Healthcare leaders from East Africa joined faculty members and researchers from Indiana and throughout North America to identify priority health challenges and discuss health innovations that have the potential to address these challenges in a variety of settings.
Indiana University (IU), Purdue University and the University of Notre Dame are members of the Indiana Clinical and Translational Sciences Institute (CTSI) which has joined the IU Center for Global Health (IUCGH) to foster an innovative program of international global health collaboration called reciprocal innovation. The Indiana CTSI and IUCGH have previously funded 24 global health pilot grants totaling $470,000 to develop collaborative processes and create a foundation for this type of research exchange. The East Africa Stakeholder Meeting follows a format similar to a meeting that was held in Indiana last year, where stakeholders identified local health priorities.
Reciprocal innovation is the bi-directional and iterative exchange of a technology, methodology, or process between at least two countries, one lower- or middle-income country and one high income country, to address a common health challenge and provide mutual benefit. Lessons learned are continually shared throughout the process to suit the needs and infrastructure of each country.
IU, Purdue and 10 other North American universities work in partnership with Moi University and Moi Teaching and Referral Hospital (MTRH) in Kenya as part of AMPATH (Academic Model Providing Access to Health Care). The 30-year partnership’s mission is focused on care, training and research.
Winstone Nyandiko, MBChB, MMed, MPH , associate professor at Moi University School of Medicine and Kenyan director of research for AMPATH, hosted the virtual meeting aimed at identifying the issues that will be prioritized for upcoming global health grant opportunities. “We want to make impact that is not just within the country, as we have already done, but regionally and worldwide,” he said. Use of community health workers, rural HIV care and control, and counterfeit drug detection technology are some of the innovations created in Africa that have been successfully adapted to address health challenges in Indiana.
“AMPATH and IU have been in the reciprocal innovation business for many years now, although I don't think we called it that,” said Kara Wools-Kaloustian, MD, MS, director of research for IUCGH and North American director of research for AMPATH.
Thomas G. Sors, PHD, co-director of the Global Health Research Program within the Indiana CTSI explained the purpose of the East Africa meeting, “We are going to take the information we obtain here today, analyze and prioritize it and work with you to identify the most critical areas to invest in.” Sors is assistant director of the Purdue Institute of Inflammation, Immunology and Infectious Disease.
Edith Kwobah, MBChB, MMed, consultant psychiatrist and head of the department of mental health at MTRH, and other health professionals provided examples of issues that are shared in high and low-resource countries that could be impacted by successful reciprocal innovations. “Mental health in Kenya has always taken a backseat. For the longest time the priorities, understandably so, have been HIV and other diseases that cause mortality. But unfortunately, we also know that many people struggle with mental illness,” she said. There are less than 150 psychiatrists for more than 40 million Kenyans. Kwobah and her colleagues have been leading innovations that provide public education about mental health, reduce stigma, form alcohol support groups and increase capacity by training clinical officers and nurses to provide care.
Sherri Bucher, PhD, associate professor of pediatrics in the division of neonatal-perinatal medicine at Indiana University School of Medicine, received a reciprocal innovation grant earlier this year to develop a biomedical device for newborns with partners in Kenya and at Purdue. “We're developing this device for use among premature babies in low-resource settings and among opioid-exposed babies in high resource settings. We think that the device will have utility among all these populations of babies,” Bucher said. “I think one of the ways that this defines an important quality of a reciprocal innovation project is that we are addressing a very well-defined, urgent problem that had global significance. We didn't build a solution and then go looking for a problem.”
Another current grant recipient, Laura Ruhl, MD MPH, assistant professor of clinical medicine at IU School of Medicine and executive field director for the AMPATH Consortium, and her colleagues are adapting a successful group intervention for pregnant women called Chamas in rural Kenya to empower pregnant adolescents both in Kenya and eventually in Indiana. “This has been a great year for understanding how to work when you aren't right next to one another because that's going to be a major need we have in our future,” she said. “We're going to be trying to move to different places with the Chamas program, not just in Indiana, but different areas of East Africa and Kenya. We're going to have to really learn how to collaborate using all the different tools that the pandemic has forced us to improve,” she continued.
Quoting a Kenyan colleague, Sonak Pastakia, Pharm D, PhD, MPH, professor of pharmacy practice at Purdue, advised that anybody partnering in international collaborations “First understand before trying to be understood.” He continued, “This forced me to reflect on a lot of the early mistakes I made when I first went to Kenya, when I thought my expertise and my training somehow made me understand problems that Kenyans had been facing all of their lives when I had only been there for a couple of months. When you think about it and put it like that, it shows how silly a notion it is that I could somehow understand better than people who've lived this for their entire lives.”
Meeting participants ranked the top East African health priorities and discussed the potential for reciprocal innovation for each. Health priorities suggested for consideration included: quality healthcare access; infectious disease, especially HIV and malaria; non-communicable diseases such as cancer and heart disease; mental health; substance use; COVID-19; maternal and women’s health; lack of access to clean water and traffic accidents.
After the priorities were discussed, Dr. Wools-Kaloustian observed that they closely reflected the top priorities identified last year in Indiana which were chronic diseases, infant mortality and maternal health, substance use disorders, and access to healthcare.
In January, the Indiana CTSI and IU Center for Global Health will release applications for planning and demonstration grants for reciprocal innovation that address the priority health challenges identified at the meeting. The grants are open to researchers at Indiana CTSI partner institutions (IU, Purdue, and Notre Dame) including individuals with full-time faculty appointments, graduate-level trainees, and post-graduate fellows. The project proposal must demonstrate collaboration with partners within Indiana and/or from low- and middle-income countries. These applications must show how their proposal addresses a shared health challenge and how it will provide a mutual benefit to both Indiana and the low-and middle-income country.
A recording for the East Africa Stakeholder meeting is available as is a series of videos further explaining reciprocal innovation:
- East Africa Stakeholder meeting (1:37:00)
- Reciprocal Innovation Introduction (11:53)
- Reciprocal Innovation in Action: Infant and Maternal Health Programs (13:39)
- Reciprocal Innovation in Action: Pharmaceutical Quality in Malawi (4:42)
- Reciprocal Innovation in Action: Pharmaceutical Quality in Malawi (3:41)
For more information, please contact Rish O’Brien.