How Kellogg faculty research is delivering critical medical care to sub-Saharan newborns
By Sachin Waikar
In low- and middle-income countries, many life-saving newborn technologies that have existed in high-income countries since the 1960s are not widely available. To address these disparities in the availability of technology, the development of effective, affordable and rugged devices is a priority for reducing deaths and disability in preterm babies.
The NEST360 program, a global effort involving researchers from Kellogg and Northwestern, is working hard to change that, as part of a broad effort to address infant welfare in sub-Saharan Africa. “NEST360’s mission is to reduce newborn illness and death associated with hospital-based deliveries in Africa,” says Kara Palamountain ’04 MBA, a research associate professor at Kellogg and a co-principal investigator for NEST360.
To support that mission, Palamountain and fellow Kellogg faculty member Rebecca Kirby ’19 MBA are working with UNICEF, key global experts from outside organizations and a wide range of Northwestern researchers to develop target product profiles (or TPPs) for low-cost, effective technologies for small and sick newborn care. By bridging critical information gaps in the supply chain, their work is spurring better product development and distribution efforts, and ultimately delivering the right equipment to the communities that need it most.
For example, in low- and middle-income countries, retinopathy of prematurity (ROP) is a leading cause of permanent, irreversible blindness in infants. While ROP-related blindness can be prevented by early screening and treatment, the technology often isn’t available or affordable in under-resourced regions. To address this urgent need, NEST360 has developed a TPP with product requirements for a low-cost imaging camera. “This TPP can help to guide research and development for low-cost and effective technologies for early ROP screening so that every newborn can survive and thrive,” says Kirby, a research assistant professor and NEST360’s market access director, who led the initiative.
Today, NEST360 is a collaboration of 17 organizations, 13 of which are in Africa. The lead institution is Rice University, and Northwestern is one of the 17 organizations, with Palamountain as the primary investigator here. NEST360 grew partly out of a proposal for the MacArthur Foundation’s 100&Change competition in 2017, where it placed among the top 4 of over 1,900 entries. The MacArthur Foundation ultimately gave $15 million in funding to NEST360, with other funders including the Bill & Melinda Gates Foundation, the Elma Foundation and Children’s Investment Fund Foundation contributing to over $68 million raised so far.
“Ending newborn deaths requires not just one technology but a whole system—a suite of technologies that small and sick babies need,” says Palamountain. Beyond the technologies themselves, NEST360 partners with governments in each of the four countries to develop training materials for clinicians and technicians, plan distribution strategies, and assist with collecting the locally-owned data used understand impact and best ways to scale.
NEST360 addresses all of those dimensions of the challenge and currently operates in four African countries: Nigeria, Tanzania, Kenya and Malawi. The organization has an impact on nearly 70 hospitals across those nations, covering about 500,000 infant births per year, with nearly 15,000 medical professionals and students trained.
Defining the right technologies
A critical area for the effort has been around defining the technologies best suited to NEST360’s mission of improving newborn welfare in those regions.
“There’s no one whiz-bang technology,” Palamountain says. “A newborn ward needs more than one device, and the technologies need to be affordable, effective — just as good for a newborn in Malawi as in Massachusetts — and rugged, such as for extreme heat.” The equipment also has to be easy to use. “In the U.S., a ward’s staffing ratio may be one or two babies per person,” Palamountain says. “In wards we visited overseas it might be 30 or 40.” That requires less-complex technologies.
In this context, Northwestern has taken a lead in defining technology that meets those criteria. Palamountain and Kirby led the development of 15 target product profiles through initial surveys across 150 global stakeholders, followed by in-person meetings with representatives of about 70 groups in Cape Town, South Africa, with critical logistical help from Kate Klein, administrative director of Northwestern’s Havey Institute for Global Health. Their work has resulted in TPPs for small and sick newborn care used for respiratory support, thermal management, infection prevention and more, and the TPPs are publicly available to the market on NEST360 partner UNICEF’s website.
This connecting of device manufacturers with healthcare providers through the TPP development process is critical, Kirby says: “Product developers on the supply side may not speak directly with user clinicians on the demand side. We facilitated that dialogue so that innovators and product developers could understand what features clinicians thought were critical versus which were more of a nice-to-have, and product developers could provide their input on technical feasibility. Those insights ultimately make the TPPs more successful.” The team is seeking to publish a paper summarizing the TPP development process.
Finding the technology
Once the technologies have been better defined, the NEST360 team has to find them in the real world.
“We need to figure out what’s currently commercially available and what product developers are working on,” Kirby says. To do that they created a comprehensive Newborn Technology Landscape Report, now in its 8th edition. The current report features over 100 different technologies from over 45 different manufacturers.
“Global non-profits and funders reference the report to see what exists specific to newborn care, and hospital procurement officers may use it to see what brands of equipment and products are available to buy, sometimes facilitated by the recommendations of clinicians who’ve seen the report,” Kirby says. “It has a wide audience.” Any technologies under consideration are rigorously studied and tested before earning status as NEST360-qualified.
Both the TPPs and the technology landscape report address a key market failure: a lack of information, Palamountain says. “We work to clarify what the demand side wants, then provide information on what actually exists, or the supply side. To the extent those areas don’t overlap gives product developers a good sense of what needs to be developed — like seeing there are lots of different CPAP machines under development, so choosing to focus on creating a sepsis test instead.”
A Northwestern-wide effort
While Kirby and Palamountain lead key NEST360 efforts at Northwestern, they draw on the support of a growing number of Northwestern departments and contributors, including Kellogg alumni.
For example, one critical area for NEST360 is financing — specifically, financing local equipment distributors in geographic areas of focus. Palamountain says, “Let’s say a distributor wants to order 50 oxygen concentrators. Most manufacturers will require upfront payment for those before they ship them. So, a local distributor might be waiting for several months get paid for products they’ve ordered, or waiting to order the products until they have collected that upfront payment from hospitals.”
To address those delays, the team engaged Kellogg alumnus Varsay Sirleaf ’08 MBA, a Liberian national who worked in banking in his home country post-Kellogg before relocating to Chicago. Sirleaf helps arrange working capital for distributors to avoid the delays and risks associated with financing. He also helps hospitals access financing through local distributors, via an organization called the Medical Credit Fund.
The collaborative effort goes beyond Kellogg to other Northwestern departments. For example, Matt Glucksberg, professor of biomedical engineering at the McCormick School, helped create an Invention Education Toolkit that provides innovators at African engineering schools and invention educators information to use in the classroom to teach innovation and scaling.
Similarly, Rob Murphy, professor of medicine at the Feinberg School of Medicine and executive director of the Havey Institute for Global Health, has used his longstanding relationships with organizations in Nigeria to connect NEST360 with the University of Ibadan and the University of Lagos. With the help of Northwestern resources, both institutes offer medical-engineering education opportunities that speak to the NEST360 mission. Lisa Hirschhorn, professor of medical social sciences at Feinberg and director of the Havey Institute for Health Ryan Center for Global Primary Care, has also been involved, helping with quality improvement (QI) processes for the technologies under the NEST360 umbrella, building on some of the work Kirby led with the development of a QI dashboard and framework for roll-out at the NEST360 sites.
A growing nest
Kirby and Palamountain continue to think about where to take NEST360 next within Africa.
“Before we go into any new country we do an analysis of the basics,” Palamountain says. “Who are the actors in the country? What’s the stage of newborn care? Who are the partners we should work with? How do we think about meeting the Ministry of Health’s goal and how to engage with them?”
These are critical questions as NEST360 moves into its second phase, for which Palamountain and Kirby are currently writing a proposal. “A lot of different people at different schools at Northwestern have been involved and will continue to be as we grow,” Palamountain says. “It’s truly a team effort.”
That effort is part of a critical, rising impact in sub-Saharan Africa, where the technologies NEST360 brings will help more newborns survive and even thrive, for the collective good.
All photos courtesy of NEST360