Combating Major Infectious Diseases
Infectious diseases, such as malaria, dengue fever, typhoid fever, and leptospirosis, are the leading cause of morbidity and death in Indonesia. Because laboratory-based diagnostic services are either unavailable or expensive, most health practitioners in remote and marginalized communities simply rely on the clinical symptoms in treating these symptoms and follow a standard procedure of indiscriminately prescribing antibiotics when the patient experiences two or three days of high fever.
Antibiotics, however, should only be warranted as treatment when the patient suffers from typhoid fever or leptospirosis. Most patients with high fever come with mild self-limiting viral infection that does not need antibiotic treatment; in the case of malaria and dengue, anti-malaria drugs and careful monitoring are recommended respective treatments. As a result, antibiotics are prescribed more than what is necessary, and patients do not receive appropriate treatment and even develop resistance to antibiotics.
Dr. Bachti Alisjahbana, a practitioner in rural areas with marginalized communities, observed and experienced the consequences of the lack of diagnostic tools in providing treatment. He co-founded the Pakar Biomedika Indonesia Company to bring innovations that will answer to these medical needs in Indonesia and adapt them to local requirements. The company partnered with the University of Padjadjaran and the Institut Teknologi Bandung in implementing this project.
Pakar Biomedika Indonesia Company worked closely with the University of Padjadjaran and the Institut Teknologi Bandung in the development, production and commercialization of diagnostic equipment such as plastic housing cassettes. Initially, the company sourced test strips from American and European companies, but has since been developing its own test strips for several diseases. It also conceptualized the Multiplex Point of Care (POC) Rapid Diagnostic Test, an innovative rapid diagnostic test kit for the four most common infectious diseases that is affordable, sensitive, user-friendly and easy to use in the field.
The first phase of the project involved investment and technical advice from the licensing partner, the Dutch Royal Tropical Institute in Amsterdam, as well as transfer of technology to Indonesia so that the test strips containing the antigens or antibodies could be optimized to the local condition, be produced locally, and conform to WHO standards. The second phase involved combining all four tests in one multiplex POC based on lateral flow assay that would allow a patient to be tested in just one procedure, reducing diagnostic costs substantially as the cost of one multiplex POC is much lower than four single POCs.
Risks, Problems and Barriers
The project encountered a barrier to applied research Indonesia: the distinction between research (the university mandate) and development (to be undertaken by a private organization), as well as between production and sales. By setting up Pakar Biomedika Indonesia Company, commercialization of university research was made possible; on the other hand, the grant support from iBoP Asia enabled an efficient public-private innovation process.
Among the challenges encountered by the project were a) the local development of test kits; and b) combining four individual tests into a multiplex system for all four diseases. To address these challenges, Pakar Biomedika Indonesia Company sought the support of the licensing partner and related government institutions to develop capacity-building programs for the firm alongside technology transfer. The project successfully produced the required test strips in the laboratory that served as basis for local production at low costs, and developed multiplex cassette test kit prototypes for clinical and field testing.
Barriers Benefits, Outcome, and Reach
The project, in its initial laboratory phase, was able to generate remarkable outcomes for the bio-tech community in Indonesia. With test strips being produced locally, dependence on imported antigens and antibodies was overcome. Further, single POC test kits for malaria, typhoid, and leptospirosis were developed and contributed to the development of the rapid multiplex test. With the finalization of a locally-developed multiplex POC, the project looks forward to testing and eventual social marketing of the tests.
The capacity-building and technology transfer components of the project led to close cooperation among public institutions. Meanwhile, the collaboration with the private company Pakar Biomedika Indonesia Company demonstrated the potential of a public-private partnership cluster.
The project illustrated that public-public and public-private partnerships with common goals and strong leadership create the potential to achieve breakthrough innovations. The individual strength of each participant, coupled with technical advice and grant resources, resulted in more affordable and appropriate treatment through better diagnostic tools. The collaborative effort also encouraged locally produced bio-tech products.
The project showed that local institutions can be successful in innovating at the BoP, as building their capacity is a crucial activity in the development phase. This strategy, hinged upon local institutions’ deep knowledge of the local situation, also offered new partnership and innovation paths for international institutions and/or corporations.
The team realized that a subsequent phase to the technology level is essential to achieve acceptance of new standards of treatment. This phase should be able to change behavior and expectations through anthropological field studies of patient and health provider behaviour, and ensure community empowerment and dissemination through education programs.
Innovative multiplex POC test kits will soon be introduced to the Indonesian health system after the completion of necessary tests. With the availability of these, health providers would be able to diagnose diseases correctly and treat patients with the right medicine. Dr. Alisjahbana has reiterated that this process of introducing the medical diagnostic innovation is expected to be as challenging as the technological innovation itself. What seems to be a purely technological innovation gets an important community perspective if the gestation of the project and dissemination is considered.
Several behaviors that are not as straightforward have to change as well. First, the diagnosis needs a certain amount of time to detect the appropriate antibodies and antigens. The correct usage of the test is to wait for five days before administering the test, which, from a patient’s perspective, is less desirable than receiving immediate remedy. Second, it should be pointed out that the availability of a diagnostic tool is a positive development as it increases practitioners’ confidence in treating patients.
Laboratory technological solutions is just one step in achieving positive outcomes at the BoP. Mastering the challenge of finding dissemination models via the public health system, and business models via the private sector, is another crucial step to create a meaningful impact at the BoP.
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