Child Relief International (CRI) commits to provide critical treatment for more than 4,350 severely jaundiced newborns, half of whom are girls, in Rwanda over three years. CRIs Partnership to Improve Newborn Health will provide 106 Brilliance Pro phototherapy devices, a D-Rev innovation, to 46 public hospitals (every district and teaching hospital in Rwanda that has a neonatal intensive care unit or special newborn care unit). D-Rev, a US-based NGO that designed Brilliance Pro, will provide and manage the delivery and installation of the devices, and manage the training of Ministry of Health staff. All three partners will coordinate to collect data to assess the health impact of the devices, as well as the scale of the impact (how many babies treated) across the entire project. Real time metrics will be available on D-Revs website.
Phototherapy is intense blue light that treats hyperbilirubinemia, or severe jaundice. Without effective treatment, newborns may suffer irreversible brain damage or even death. The Brilliance Pro devices are state of the art, require minimal maintenance, and consume less than half the power of comparable devices. They are also designed to be radically affordable, costing $500 compared to comparable devices in the U.S. that cost more than $3,000 each.
CRI, with its history of support for high impact sustainable programs in Rwanda, facilitated the introduction of D-Rev and the MOH in this commitment. CRI is supporting the purchase and installation of the devices in hospitals, the training of technicians, spare parts to the MOHs Medical Technologies & Infrastructure Division, and comprehensive impact assessment. Andrew Weiss, CRI co-founder and founder of the Weiss Family Program Fund for Research in Development Economics, will advise on the design of the impact study, along with Professor Kekti Sheth of the University of California, Merced. With guidance from the MOH, D-Rev will execute the assessment with local enumerators.
The partnerships impact will continue to grow sustainably for over 10 years after the CGI commitment period. The MOH will maintain the devices through their Medical Technologies & Infrastructure division, and D-Rev and CRI will continue to monitor impact. This comprehensive commitment represents a cost effective, high impact, country wide program that will model sustainable, impact driven, public-private health partnerships in all countries.
Q3 2016: CRI makes grant to D-Rev to kick off program. D-Rev will work with Indian partner Phoenix Medical Systems to deliver and install the products, train MOH staff and local servicing agents, and provide spare parts. MOH supplies additional data on selection criteria for target. D-Rev, with partners approval, finalizes impact assessment methodology and timelines.
Q4 2016: First shipment of Brilliance Pro units delivered to Rwanda, baseline data collection. Units will arrive by ship to Mombasa and then be transported by road to Kigali. There, a local distributer, Crown Agents, working with Phoenix and the MOH will oversee installation and training. D-Rev, with assistance from MOH, hires a Study Manager to select, train, and oversee data collectors (enumerators) as well as manage data collection, entry, and cleaning.
Q1 2017: Impact study manager oversees baseline data collection (Round A) at all 46 hospitals. Data collection will involve in-person visits to each hospital, and completion of a 30-minute survey with a hospital representative.
Q2 2017: First round installation and training. Crown Agents working with the MOH's Medical Technology & Infrastructure Division will install 53 devices at first set of 23 hospitals (Group One). Two months after installations at these hospitals are complete, the impact study manager will oversee data collection (Round B) at all 46 hospitals. Ideally, data should show changes in Group One hospitals, but not in Group Two hospitals.
Q3 2017: Second round installation and training. Crown Agents working with the MOH's Medical Technology & Infrastructure Division will install 53 devices at second set of 23 hospitals (Group Two). Two months after installations at these hospitals are complete, the impact study manager will oversee the final survey (Round C) of all 46 hospitals. Ideally, data will show similar changes in effect at Group Two hospitals as was seen at Group One hospitals.
Q2 2018: Completion of all data collection. Study manager will arrange for in-person visits by local enumerators to all 46 hospitals to collect machine usage data from all machines. This will involve reading data off the machines, not a survey, and is likely to take less than 20 minutes per hospital
Q1 2019: Final results of assessment and impact achieved. D-Rev will coordinate the completion of a final analysis and report from Dr. Sheth on the impact study. The findings of the study, as well as machine usage rates, will help us validate our estimates of both the health impact of the devices, as well as the scale of the impact (how many babies treated) across the entire project. Rates of treatment could also be used to estimate future impact for the lifetimes of the devices.
Project impact reporting will start one month after the first installations and be available real-time on D-Revs website in the Newborn Health Impact Dashboard for Rwanda.
Child Relief International seeks to end newborn brain damage and death from severe jaundice (hyperbilirubinemia), an easily treatable condition. Severe jaundice affects one in six newborns and can lead to kernicterus, a type of permanent brain damage that can cause subtle to debilitating conditions such as deafness, cerebral palsy, significant learning disabilities, or even death (Bhutani, et al., 2013). Research conducted at Stanford University School of Medicine found that globally, more than 10.8 million babies with severe jaundice (45% who need treatment) are not receiving adequate treatment annually (Cline, et al., 2011). Medical practitioners have repeatedly identified newborn jaundice in low income countries as a priority: it can be easily treated through phototherapy, an intensive blue light, but standard devices are not context appropriate, an issue that Dr. Agnes Binagwaho, the former Minister of Health of Rwanda, has repeatedly raised within the global health community. An audit of donated equipment to hospitals in low income countries has indicated that up to 90% of devices are broken, ineffective, or inadequate (WHO, 2010); and in other cases hospitals simply do not have the quality, affordable, and appropriate devices they require, as is the case with the Rwanda Ministry of Health.
D-Rev develops world class, context appropriate medical devices specifically for the needs of practitioners in complex environments at radically affordable prices. The Brilliance line of products treats severely jaundiced newborns at $500 per device, compared to over $3,000 for a comparable device in the United States. Wired Magazine described D-Revs Brilliance Pro, the latest Brilliance device, as the MacBook Air of developing world jaundice treatment (Vanhemert, 2015). At NEOCON, Indias largest neonatal conference, Brilliance Pro took Best in Show in December 2014, beating out well known multinational companies and other innovative health products. It has also been selected as the Retrospective Health Laureate for the Silicon Valley Tech Awards (embargoed until September 2016). The Brilliance products have been on the market since late 2012, and have been purchased by hospitals and distributors in 41 countries to date.