than half of women in Zanzibar deliver at home without skilled care, and only approximately one third of women and babies receive postpartum care within one week of delivery. D-tree International, in collaboration with the Zanzibar Ministry of Health, is implementing the Safer Deliveries program to increase facility delivery rates and improve postpartum follow-up care. This program trains Community Health Workers (CHWs) to use a mobile phone equipped with decision support tools which supports them to register pregnant women in their communities and develop tailored birth plans, provide counseling and education, screen for danger signs, and help women estimate costs and develop a savings plan. It links women with community savings groups and community drivers. Community feedback around the quality of services is captured in the mobile application and linked with the Ministry of Health performance based financing system to support improvements in the quality of care at health facilities. Once at scale, this program will support 400 Community Health Workers in all districts of Zanzibar, reaching approximately 30,000 women per year (60% of all pregnant women). Country of Impact Tanzania

Saving Lives at Birth: A Grand Challenge for Development

In Kenya fewer than 20% of women receive postnatal care in the six-week postpartum period. Jacaranda Health seeks to find a cost-effective way to increase coverage of postnatal care and postnatal family planning through a chain of maternity clinics in Kenya that provide deliveries, antenatal and postnatal care, and family planning. Jacaranda’s approach focuses on the postpartum period, and compares several low-cost and easily scalable interventions to improve the uptake and quality of postnatal care. By implementing a strategy for improving patient safety in the first week postpartum, testing promising strategies for improving uptake of postpartum family planning, and reducing the barriers of cost of postnatal services using pricing promotions, Jacaranda Health combines the MamaKiba mobile savings tool with a cross-cutting approach to address the challenges and risks in the postpartum period. Country of Impact Kenya

Que Vivan Las Madres

Solar Suitcase

An integrated approach to reduce maternal and perinatal mortality through simulation-based training

Use of reliable solar power to save mothers and babies Organization

Organization Epidemiological Research Center in Sexual and Reproductive Health, Non-profit Location Guatemala City, Guatemala In rural Guatemala, maternal mortality ratio is cyclical, and the proportion of maternal deaths due to direct and indirect causes continue without change. Most births are home-births and assisted by non-qualified health personnel that increases the rates of maternal and perinatal morbidity and mortality. This innovative approach creates a massive promotional campaign encouraging institutional birth, professional midwives link to traditional birth attendants and the training of doctors and nurses in the management of emergency obstetric care. More than 400 health care providers will be trained in the management of obstetric emergencies. Country of Impact Guatemala

African Medical Research Foundation /We Care Solar, Non-profit Location Uganda Uganda has one of the highest maternal and newborn mortality rates in the world mainly due to poor quality and utilization of maternal and newborn health services. This integrated approach is saving the lives of mothers and babies at the time of birth using solar energy by improving the birth environment (technology: communication, learning and data and light), improving BeMONC services (skills, planning, monitoring and management) and creating demand (awareness, accountability and policy/social mobilization). In this program, the We Care Solar Suitcase provided health centers with power for medical lighting, phone charging, headlamps, and computers. Together, solar energy is improving antenatal care and skilled birth attendance for pregnant women in rural Southwestern Uganda. In Uganda alone, there are nearly 3,000 similar public and private health facilities that could receive this intervention, ensuring that 240,000 safer deliveries could be added achieved in a short period of time. Country of Impact Uganda


Zipline Unmanned Aerial Delivery System Emergency aerial delivery of blood and life saving medicines to mothers

108 facilities (roughly 52,000 births annually) currently have severely limited access to blood and urgent medicines in Uganda.

Organization Ifakara Health Institute/Zipline, Non-profit/For-profit Location Dar Es Salaam, Tanzania Postpartum hemorrhage is the largest cause of maternal mortality in Tanzania, yet many of these mothers could be saved with a blood transfusion. Lack of fast, affordable delivery of blood profoundly restricts the number of lifesaving transfusions performed in the Dodoma region. Ifakara Health Institute is using the Zipline autonomous Unmanned Aerial System (UAS) to transport screened and typed blood from a blood bank in Dodoma to peripheral health facilities, on-demand, already delivering over 1kg over 75km in less than 45 minutes at a cost of $10, outperforming all known alternatives. Country of Impact Tanzania

Leapfrogging Solutions: The Zipline Autonomous Unmanned Aerial Delivery System More than two billion people lack adequate access to essential medical products, often due to challenging terrain and gaps in infrastructure. For example, is not often feasible to stock blood at many health facilities and blood donor volumes are insufficient to ensure a match. Up to 150,000 pregnancy-related deaths could be avoided each year if mothers had reliable access to safe blood. Zipline was developed as the most efficient way to make rapid, on-demand deliveries of blood and urgent medicines to rural health facilities, which would be impossible or too costly to reach using traditional means. Aerial delivery addresses a need that is entirely unmet by current systems, and virtually impossible to meet with other technologies.

Saving Lives at Birth: A Grand Challenge for Development


Healthy mothers and newborns are the foundation of healthy and prosperous societies…We must partner to develop new technologies and seek new ways of delivering solutions to women and children who need them most. [Saving Lives at Birth] will speed up progress we’re already making—and will lead to new kinds of progress that we have yet to conceive.

Melinda Gates Co-Chair of the Bill & Melinda Gates Foundation

Saving Lives at Birth: A Grand Challenge for Development




Contraceptive Implant Assistive Device

Augmented Infant Resuscitator (AIR) Bempu Temperature Monitoring Band Bili-HutTM BreathAlert E-Partogram FREO2 Hemafuse MOYO Fetal Heart Rate Sensor NIFTY Cup

Iron Fortified Tea

Odon Device™ PharmaChk PIERS on the Move InfaClip Postpartum Intrauterine Device Inserter Multi-use Intrauterine Device Inserter SimPrints Biometric System Every Second Matters: Uterine Balloon Tamponade System (ESM-UBT TM) Xstat Mini-Sponge Applicator for Obstetric Use

Lucky Iron FishTM


Quadruple Fortified Salt Lactoferrin To Correct Iron Deficiency in Pregnancy



Gene-RADAR Nanotech platform


Point-of-Care Diagnosis of Active Syphilis

The Urine Congo Red Dot (CRD) Test



Point-of-Care Diagnosis of Bacterial Neonatal Pneumonia Point-of-Care Diagnosis of Preeclampsia Point-of-Care Screening and Diagnosis of Preeclampsia Tuberculosis and HIV Diagnostic

Inexpensive Preeclampsia Treatment


Inhaled Formulation of Oxytocin (Mintaka)

Every Second Matters Ketamine (ESM-KetamineTM)

Inhaled Formulation of Oxytocin (Monash) Tetanus Toxoid Microneedle Patch

A Loyalty Program for Mothers Collaborative Community-based Technology APPROACHES & SERVICES



Icterometer and Newborn Health Mobile Phone Application


Empowering Islamic Leaders for Improved Health mHealth for Safer Deliveries




BreathAlert: 3rd Stone Design/Hadleigh Health Technologies,

Mama-U Pumani bubble Continuous Positive Airway Pressure (bCPAP) System

William Marsh Rice University

Simulation-based Training Model for Cesarean Sections

Pumani bubble Continuous Positive Airway Pressure (bCPAP) System: 3rd Stone Design/Hadleigh Health Technologies, William Marsh Rice University Mama-U: Laerdal Global Health, Jhpiego Corporation NIFTY Cup: Laerdal Global Health, PATH Odon Device™: BD, WHO Every Second Matters- Uterine Balloon Tamponade System (ESM-UBTTM): Center for Maternal Health Innovations, Massachusetts General Hospital

mChip: Junco Labs, Columbia University The Urine Congo Red Dot (CRD) Test: GestVision, The Research Institute at Nationwide Children’s Hospital

Chlorhexidine: Lomus Pharmacuticals, JSI Research & Training Institute, Inc.

Chlorhexidine Pratt Pouch

Inhaled Formulation of Oxytocin (Monash): GSK, Monash University Pratt Pouch: EGPAF, Maternova, Pratt Pouch Consulting, Elizabeth Glaser Pediatric AIDS Foundation Tetanus Toxoid Microneedle Patch: Georgia Tech, Emory University

All Babies Count (ABC): MOH Rwanda, Partners in Health

Postpartum Empowerment Que Vivan Las Madres Solar Suitcase Zipline Unmanned Aerial Delivery System Community-Based Health Insurance and Quality Improvement All Babies Count (ABC) Building and Sustaining Capacity of Frontline Health Workers

Collaborative Community-based Technology: Dimagi, Virtual University of Senegal, Africare Que Vivan Las Madres: PRONTO International, Epidemiological Research Center in Sexual and Reproductive Health Solar Suitcase: We Care Solar, White Ribbon Alliance, African Medical Research Foundation Zipline Unmanned Aerial Delivery System: Zipline, Ifakara Health Institute

Saving Lives at Birth: A Grand Challenge for Development

Index of Innovations 56 A Loyalty Program for Mothers

25 MOYO Fetal Heart Rate Sensor

56 All Babies Count (ABC)

29 Multi-use Intrauterine Device Inserter

20 Augmented Infant Resuscitator (AIR)

25 NIFTY Cup

20 Bempu Temperature Monitoring Band

26 Odon Device™

21 Bili-HutTM

27 PharmaChk

48 BiliSpec

28 PIERS on the Move

48 Bilistick

52 Point-of-Care Diagnosis of Active Syphilis

21 BreathAlert

52 Point-of-Care Diagnosis of Bacterial Neonatal Pneumonia

57 Building and Sustaining Capacity of Frontline Health Workers

50 Point-of-Care Diagnosis of Preeclampsia

56 Chlorhexidine

50 Point-of-Care Screening and Diagnosis of Preeclampsia

57 Collaborative Community-based Technology

59 Postpartum Empowerment

58 Community-Based Health Insurance and Quality Improvement

29 Postpartum Intrauterine Device Inserter

28 Contraceptive Implant Assistive Device

56 Pratt Pouch

58 Empowering Islamic Leaders for Improved Health

30 Pumani bubble Continuous Positive Airway Pressure (bCPAP) System

22 E-Partogram

36 Quadruple Fortified Salt

32 Every Second Matters—Ketamine (ESM-KetamineTM)

60 Que Vivan Las Madres

56 Every Second Matters—Uterine Balloon Tamponade System

31 SimPrints Biometric System

22 FREO2

31 Simulation-based Training Model for Cesarean Sections

49 Gene-RADAR® Nanotech platform

60 Solar Suitcase

23 Hemafuse

56 Tetanus Toxoid Microneedle Patch

23 Icterometer and Newborn Health Mobile Phone Application

51 The Urine Congo Red Dot (CRD) Test

56 Inexpensive Preeclampsia Treatment

53 Tuberculosis and HIV Diagnostic

24 InfaClip

32 XStat Mini-Sponge Applicator for Obstetric Use

56 Inhaled Formulation of Oxytocin

61 Zipline Unmanned Aerial Delivery System

56 Inhaled Formulation of Oxytocin 36 Iron Fortified Tea 38 Lactoferrin To Correct Iron Deficiency in Pregnancy 37 Lucky Iron FishTM 24 Mama-U 49 mChip 59 mHealth for Safer Deliveries


W W W.SAVINGLIVESATBIR TH.NE T Saving Lives at Birth: A Grand Challenge for Development



Saving Lives at Birth Innovation Catalogue  
Saving Lives at Birth Innovation Catalogue