Improving access to tools that detect critically ill children

Improving access to tools that detect critically ill children

New Unitaid-funded initiative—a key step toward improving primary health care and reducing childhood mortality

Mourtala Mohammed Aboubacar, a nurse at ALIMA’s Ambulatory Therapeutic Feeding Center in Dogo, Niger, examines 10-month old Ousseina, held by her mother, Dahara. Photo credit: WTYSL/ALIMA

In 2018, an estimated 5.3 million children globally died before their fifth birthday, most from diseases that can be prevented and treated, including pneumonia. To improve detection of critically ill children and reduce childhood mortality, one of the most effective steps that governments can take is to ensure that tools to identify severe illness are available and accessible at the primary health care (PHC) level.

Devices like pulse oximeters (POX), which measure oxygen saturation, or clinical decision support tools (CDSTs) that help process patient information and symptoms through digital applications, are essential for alerting PHC workers to signs of severe disease and need for urgent treatment or hospital referral. While routinely used in high-income countries, in low-resource settings these critical tools are often not available, not functioning properly, not suited for infants who need them most, or providers lack appropriate training.

That’s why in July 2019, Unitaid, together with the Alliance for International Medical Action (ALIMA) and PATH, announced a new US$43 million initiative to improve access to affordable, appropriate, and cost-effective tools across nine countries in Asia and Africa to help better identify and treat critically ill children. Unitaid is funding two complimentary projects under the new initiative: ALIMA’s US$14.9 million grant runs through 2022, and PATH’s US$28.4 million grant through 2023.

ALIMA’s project will pilot POX in PHC facilities in four countries—Burkina Faso, Guinea, Mali, and Niger—and assess data on their affordability, feasibility, cost-effectiveness and impact in around 200 PHCs. They will also help countries with procurement of the devices and development of policies on their use. ALIMA will work in partnership with the French Institute of Health and Medical Research, non-governmental organizations Solthis and Terre des hommes, as well as ministries, civil society, and scale-up partners.

Dr Mame Nyarko examining a child that is held by his mother at Princess Marie Louise Children’s Hospital. Credit: PATH/Doune Porter

PATH will work with the Swiss Tropical and Public Health Institute, and Ministries of Health in India, Kenya, Myanmar, Senegal and Tanzania to put POX and novel CDSTs that reflect local childhood illness management guidelines into the hands of frontline health workers in 360 PHC facilities across the five countries. The partners will generate important and currently missing data on the feasibility, cost-effectiveness, and health impact of these devices to address evidence gaps and inform global guidelines and policy.

The project also seeks to accelerate the development of multimodal devices that can measure additional vital signs, such as respiratory rate, hemoglobin, and temperature—and validate these new tools in the field.

By expanding access to critical diagnostic tools at the PHC level, and demonstrating that these tools improve the management of sick children and can be sustainably implemented, this work will generate evidence-based demand, increase donor engagement, and provide incentives for manufacturers to innovate and for governments to pursue adoption.

At a global level, by making PHC service delivery more accessible, accountable, affordable, and reliable, this initiative can help establish progress toward universal health coverage targets mandated by United Nations Sustainable Development Goal 3.8 by 2030.

AUTHORS: ALIMA, PATH