• Social Innovation Fellowship

Award Year 

Zanzibar Utilization Project

MED International is a nonprofit that works on the supply, delivery and utilization of donated medical equipment to developing countries. Jayson Marwaha ’14 and a colleage of his, Han Sheng Chia '14, run the organization. Their Starr Fellowship proposal is part of MED International’s endeavor to increase the utilization of donated medical technology to Zanzibar. This will be accomplished in the summer of 2012 by working with recipients of medical equipment, the Ministry of Health and other local partners in Zanzibar over the course of 10 weeks.

MED International will broker its first international donation to Zanzibar, Tanzania in early 2012. This is a result of a partnership with the government of Zanzibar that Jayson established after meeting with the Second Vice President and Minister of Health of Zanzibar. The donations will support the implementation of Zanzibar’s extensive Essential Health Care Package, a government-run healthcare system overhaul. However, while donated technology may help alleviate high equipment costs and improve standards of medical care, it is of no use if the technology is not utilized on the ground. The Starr Fellowship will help Jayson and Hans gain a first-hand understanding of the barriers to utilization in Zanzibar. 

While in Zanzibar, Jayson and Hans aim to conduct a 3-part project comprised of a qualitative study, a quantitative study and a solutions development phase. The qualitative study involves conducting focus group discussions and key informant interviews with administrators and health professionals involved with the procurement and utilization process. This phase will give them an initial understanding of the barriers to equipment utilization.

This will be followed by the quantitative phase in which they administer a survey that numerically documents the extent of underutilization and the reasons behind it. The results from this quantitative survey will form the baseline for future years to compare their rates of utilization.

The final phase involves working with local and international partners to develop solutions to underutilization. These solutions can take place on two fronts: the first front will be an enhancement of MED International's matching process (i.e., accurately matching a facility’s needs with technology that addresses those needs) to increase the relevance of donations to the local Zanzibar context. By better understanding the local epidemiology of health facilities and their specific needs, Jayson and Hans will be more able to procure equipment that is suited for them, in turn increasing their technology utilization rates. The second front involves working with partners on the ground to meet barriers to utilization. For example, should hospitals require medical technicians to be trained in maintenance, Jayson and Hans plan on working with training facilities to develop this relationship. 

MED International’s commitment to Zanzibar’s medical equipment utilization extends far beyond Summer 2012. In the fall of 2012, Jayson and Hans will be refining MED International's matching and procurement processes based on their enhanced understanding of local needs. They will also move to offer a wider suite of services that increase the chances of utilization. This may include greater ties between technicians in Zanzibar and those working for US manufacturers. It may also include sourcing for spare parts and reagents that are necessary for the continued operation of the equipment. More importantly, MED International will maintain close ties with identified partners from Zanzibar who can coordinate our utilization strategies. It is crucial that MED International have a local network that can sustain the endeavor after Jayson and Hans's departure.  

Personal Statement

Jayson Marwaha is a sophomore at Brown and is majoring in Human Biology with an emphasis on health policy. Jayson is a member of the Program in Liberal Medical Education at Brown: an 8-year program that takes its students through 4 years of undergraduate school and 4 years at Brown Medical School. Given his proclivity for studying medicine, Jayson founded MED International in 2011 as a result of his heightened sensitivity to the wastage of fully-operational medical equipment; he believes that technology plays a central role in diagnosis and treatment, and that all health care facilities should have access to such technology. Jayson will be going to Zanzibar this summer with Han Sheng, his business partner, to study barriers to medical technology utilization in its public hospitals. 

The issue of equipment underutilization is inherently an incredibly exiting one to Jayson, especially since it focuses on resource-poor places as MED International hopes to do. The potential to raise the quality of health care in these regions is enormous given the large supply of used medical technology from the developed world. But this hasn’t yet been accomplished due to infrastructural barriers such as lack of electricity and trained personnel, as well as procedural barriers like matching the right needs with the right donations. But tackle these barriers, and all of a sudden, a burdensome metal behemoth of a machine transforms into a mode of access to outstanding medical care.

To fill the need for an organization that focuses exclusively on utilization, Jayson started MED International, a nonprofit that partners with local facilities to eliminate barriers and better match donations with needs. He then took this issue to U.S. distributors who expressed interest in donating surplus equipment for a tax deduction. After this, he met with Zanzibar's Vice President and Deputy Minister of Health, who described a need for the effective introduction of technology and an interest in collaboration. The goal of MED International is to increase access to appropriate medical technology in Zanzibar so that hospitals there can deliver the necessary health care to those who need it most.