Design Approaches to Developing Technologies for Global Surgery

Surgical care is a fundamental component of an effective healthcare system, yet most people living in low and middle-income countries have no access to it. Critical to addressing this is the ability to equip low-resource healthcare contexts with appropriate surgical technologies. An estimated 40% of healthcare equipment is unused in these contexts, and there is increasing recognition that new technologies must be designed specifically for them, to provide Affordable, Available, Accessible, Appropriate and Quality solutions. For this, researchers suggest conventional approaches to medical device design are not appropriate, but recommended alternative approaches are in early development stages, and since their use is rarely reported in the literature, little evidence exists with which to improve them. This thesis addresses this paucity of evidence, and describes the integration, implementation, and evaluation of recommended approaches to designing technologies for low-resource healthcare contexts. A design roadmap, and the principles of frugal innovation and participatory design are applied to design a device for gasless laparoscopy in rural hospitals in Northeast India. The evaluation of these approaches considers their influence on the development of the design through a review of the design history of the device and uses an exploratory qualitative study to understand whether the participatory approach was beneficial to the clinical stakeholders, who were participants. The design roadmap provided appropriate structure and advice for the design process but requires further development. A thorough understanding of the use context, local stakeholder participation and ability to maintain quality are important for innovating frugally, but specific methods to guide frugal innovation are required. Clinical stakeholders benefited from participating throughout the design process and supported the process by revealing potential barriers to collaboration as well as potential solutions to them. The results highlight the value and potential for using these approaches to increase global access to surgical care.