Increasing Medical Technology Use in Zanzibar, Tanzania Jayson Marwaha Han Sheng Chia Natalie Ring Elizabeth Kinnard

Zanzibar is made up of 2 islands 1 Million People Just a 48 -Year Life Expectancy Only 1 Tertiary Hospital 8 Secondary Hospitals PROBLEM 1 All Hospitals Lack Life Saving Equipment

1. Zanzibar receives costly equipment, patients benefit 2. US facilities receive tax-write offs, 3. Excess machines avoid idling/land fill, win-win-win solution SOLUTION 1 US facilities have excess equipment due to big budgets Excess is sold/scrapped/idles MED International collects excess Delivers it to Zanzibar

But wait… 70% of equipment donated to the developing world is wasted 1 Why? Donated equipment is 1. poorly matched to needs of recipient 2. Barriers to Utilization like no engineers/ spare parts/ reagents prevent continuous use PROBLEM 2 1 Malkin 2007

Good Matching: The pairing of donated equipment to the needs and capacities of recipients Barrier Elimination: The design of support systems such as technician training and access to spare parts necessary for the continuous operation of equipment SOLUTION 2 MED International will incorporate 1. Good Matching and 2.Barrier Elimination into our Donation Strategy

Donation Strategy with Good Matching + Barrier Elimination We coordinate 3 primary functions Domestic Shippers International Shippers Suppliers Suppliers donate the equipment, local transport firms deliver it to port, Tanzanian government ships it to Zanzibar Barrier Elimination Barrier Elimination Good Matching To increase utilization, MED International employs good matching and works with partners to eliminate barriers on the ground

Barrier Elimination Specifics Zanzibar Hospital Lack of US made Spare Parts Equipment Breakdown Equipment Breakdown No Trained Staff Undefined Barrier* Barrier to Utilization Partners & Solution Providers MED International + Manufacturers MED International + Manufacturers Trained Maintenance Unit Practitioner training facilities TBD Solution TBD Solution *More barriers, and priority of barriers to be determined during summer assessment in Zanzibar

Other Organizations in this Space They focus $ on Horizontal Integration– Expanding the supply of equipment to many countries without good matching or barrier elimination leading to 70% under utilization Rwanda BoliviaNigeriaVietnam EquipmentEquipmentEquipmentEquipment We focus $ on Vertical Integration Zanzibar Technician Training Access to Spare Parts Access to Reagents Equipment One location+ More services = Higher Utilization

Vertical Integration is Challenging Government of Zanzibar Partner, Recipient Ivo de Carneri Foundation Advisor Cadwalader, Wickersham & Taft, LLC Legal Representative Brown University Sponsor, Advisor NUS School of Public Health Advisor Equipment Donors* African Engineering Schools and Reagent Suppliers** *Company name confidential for indemnity ** Relationship TBC But a growing network of partners & advisors situates us well

Partners in Zanzibar Chake Chake Hospital has a parasitology lab, the room is there, but it is empty. - Yahyah Al-Sawafy, Resident Representative Ivo de Carneri Foundation I am the only biomedical engineer… Spare parts and training upgrade. Both are important for us. - Marine Mathna, Biomedical Engineer Mnazi Moja Hospital I am pleased and satisfied with the discussions we had and I look forward to working with you very closely to implement what we have agreed upon. - Amb. Seif A. Iddi, 2 nd Vice-President of Zanzibar Co-Director Jayson Marwaha meets 2 nd VP Seif A. Iddi

Timeline Aug 2011 Oct Jan-Mar 2012 Mar Apr MED International incorporates Jayson Marwaha meets Zanzibar Government MED liases with Zanzibar contacts, receives hospital needs list Forms new board of directors, expands operations team Sends 1 st Shipment for MOH Chemistry Laboratory to Baltimore port Milestones Next Steps Apr Apr-Jun Jun-Aug Aug- Dec Jan-May 2013 Preparation for 2 nd Shipment Design summer 10-week study in Zanzibar Liaise with engineering contacts Execute 2 nd shipment 10-week study in Zanzibar to evaluate barriers to utilization Negotiations with MOH, training schools, engineers, suppliers in Zanzibar Compile data Expand number of donor suppliers Expand funding base Two more shipments Training of 2 biomedical technicians from Zanzibar

Potential Funding Model In the near future, we aim to adopt a resale model For every 10 pieces of equipment that suppliers donate, we will sell 1 on the second hand US market and donate 9 to Zanzibar *Ratio TBD All funds will be channeled back into the organization to cover operations cost, reducing dependency on grants We have been working with our lawyers and will meet with suppliers in June to structure this

Why Zanzibar? Why Now? Zanzibars Ministry of Health is rolling out its Essential Health Care Package (EHCP) and we are an official partner The EHCP is a health care revamp of all its public health facilities Government motivation for better health care is high Needs are great MED International is positioned to capitalize on this. With your help, we will be able to bring and support vital medical equipment to the people of Zanzibar And they need support