In mid-April, a spokesperson for the Ugandan government admitted that the country’s only functioning cancer treatment machine had broken earlier that month. The radiotherapy machine, donated by China to Uganda in 1995 and housed at Mulago Hospital in Kampala, is now considered beyond repair.
While the government did acquire a second radiotherapy machine in 2013, it has not been operational because of delays in allocating 30 billion shillings, about $9 million, to construct a new building to house it. The funding delay has lifted, but the machine won’t be up and running for at least six months.
The government has announced plans to airlift some cancer patients to Nairobi for treatment, but that plan will only accommodate 400 of the estimated 17,000 to 33,000 cancer patients who need treatment annually in Uganda.
This breakdown of technology is a human tragedy for the cancer patients from Uganda as well as elsewhere in East Africa that the radiotherapy machine helped treat.
Beyond the personal level, though, the episode illustrates a larger shortcoming in global health. Total annual development assistance for health is approximately $36 billion, but that funding is overwhelmingly concentrated on specific infectious diseases.
Noncommunicable diseases like cancer receive relatively little international funding, only 1.3 percent in 2015, and the dollar amount has declined since 2013. Funds to strengthen health systems, geared toward building and supporting a resilient health care system, are similarly low, making up only 7.3 percent of development assistance in 2015.
Noncommunicable diseases kill more people every year than infectious diseases and accidents do, but this balance is not reflected in global health spending.
These shortcomings also speak to larger problems in global health around issues of technology transfers and long-term commitments to keep that technology working. It’s one thing to provide necessary medical technologies in the first place; it’s another to ensure that those technologies are accessible and operational going forward.
Despite the importance of technology transfers, questions of long-term support for them have received relatively little attention from the global health regime. As noncommunicable diseases like cancer cause an even-higher proportion of deaths each year, it will become all the more imperative that the international community addresses this gap in sharing and funding crucial health care technology.
This does not mean that there are no efforts to facilitate technology transfers around the world. The Fogarty International Center, a part of the U.S. National Institutes of Health, has had an Office of Technology Transfer since 1989 to make medical innovations developed in the United States more widely available.
The World Health Organization (WHO) also has a Technology Transfer Initiative to improve access to health care technologies in developing countries. These efforts are laudable, but their interpretation of technology transfer is almost entirely rooted in access to pharmaceuticals and vaccines. To be sure, that is a very important issue—but it only deals with one narrow element of technology transfer.
The problems of global health technology transfers illustrated in Uganda underscore a larger issue: the need for a so-called fourth industrial revolution, what has been described as “blurring the real world with the technological world.”
This idea gained prominence earlier this year when it served as the theme for the World Economic Forum in Davos.
For global health, this means embracing technology to find low-cost ways to promote health, spread education, and reach communities whose access to the health care infrastructure is weak. It expands on the notion of telemedicine and eHealth to make it more encompassing.
According to health care entrepreneur Jonathan Jackson, the fourth industrial revolution could change global health by encouraging a shift in focus “from healthcare to health promotion.” Moving from high-cost treatment to low-cost prevention, he has argued, will have significant and far-reaching positive economic implications for developing countries around the world.
Its inspiring sense of technological optimism notwithstanding, this sort of approach cannot be the sole focus of technology transfers in global health. Prevention is indeed important, but the fact of the matter remains that people will get sick—and those sick people will need treatment.
Mobile applications and electronic access to health care providers can be useful, but they cannot replace a radiotherapy machine. Understanding the root causes of noncommunicable diseases goes far beyond individual choices and intersects with the larger political, economic and social context, so we cannot assume that cybertechnology alone can stop cancer.
It is also important to remember that the results of greater technological innovation and integration won’t be free. Sub-Saharan African states, on average, spend $200 per person per year on health care.
Even if technology allows costs to decline, they are still likely to be out of reach for many people in most of these countries, in the same way that the purchase and maintenance of medical technologies are prohibitively expensive in these same states today. Technology in and of itself is not useful unless it can be maintained over the long term.
This, then, is a weak link in the larger global health system: How do we ensure access to life-prolonging medical technologies beyond pharmaceuticals and vaccines in a sustainable way? Consider two ideas. First, development assistance for health must orient more of its resources toward treating noncommunicable diseases and strengthening health systems.
These are the areas in which these technologies are likely to be used, but are not currently supported by the international system. The changing nature of health and disease will only make them even more important in the years to come.
Second, longer-term funding commitments would provide a greater opportunity to incorporate medical technologies into health care systems sustainably.
Machines will break down, and technologies will fail. That is inevitable. But the global health regime, from the WHO and its regional organizations like the Regional Office for Africa to major donors like the United States government and the Bill and Melinda Gates Foundation, needs to figure out how to ensure that these problems do not put lives in peril.
Technology alone will not improve global health unless it is properly supported and funded.
© Jeremy Youde is a senior lecturer in international relations in the Coral Bell School of Asia Pacific Affairs at the Australian National University, where he studies issues of global health governance.