Making health innovation more inclusive in Ethiopia

The COVID-19 global pandemic brought much Research and Innovation (R&I) to an abrupt halt. It also generated an urgent need for specific R&I to address particular challenges in the health sphere. Existing inequalities were exacerbated – between countries, and between population groups within countries – as those with more resources adapted more quickly and safely to changed circumstances than those with less. With travel and face-to-face interaction curtailed, communication, collaboration and community-building was pushed into the digital realm. In many places around the world whatever could not be done virtually could not be done at all. The collaboration between the Centre for Global Equality (CGE) in Cambridge, UK, and the Bahir Dar Institute of Technology (BiT) in Ethiopia, to establish a Makerspace at Bahir Dar University was a case in point. Funded by the Bill & Melinda Gates Foundation, the founding of BiT Makerspace is part of an ongoing partnership between BiT and CGE to create an enabling environment in Bahir Dar for Inclusive Innovation – innovation for, with and by the rising billions. The makerspace is now a flagship initiative of BiT’s Business Incubation and Techno-Entrepreneurship Centre. Within a few months of opening 3D printers at Bit Makerspace were being used to fabricate more 3D printers, and a group was developing a fingerprint scanner for the University. The strong commitment to collaboration and co-creation that underwrites the Inclusive Innovation approach was evident in a number of initiatives: BiT staff participated in a peer-learning programme on Human-Centred Design for Health at Nairobi Makerspace in Kenya, attended an Africa Makerspace Gathering in Ghana, and hosted an Africa Biomaker Challenge workshop in Ethiopia.  International co-design projects between students from the Universities of Bahir Dar and Cambridge on soil moisture monitoring and plastic recycling, and an Agri-Makerthon with participants from the UK and Ethiopia were postponed due to COVD19. The authors of this poster have been working together since the beginning of the pandemic to enable international co-design and digital fabrication collaborations to strengthen local responses to COVID19 in Africa. Here we share insights from the challenges and successes experienced in ongoing COVID19 response projects at BiT Makerspace that demonstrate the three Inclusive Innovation registers of collaboration between international innovators, many of whom live in high income countries, and innovators and end-users in low- and middle-income countries. These registers – innovation ‘for’, ‘with’ and ‘by’ the rising billions – oscillate between weak and strong levels of co-design and design leadership between countries. We argue that each register has the potential to contribute to genuinely inclusive innovation, and each faces challenges in fulfilling this objective. In response to the pandemic the global Open Source Hardware (OSH) community produced a remarkable plethora of freely available designs for COVID19 equipment and instruments for under-resourced contexts. Here we analyse the adoption and adaption of UK open source designs for Personal Protection Equipment (PPE) masks and face shields at BiT Makerspace and Twenti Makerspace in Malawi. We explore the efforts made by engineering teams in Bahir Dar and Cambridge to design an Oxygen Concentrator for the Open Ventilator System Initiative (OVSI) with each other. And we discuss the fabrication of infra-red thermometers and pulse rate oximeters for use in Ethiopia by BiT Makerspace. We investigate challenges that reduce the potential of both Open Source Hardware and small scale digital fabrication in makerspaces (3D printing, laser cutting and CNC milling). In particular we discuss the importance of effective documentation of design processes as well as final designs, difficulties ensuring quality control in distributed manufacturing facilities such as makerspaces, and the challenges faced in many countries to test, certify and regulate medical equipment effectively. We also discuss progress towards the development of a rapid response roadmap to identify the key activities and requirements for deploying digital fabrication tools in a crisis. The aim is to offer insights relevant to other regions with limited manufacturing infrastructure, and to improve preparedness for future pandemics and related humanitarian crises.