December 1, 2016
With this issue of Carolina Public Health, we introduce a recurring feature on innovation that will highlight projects by Gillings School faculty and staff members and students. By exploring the process through which a public health need is identified and met, we hope to illuminate the journey – from first creative spark, to earnest inquiry and collaboration, to the data-driven implementation of a program or system.
This issue features the student team of Liz Chen and Cristina Leos (both health behavior doctoral students at the Gillings School) and their colleague Vichi Jagannathan, Master of Business Administration candidate at Yale University’s School of Management. The three women, who recognized the need for more effective reproductive health education for young adolescents, won $405,000 to develop an app for middle-school students, through which the students can obtain information and support about sexual and reproductive issues.
As a preamble to the first innovation article, we invited Jamie Bartram, PhD, to share some thoughts about the importance of leadership in innovation, using examples from The Water Institute at UNC, which is based in the Gillings School. Bartram is Don and Jennifer Holzworth Distinguished Professor of environmental sciences and engineering and director of The Water Institute.
Innovation in devices
Chitosan is extracted easily from discarded crustacean shells. The substance combines characteristics attractive for water treatment; it is highly absorptive, nontoxic, biodegradable, abundant and cheap! Its potential is vast – for treatment of small volumes of water in underserved households, through dispensing units; for in situ treatment in wells; and potentially for industrial-scale treatment plants.
Postdoctoral fellow Lydia Abebe, PhD, is leading innovation to employ chitosan for water safety, work that is supported by a Gillings Innovation Lab. Abebe has determined which doses of chitosan are effective, and she is beginning to develop prototypes. Along the way, she has benefited from a UNC CUBE social innovation venture to explore routes to commercialization and entrepreneurship.
Innovations matter in public health. They fill gaps in our arsenals, offer improved alternatives, and increase impact and efficiency of our interventions.
Seven years ago, as we conceived The Water Institute at UNC, we wanted its focus to be on innovative, visionary approaches that transform the water and sanitation landscape. Since then, we have led innovations across the spectrum of devices, ideas and methods, and have aimed both to adapt existing options and bring forward entirely new ones.
Innovation in methods
Continuous quality improvement (CQI) has had dramatic and well-documented impacts in the auto and health-care industries, delivering improvements in quality and efficiency. CQI had not been applied to drinking water supply, however, despite the fact that high water-system failure rates have adverse consequences for health and the economy.
Across sub-Saharan Africa, at any given time, one-third of village handpumps are not functioning. Contamination of small water systems is frequent, in developed and developing countries alike. Our team, led by project manager Kaida Liang, MPH, works with large implementing agencies, including World Vision, to reform how projects are evaluated – aiming to move from conventional assessment (a pass or fail at the end of a project, after as much as three to five years) to faster learning and improvement cycles of one year or less.
In Ghana, one cycle of improvement alone doubled the proportion of households with safe water, and a second cycle with similar potential is already in hand. Delivering these changes increases impact and efficiency, but if we’re to have innovation in “methods,” there must be widespread adoption. Therefore, we are collaborating with other partners to apply CQI in water programs in 10 countries and intend to see the idea adopted as global policy.
Innovation in ideas
Despite advances in medicine, safe health care is compromised by poor environmental conditions in health-care facilities. The Water Institute’s strategic plan identified health-care settings as a key opportunity for exerting influence. We set out to establish the idea of improving this situation as an opportunity for both the health-care and water and sanitation sectors. We published an “opinion piece” to initiate discussion, analyzed monitoring potential and prepared a first-of-its-kind review of surveys of health-care facilities.
That review documented that 40 percent of 66,000 health facilities in 54 low- and middle-income countries did not have safe water. One-third were without soap for handwashing, and 20 percent lacked a toilet. Our work contributed to the inclusion of these issues in international policy – as a global action plan for the World Health Organization and in monitoring of the U.N.’s Sustainable Development Goals. Our compelling evidence is driving additional partners to contribute, and our “innovation in ideas” is now focused on ensuring that this is seen as an opportunity for health-care providers to reduce costs and impacts of health-care-acquired infection and confront the challenge of antimicrobial resistance.
Leading the way
Leadership in innovation means embracing the breadth of that concept and applying it appropriately. New and adapted devices are needed for some challenges, such as water treatment. For other purposes, new perspectives and new thinking are required – sometimes including naming the proverbial elephant in the room. Often, tools and methods already proven in other applications can be transferred, adapted and applied to great benefit. To innovate is to characterize, understand and tackle problems – and in so doing, to deliver impact and efficiency that improves lives and livelihoods.
— Dr. Jamie Bartram
Carolina Public Health is a publication of the University of North Carolina at Chapel Hill Gillings School of Global Public Health. To view previous issues, please visit sph.unc.edu/cph.