A new reservoir-based CPAP with low oxygen consumption: the Bag-CPAP.

BACKGROUND: Several noninvasive ventilatory supports rely in their design on high oxygen consumption which may precipitate oxygen shortage, as experienced during the COVID-19 pandemic. In this bench-to-bedside study, we assessed the performance of a new continuous positive airway pressure (CPAP) device integrating a large reservoir ("Bag-CPAP") designed to minimize oxygen consumption, and compared it with other CPAP devices. METHODS: First, a bench study compared the performances of Bag-CPAP and four CPAP devices with an intensive care unit ventilator. Two FiO2 targets (40-60% and 80-100%) at a predefined positive end expiratory pressure (PEEP) level between 5 and 10 cm H2O were tested and fraction of inspired oxygen (FiO2) and oxygen consumption were measured. Device-imposed work of breathing (WOB) was also evaluated. Second, an observational clinical study evaluated the new CPAP in 20 adult patients with acute respiratory failure in two hospitals in France. Actual FiO2, PEEP, peripheral oxygen saturation, respiratory rate, and dyspnea score were assessed. RESULTS: All six systems tested in the bench study reached the minimal FiO2 target of 40% and four reached at least 80% FiO2 while maintaining PEEP in the predefined range. Device-delivered FiO2/consumed oxygen ratio was the highest with the new reservoir-based CPAP irrespective of FiO2 target. WOB induced by the device was higher with Bag-CPAP. In the clinical study, Bag-CPAP was well tolerated and could reach high (> 90%) and moderate (> 50%) FiO2 with an oxygen flow rate of 15 [15-16] and 8 [7-9] L/min, respectively. Dyspnea score improved significantly after introduction of Bag-CPAP, and SpO2 increased. CONCLUSIONS: In vitro, Bag-CPAP exhibited the highest oxygen saving properties albeit had increased WOB. It was well accepted clinically and reduced dyspnea. Bag-CPAP may be useful to treat patients with acute respiratory failure in the field, especially when facing constraints in oxygen delivery.

KeyLoop retractor for global gasless laparoscopy: evaluation of safety and feasibility in a porcine model.

BACKGROUND: Many surgeons in low- and middle-income countries have described performing surgery using gasless (lift) laparoscopy due to inaccessibility of carbon dioxide and reliable electricity, but the safety and feasibility of the technique has not been well documented. We describe preclinical testing of the in vivo safety and utility of KeyLoop, a laparoscopic retractor system to enable gasless laparoscopy. METHODS: Experienced laparoscopic surgeons completed a series of four laparoscopic tasks in a porcine model: laparoscopic exposure, small bowel resection, intracorporeal suturing with knot tying, and cholecystectomy. For each participating surgeon, the four tasks were completed in a practice animal using KeyLoop. Surgeons then completed these tasks using standard-of-care (SOC) gas laparoscopy and KeyLoop in block randomized order to minimize learning curve effect. Vital signs, task completion time, blood loss and surgical complications were compared between SOC and KeyLoop using paired nonparametric tests. Surgeons completed a survey on use of KeyLoop compared to gas laparoscopy. Abdominal wall tissue was evaluated for injury by a blinded pathologist. RESULTS: Five surgeons performed 60 tasks in 15 pigs. There were no significant differences in times to complete the tasks between KeyLoop and SOC. For all tasks, there was a learning curve with task completion times related to learning the porcine model. There were no significant differences in blood loss, vital signs or surgical complications between KeyLoop and SOC. Eleven surgeons from the United States and Singapore felt that KeyLoop could be used to safely perform several common surgical procedures. No abdominal wall tissue injury was observed for either KeyLoop or SOC. CONCLUSIONS: Procedure times, blood loss, abdominal wall tissue injury and surgical complications were similar between KeyLoop and SOC gas laparoscopy for basic surgical procedures. This data supports KeyLoop as a useful tool to increase access to laparoscopy in low- and middle-income countries.

Evaluation of hernia surgical meshes sterilised with ethylene oxide for adoption under UK regulations.

BACKGROUND: Low-cost meshes (LCM) have been successfully used in low-income countries (LIC) over the past decades, demonstrating comparable surgical outcomes to commercial meshes at a fraction of the cost. However, LIC sterilisation standards (autoclave sterilisation at 121 °C) do not meet UK regulations for medical devices, which require either ethylene oxide (EO) sterilisation or steam sterilisation at 134 °C. Therefore, the aim of this study was to sterilise UK LCM and characterise their mechanical properties and in vitro biocompatibility to verify whether EO sterilisation causes changes in the mechanical properties and biocompatibility of LCM. METHODS: EO sterilised LCM were used. Uniaxial tensile tests were performed to measure mechanical properties. Biocompatibility was measured through viability and morphology of Human Dermal Fibroblasts (HDFs) cultured in mesh-conditioned media, and by calculating the metabolic activity and proliferation of HDFs attached on the meshes, with alamarBlue assay. RESULTS: Break stress of LCM1 was significantly higher than LCM2 (p < 0.0001), while Young's modulus of LCM1 was significantly lower than LCM2 (p < 0.05) and there was no significant difference in break strain. Viability and morphology showed no significant difference between LCM and control. Attachment and proliferation of HDFs on LCM showed a better proliferation on LCM2 than LCM1, with values similar to the control at the final time point. CONCLUSIONS: We demonstrated that EO sterilisation affects LCM mechanical properties, but they still have values closer to the native tissues than the commercially available ones. We also showed that in vitro biocompatibility of LCM2 is not affected by EO sterilisation, as HDFs attached and proliferated on the mesh, while EO affected attachment on LCM1. A more detailed cost analysis of the potential savings for healthcare systems around the world needs to be performed to strengthen the cost-effectiveness of this frugal innovation.

Paediatric urology in Sub-Saharan Africa: challenges and opportunities.

The need for paediatric urological care in low- and middle-income countries in sub-Saharan Africa (SSA) is enormous due to a burgeoning paediatric-aged population and a disproportionate burden of congenital malformations. There are formidable challenges in the provision of a skilled workforce and appropriate infrastructure, resulting in a huge unmet need with consequent effects on the long-term health and prosperity of the population. Constraints of funding, geography, culture, surgical and anaesthetic skills, and instrumentation means that many conditions present late and with complications that could have been avoided by an earlier attendance. It also means that the management of congenital malformations, e.g., bladder exstrophy and congenital obstructive posterior urethral membrane, differ substantially from that seen in the developed world, with the outlook for children with renal failure being particularly bleak. Collaborations between paediatric urologists from high- and low-income countries are beginning to help with the development of a surgical infrastructure customised to paediatric care, and with the training of specific paediatric urological knowledge and skills. These collaborations, whilst welcome, still require substantial expansion to achieve more equitable access to appropriate paediatric urological care for children in SSA. Future efforts have to focus on the creation of sustainable and equal partnerships between urologists from low- and high-income healthcare environments, with an emphasis on providing sustainable management, appropriate to local need and available resources. The provision of shared learning, utilising the benefits of global digital communication, will improve mutual understanding of needs in a resource-poor environment and the involvement of trainees from both income settings can help perpetuate long-term collaborations.

Review of a frugal cooling mattress to induce therapeutic hypothermia for treatment of hypoxic-ischaemic encephalopathy in the UK NHS.

Hypoxic ischaemic encephalopathy (HIE) is a major cause of neonatal mortality and disability in the United Kingdom (UK) and has significant human and financial costs. Therapeutic hypothermia (TH), which consists of cooling down the newborn's body temperature, is the current standard of treatment for moderate or severe cases of HIE. Timely initiation of treatment is critical to reduce risk of mortality and disability associated with HIE. Very expensive servo-controlled devices are currently used in high-income settings to induce TH, whereas low-income settings rely on the use of low-tech devices such as water bottles, ice packs or fans. Cooling mattresses made with phase change materials (PCMs) were recently developed as a safe, efficient, and affordable alternative to induce TH in low-income settings. This frugal innovation has the potential to become a reverse innovation for the National Health Service (NHS) by providing a simple, efficient, and cost-saving solution to initiate TH in geographically remote areas of the UK where cooling equipment might not be readily available, ensuring timely initiation of treatment while waiting for neonatal transport to the nearest cooling centre. The adoption of PCM cooling mattresses by the NHS may reduce geographical disparity in the availability of treatment for HIE in the UK, and it could benefit from improvements in coordination across all levels of neonatal care given challenges currently experienced by the NHS in terms of constraints on funding and shortage of staff. Trials evaluating the effectiveness and safety of PCM cooling mattresses in the NHS context are needed in support of the adoption of this frugal innovation. These findings may be relevant to other high-income settings that experience challenges with the provision of TH in geographically remote areas. The use of promising frugal innovations such as PCM cooling mattresses in high-income settings may also contribute to challenge the dominant narrative that often favours innovation from North America and Western Europe, and consequently fight bias against research and development from low-income settings, promoting a more equitable global innovation landscape.

Frugal innovation in wound care: a critical discussion of what we can learn from low-resource settings.

Frugal innovation is a common philosophy in low-income settings due to limited access to resources. However, with both the increasing prevalence and clinical acuity of patients with wounds in the UK, it is essential that alongside innovation such as harnessing cutting-edge new technologies, frugal innovation is also pursued. This may improve both economic efficiency and patient outcomes. Frugal innovations were adopted throughout the COVID-19 pandemic and included opportunistic solutions such as video-conferencing services to run clinics. However, there are many more opportunities for frugal innovation in wound care, including the use of smartphone technology, which is already accessible to 99.5% of UK clinicians caring for wounds, or the simplification of wound-assessment processes using pulse oximeters as an alternative to dopplers, as in the Lanarkshire Oximetry Index. This article explores what frugal innovation is and how it could improve UK wound services. The authors invite clinicians working in wound care to consider their access to existing resources that may not be considered useful for wound-care processes and explore how these could be used to improve clinical outcomes.

Low-cost procedure for deformity correction in rheumatoid hands.

BACKGROUND: Surgical correction of ulnar drift of metacarpo-phalangeal joint (MPJ) due to Rheumatoid arthritis (RA) is conventionally done by silicon joint arthroplasty which is expensive and may be associated with many complications. We report the outcome of low-cost autologous interpositional arthroplasty. MATERIAL AND METHODS: Five patients (8 hands, 32 arthroplasties) underwent correction of ulnar drift of MPJ by dorsal capsule interpositional arthroplasty. Results were assessed according to the degree of recovery of movement at the MPJ and correction of ulnar drift. Functional improvement was graded as excellent, good and fair. Pain alleviation was assessed by visual analogue score (VAS) score. RESULTS: Excellent results were seen in 3 patients (5 hands, 20 arthroplasties), good in 1 patient (2 hands, 8 arthroplasties) and fair in 1 patient (1 hand, 4 arthroplasties). VAS score for pain decreased from mean preoperative 8.2/10 to 1/10. On average follow up of 1.4 years there was good hand function, no recurrence of deformities and patients were pain free. CONCLUSION: Interpositional arthroplasty for MPJ using dorsal capsule for correction of post RA ulnar drift is a low-cost option which improves the hand function and cosmesis. Additionally, it avoids all the complications related with the use of silicon joints.

Breaking the chain: Governmental frugal innovation in Kerala to combat the COVID-19 pandemic.

As the COVID-19 pandemic causes unprecedented disruptions in citizens' lives and work, prompting a wide range of responses from governments across the globe. The southern Indian state of Kerala, India's COVID-19 "ground zero", stands out with a fatality rate at a fraction of other richer Indian states and countries. This has happened despite the state presenting strong vulnerabilities to COVID-19. Using the theoretical lens of frugal innovation, I analyse how the Kerala State Government (KSG) combated the spread of COVID-19. This research uncovers the mechanisms at play as KSG implemented and used frugal technologies as platforms that helped decision making and strategy to fight the pandemic. I find a rich interplay of frugal innovations promoted by the government, in partnership with research institutes and private sector actors, which are cheap and efficacious. The study defines and promotes the concept of government frugal innovation (GFI) and provides valuable insights and tools to help governments navigate and effectively respond to this crisis, encouraging the rest of the world to learn from Kerala's experience. My conceptual model characterizes GFI as involving collaborative aspects, and holds practical implications beyond the times of crises.

Use of an Interdisciplinary Student Medical Innovation and Entrepreneurship Program to Create Affordable Global Health Care Solutions.

BACKGROUND: Bench to Bedside is a 7-month-long medical innovation and entrepreneurship program at the University of Utah in which teams comprising students from various disciplines work together to identify health care problems and develop novel technology solutions. Student teams are provided a small prototyping budget, access to device development workshops, prototyping facilities, and expert faculty and industry mentors. Teams then compete for seed funding at the Bench to Bedside competition at the end of the program. In 2014, we created global health-specific resources, mentorship, guidance, and award incentives as a means to drive global health technology development in the program and then studied our impact after 6 years. METHODS: We reviewed program data collected continuously between 2011 and 2018 to evaluate the impact of global health incentive initiatives on the development of global health-related technologies. We quantified the number of global health teams based on both team-declared data and objective evaluation of each competing technology. RESULTS: The initiation of global health technology incentives was associated with an annual overall doubling of teams pursuing the development of global health-related technologies from an average of 11.4% to 24.8% ( P = .003). CONCLUSIONS: A student medical technology innovation program designed to address global health needs is an effective means of generating new solutions to improve global health care. The use of global health-specific awards and mentors raised awareness of the need for affordable global solutions and incentivized teams to pursue development.

Perceived reciprocal value of health professionals' participation in global child health-related work.

BACKGROUND: Leading children's hospitals in high-income settings have become heavily engaged in international child health research and educational activities. These programs aim to provide benefit to the institutions, children and families in the overseas locations where they are implemented. Few studies have measured the actual reciprocal value of this work for the home institutions and for individual staff who participate in these overseas activities. Our objective was to estimate the perceived reciprocal value of health professionals' participation in global child health-related work. Benefits were measured in the form of skills, knowledge and attitude strengthening as estimated by an adapted Global Health Competency Model. METHODS: A survey questionnaire was developed following a comprehensive review of literature and key competency models. It was distributed to all health professionals at the Hospital for Sick Children with prior international work experience (n = 478). RESULTS: One hundred fifty six health professionals completed the survey (34%). A score of 0 represented negligible value gained and a score of 100 indicated significant capacity improvement. The mean respondent improvement score was 57 (95% CI 53-62) suggesting improved overall competency resulting from their international experiences. Mean scores were >50% in 8 of 10 domains. Overall scores suggest that international work brought value to the hospital and over half responded that their international experience would influence their decision to stay on at the hospital. CONCLUSIONS: The findings offer tangible examples of how global child health work conducted outside of one's home institution impacts staff and health systems locally.

The Emergence of Personalized Health Technology.

Personalized health technology is a noisy new entrant to the health space, yet to make a significant impact on population health but seemingly teeming with potential. Devices including wearable fitness trackers and healthy-living apps are designed to help users quantify and improve their health behaviors. Although the ethical issues surrounding data privacy have received much attention, little is being said about the impact on socioeconomic health inequalities. Populations who stand to benefit the most from these technologies are unable to afford, access, or use them. This paper outlines the negative impact that these technologies will have on inequalities unless their user base can be radically extended to include vulnerable populations. Frugal innovation and public-private partnership are discussed as the major means for reaching this end.

Designing metallic iron based water filters: Light from methylene blue discoloration.

Available water filtration systems containing metallic iron (Fe(0) filters) are pragmatically designed. There is a lack of sound design criteria to exploit the full potential of Fe(0) filters. A science-based design relies on valuable information on processes within a Fe(0) filter, including chemical reactions, hydrodynamics and their relation to the performance of the filter. The aim of this study was to establish a simple method to evaluate the initial performance of Fe(0) filters. The differential adsorptive affinity of methylene blue (MB) onto sand and iron oxide is exploited to characterize the evolution of a Fe(0)/sand system using the pure sand system as operational reference. Five systems were investigated for more than 70 days: pure sand, pure Fe(0), Fe(0)/sand, Fe(0)/pumice and Fe(0)/sand/pumice. Individual systems were characterized by the extent of changes in pH value, iron breakthrough, MB breakthrough and hydraulic conductivity. Results showed that for MB discoloration (i) pure sand was the most efficient system, (ii) hybrid systems were more sustainable than the pure Fe(0) system, and (iii) the pores of used pumice are poorly interconnected. Characterizing the initial reactivity of Fe(0) filters using MB discoloration has introduced a powerful tool for the exploration of various aspects of filter design.

Poor man's NOTES: can it be a good approach for adhesiolysis? A first case report with video demonstration.

STUDY OBJECTIVE: To show that in selected cases transvaginal NOTES can be a frugally innovative approach for adhesiolysis and that it can be performed in a low-cost setting. DESIGN: Step-by-step explanation of the technique using videos and pictures (educative video). PATIENTS AND MEASUREMENTS: A 51-year old (para 2, gravida 2) presented with meso- and hypogastric pain. Two years before, an umbilical hernia had been repaired using a Proceed Ventral Patch mesh. The diagnosis of pain caused by adhesions was made, and laparoscopic adhesiolysis was planned. On ultrasound, a small left ovarian fibroma was visualized. Because of the suspected umbilical location of the adhesions, we decided to use a transvaginal NOTES approach to perform adhesiolysis and left adnexectomy. Pathological examination confirmed a small benign papillary serous adenofibroma of the ovary. INTERVENTIONS: A transvaginal NOTES approach to perform adhesiolysis combined with left adnexectomy using only standard reusable laparoscopic instruments and a low-cost self-constructed NOTES port. MAIN RESULTS: The procedure and postoperative recovery were uneventful. No minor or major complications occurred. The patient has been cured of her pain. CONCLUSION: Transvaginal NOTES is a novel approach that requires further validation. This case report shows that transvaginal NOTES can be used to perform adhesiolysis for abdominal pain and that it can be performed in a low-cost setting without the need for expensive ports or disposable instruments.

Laparoscopic hysterotomy for a failed termination of pregnancy: a first case report with demonstration of a new surgical technique.

STUDY OBJECTIVE: To show a new technique of hysterotomy via laparoscopy for a failed termination of pregnancy as an alternative for a hysterotomy via laparotomy. DESIGN: Step-by-step explanation of the technique using parts of the original video of the procedure (Canadian Task Force classification III). SETTING: A 39-year-old woman, para 1 gravida 2, was diagnosed with a trisomy 21 pregnancy at 18 weeks' gestation. After 7 days of failed medical and mechanical induction, including misoprostol per vaginam, intravenous sulprostone , intravenous oxytocin, a transcervical Foley catheter, and a transcervical Bakri balloon (Cooke Medical, Bloomington, IN), the decision was made to perform a laparoscopic hysterotomy. INTERVENTIONS: A laparoscopic hysterotomy was performed with extraction of the fetus and placenta in an endobag. The uterus was sutured using a double layer of 2 continuous Vicryl 1 sutures (Ethicon, Cincinnati, OH). The umbilical incision was enlarged to 2.5 cm to extract the endobags. The procedure was performed using only standard reusable laparoscopic equipment. FOLLOW-UP: The patient's postoperative recovery was uneventful. On the postoperative ultrasound, we suspected that a small piece of placental tissue had been left in the uterine cavity. A hysteroscopy confirmed this and showed a normal uterine cavity. The small placental fragment regressed spontaneously on the follow-up ultrasounds. A 2-year follow-up of the patient has shown no minor or major complications. The patient has used contraception since the procedure because she has no further desire for childbearing. CONCLUSION: This new technique can help surgeons avoid a laparotomy when a hysterotomy for a failed midtrimester termination of pregnancy is required. The risk of uterine rupture in a next pregnancy needs to be taken into account. This frugally innovative technique may potentially be performed in a low-resource setting because only standard reusable laparoscopic equipment was used.

Total Vaginal NOTES Hysterectomy: A New Approach to Hysterectomy.

The aim of this study was to demonstrate the feasibility of a total hysterectomy performed entirely by transvaginal natural orifice transluminal endoscopic surgery (vNOTES). Conventional, reusable laparoscopic instruments were used, inserted through an inexpensive, self-constructed single-port device. Ten total vaginal NOTES hysterectomies (TVNHs) were performed by a single surgeon. The self-constructed single-port device was made by assembling a surgical glove, a wound protector or modified laryngeal mask airway, 1 reusable 10-mm trocar, and 4 reusable 5-mm trocars. This gloveport was inserted into the vagina to create a pneumovagina. The conventional steps of a vaginal hysterectomy were followed, but performed endoscopically with standard reusable endoscopic instruments. The patient and perioperative data were analyzed. No conversion to standard laparoscopy or laparotomy was necessary in any of the 10 patients who underwent a TVNH. Mean operation time was 97 min (range: 60-120); mean drop in hemoglobin level was 1.5 g/dL (range: 0.5-2.4). There were no operative complications, and postoperative pain scores were very low. This first report on a small number of patients demonstrates that TVNH is possible. By incorporating the advantages of endoscopic surgery, TVNH broadens the indications for vaginal hysterectomy and helps overcome its limitations. At the same time, the NOTES approach avoids abdominal wall wounds and trocar-related complications. TVNH is feasible, even when performed with reusable, conventional laparoscopic instruments. This frugally innovative technique also enables surgeons to perform hysterectomies by vNOTES in low resource settings.

Rural electrification in Nigeria: A review of impacts and effects of frugal energy generation based on some of e-waste components.

Nigeria is the seventh most populous country in world being the highest in Africa. The country is blessed with vast natural resources and is one of the highest producers of oil in the world. However, the inadequate supply of electrical energy is a major setback in the nation's economic development. Thus, there is need for an urgent and immediate solution to address the electricity access situation in Nigeria. It is in view of this that we first present an overview of the electrical energy situation of Nigeria (especially in the rural areas). The benefits of rural electrification and it impacts are discussed to buttress the need for electrifying rural areas and an overview of the abundant renewable energy resources in Nigeria is presented. As a proposed solution to improve the electricity situation, the concept of a reuse solar photovoltaic system based on e-waste components and old materials is presented. The system comprises repurposed Power Supply Unit (PSU) from old desktop computers, old thermal car Lead-acid batteries, old solar panels and Uninterruptible Power Supply (UPS) units. The possibility of adopting this solution in Nigeria depends on the amount of e-wastes generated annually thus necessitating the need for an analysis to see the annual impact of this system on electricity access based on the amount of available e-waste. Using the huge amount of e-waste generated/received annually in Nigeria, the feasibility of our solution is assessed by estimating the possible number of households that could be electrified by the second life renewable energy systems we propose. Due to the lack of official data in this field, certain constraints and assumptions were defined for the purpose of this analysis which resulted in obtaining a range of results that showed the possible impacts of adopting the reuse system. The analysis showed the minimum and maximum impacts the reuse solution could have on electricity access in Nigeria, based on best and worst case scenario respectively. The results further showed that an average of 287,000 households can be electrified annually if this solution is adopted, causing 2.2 % increment in population with electricity access in a year (between 620 thousand and 4.1 million individuals). Thus, the result is an indication that it is possible to achieve immediate growth in electricity access based on renewable energy integration, frugal innovation and reuse/repurposing of e-waste materials. In addition, this extension of their lifespan reduces their ecological footprint. It is expected that the energy demands of the continuously growing population can be met by strict adherence to set targets including adoption of smart-grids, generation diversification and focusing on rural electrification.

Driving frugal innovation in SMEs: how sustainable leadership, knowledge sources and information credibility make a difference.

This study investigates the driving factors behind frugal innovation in Small and Medium-sized Enterprises (SMEs). It specifically examines sustainable leadership as an independent variable, considering its impact on frugal innovation, with sources of knowledge mediating this relationship and information credibility moderating the effects. Employing a Partial Least Squares Structural Equation Modeling (PLS-SEM) approach, data were gathered from 325 employees of SMEs in Pakistan. This methodology was chosen for its ability to handle complex relationships between multiple variables simultaneously, offering robust insights into the interplay among sustainable leadership, sources of knowledge, information credibility, and frugal innovation. The results reveal significant associations between sustainable leadership, sources of knowledge, information credibility, and frugal innovation. Sustainable leadership demonstrates a substantial influence on both sources of knowledge and frugal innovation. Furthermore, sources of knowledge play a vital role in mediating the relationship between sustainable leadership and frugal innovation. Information credibility emerges as a significant moderator, affecting the pathways between sustainable leadership, sources of knowledge, and frugal innovation. The findings underscore the importance of sustainable leadership and credible information sources in driving frugal innovation within SMEs. They highlight the intricate interdependencies among these variables and emphasize the pivotal role of information credibility in shaping these dynamics. These results carry significant implications for SMEs in Pakistan, shedding light on the mechanisms through which sustainable leadership and reliable knowledge sources can stimulate frugal innovation in emerging economies.

Learning from socially driven frugal innovation to design the future of healthcare: A case of mobile Primary Health Center.

Background and Aim: Despite their flaws, the low-cost but powerful economical solutions can ensure everyone has access to health. The main aim of this study is to extract characteristics of frugal innovation (FI) and social innovation (SI) for Primary Health Centers (PHCs) in low resource settings (LRS) for sustainable development. We will use the gained insights to design the mobile primary healthcare infrastructure using FI and SI strategies. There is a lack of methodology to design sustainable healthcare infrastructure for LRS. There is a gap in the literature about building sustainable infrastructure to provide basic healthcare facilities essential to the community. This article studies several factors necessary for designing sustainable infrastructure from the lens of FI, SI, and sustainability to develop a mobile healthcare infrastructure for last-mile people. Methods: Started with purposive sampled case studies to find out factors and criteria that most affect the success for an innovation to be frugal, social, and sustainable. The established criteria were used to design, develop, and deploy the mobile Primary Health Center (mPHC). Moving forward, we tested the system designed with stakeholders to gather insights. At this stage we found the feedback loop from the stakeholders and the role of interdisciplinary discussions between experts, medical officers, nurses, patient, and other staff of PHCs during the design, development, deployment, and test stage to be useful in taking design decisions efficiently. Results: The designed healthcare infrastructure of mPHC through the aspects of FI and SI proves to be efficient in providing key healthcare services to LRS. Conclusion: Focusing on essential capabilities and optimizing performance with technology, methodologies, and processes reduces costs in an innovation. Focus on socially inclusive and rebalancing power disparities, overcome societal challenges and improve human capabilities will create a sustainable and novel solution.

Frugal indigenous vessel loop made from a surgical glove.

We report a simple cost effective alternative to commercially available vessel loops made from sterilized surgical gloves for retraction of vital structures during vascular trauma, micro-vascular, micro-neural surgery.

Task-shifting for point-of-care cervical cancer prevention in low- and middle-income countries: a case study from Uganda.

Cervical cancer remains the leading cause of female cancer deaths in sub-Saharan Africa. This is despite cervical cancer being both preventable and curable if detected early and treated adequately. This paper reports on a series of action-research 'cycles' designed to progressively integrate a comprehensive, task-shifted, point-of-care, prevention program in a community-based public health facility in Uganda. The work has been undertaken through a UK-Ugandan Health Partnership coordinated by Knowledge for Change, a UK-registered Charity. The intervention demonstrates the effectiveness of task-shifting responsibility to Community Health Workers combined with the use of Geographic Information Systems to strategically guide health awareness-raising and the deployment of medical devices supporting respectful and sustainable point-of-care screen-and-treat services. The integration of this with public human immunodeficiency virus services demonstrates the ability to engage hard-to-reach 'key populations' at greatest risk of cervical cancer. The findings also demonstrate the impact of external influences including the Results Based Financing approach, adopted by many foreign Non-Governmental Organizations. The model presents opportunities for policy transfer to other areas of health promotion and prevention with important lessons for international Health partnership engagement. The paper concludes by outlining plans for a subsequent action-research cycle embracing and evaluating the potential of Artificial Intelligence to enhance service efficacy.