In the two decades after 1990, the rates of child and maternal mortality dropped by over 40% and 47%, respectively. Despite these improvements, which are in part due to increased access to medical technologies, profound health disparities exist. In 2015, a child born in a developing region is nearly eight times as likely to die before the age of 5 than one born in a developed region and developing regions accounted for nearly 99% of the maternal deaths. Recent developments in nanotechnology, however, have great potential to ameliorate these and other health disparities by providing new cost-effective solutions for diagnosis or treatment of a variety of medical conditions. Affordability is only one of the several challenges that will need to be met to translate new ideas into a medical product that addresses a global health need. This article aims to describe some of the other challenges that will be faced by nanotechnologists who seek to make an impact in low-resource settings across the globe.

No abstract

South Africa has embarked on major health policy reform to deliver universal health coverage through the establishment of National Health Insurance (NHI). The aim is to improve access, remove financial barriers to care, and enhance care quality. Health technology assessment (HTA) is explicitly identified in the proposed NHI legislation and will have a prominent role in informing decisions about adoption and access to health interventions and technologies. The specific arrangements and approach to HTA in support of this legislation are yet to be determined. Although there is currently no formal national HTA institution in South Africa, there are several processes in both the public and private healthcare sectors that use elements of HTA to varying extents to inform access and resource allocation decisions. Institutions performing HTAs or related activities in South Africa include the National and Provincial Departments of Health, National Treasury, National Health Laboratory Service, Council for Medical Schemes, medical scheme administrators, managed care organizations, academic or research institutions, clinical societies and associations, pharmaceutical and devices companies, private consultancies, and private sector hospital groups. Existing fragmented HTA processes should coordinate and conform to a standardized, fit-for-purpose process and structure that can usefully inform priority setting under NHI and for other decision makers. This transformation will require comprehensive and inclusive planning with dedicated funding and regulation, and provision of strong oversight mechanisms and leadership.

Airborne infection control measures are used extensively in health-care settings to curtail the spread of airborne infectious diseases. Few such measures are applied in public congregate spaces outside health facilities, such as those associated with public transport. In minibus taxis – a popular form of public transport in South Africa – poor ventilation creates conditions that allow for transmission of airborne diseases, particularly tuberculosis. In this study, we focused on developing quantitative ventilation profiles for the 16-seater Toyota Quantum Ses’fikile model commonly used in the Cape Town metropole. We studied the ventilation rates achievable in an occupied taxi under varying operational conditions, such as driving speed and open window configurations, which were based on observations made during preliminary taxi journeys. Two open-window configurations were found to provide ventilation rates close to or exceeding WHO recommended per-person requirements for high-risk clinical areas and are therefore likely to be effective in reducing the risk of tuberculosis transmission.

Management information systems (MIS) and decision support systems (DSS), used as part of broader healthcare technology management, are considered to be health technologies. As such, they should meet the criteria of affordability, appropriateness, cost-effectiveness, ease of use and sustainability if they are to be implementable and have a lasting impact on healthcare service delivery. They should also facilitate and support improved quality of healthcare. We have developed a suite of management-support tools around a concept of integrated healthcare resource planning and management (iHRPM). We believe that these tools meet the above-mentioned criteria and therefore lend themselves to widespread applicability in diverse healthcare and socio-economic contexts, not least in supporting performance monitoring and benchmarking.