Disclaimer: The views expressed in this paper/presentation are the views of the author

and do no necessarily reflect the views or policies of the Asian Development Bank
(ADB), or its Board of Governors, or the governments they represent. ADB does not
guarantee the accuracy of the data included in this paper/presentation and accepts no
responsibility for any consequence of their use. Terminology used may not necessarily
be consistent with ADB official terms.
the essential, accessible, smart, integrated operating room

A paradigm shift in Global Health

Russell Gruen MBBS PhD FRACS Esabelle Yam BSc (Hons)

Professor of Surgery, Manager,

Lee Kong Chian School of Medicine; Centre for Global Health,
Executive Director, Lee Kong Chian School of Medicine
NTU Institute for Health Technologies
3
Period Stage Focus

15th century - Colonial Conceptions of Non-native diseases, Process of urbanization (crowded

1914 Health urban centers), Mechanisms of oppression (served the
interests of colonial powers)
Early 19th Early Conceptions of Germ Theory, bacteriological paradigm dominated-
century - 20th Medicine - Therapeutic research.
century Revolution
1955 – 1990s Eradication Efforts: Malaria Malaria - Suboptimal results achieved and emergence of
vs. Smallpox resistance to DDT and anti-malarial drugs. Realisation that
poor health systems were incapable of effectively
implementing novel tools and providing adequate
surveillance.
Smallpox - eradication declared in 1980!
early 1970’s Primary Health Care - Shifts Shift in focus to socioeconomic status, distribution of
in Conventional Wisdom resources, a focus on health system development, and
emphasis on basic health services.
1980s Selective Primary Health • GOBI-FFF
Care GOBI - Growth monitoring, oral rehydration therapy,
breastfeeding, and immunization (GOBI).
FFF - Family planning, female education, and food
supplementation
late 1970s to The Development Development, Neoliberalism, and Structural Adjustment
mid-1980s Discourse
2000s Modern Global Health Drug Resistance, chronic diseases, ageing populations
Challenges
7
Features of the ‘next paradigm’

1. Driven by GBD priorities

2. Systems-focused as well as individual disease &
social determinants-focused
3. Facility-based as well as community and
healthworker-based
4. Technology-enabled to leapfrog developed
economies
5. Sustainable innovative financing as well as aid &
public funding: business as part of the solution.
8
Health Care Facilities

Scholz et al. BMC Health Services Research (2015) 15:183

9
Global Surgery 2030: A Lancet Commission

Universal access to safe,

affordable surgical and
anesthesia care when needed
 Lancet Commission in Global Surgery
5 Key Messages
• 5 billion people lack access to safe, affordable surgical
and anaesthesia care when needed.
• 143 million additional surgical procedures are needed
each year to save lives and prevent disability.
• 33 million individuals face catastrophic health
expenditure due to payment for surgery and anaesthesia
each year.
• Investment in surgical and anaesthesia services is
affordable, saves lives, and promotes economic growth.
• “SURGERY IS AN INDIVISIBLE, INDISPENSABLE PART
OF HEALTH CARE.” Dr Jim Kim, President, World Bank.
The Global Surgery 2030 Movement
Government, NGOs & Intergovernmental agencies; Collaborators in
over 110 countries; Over 300 publications, abstracts & teaching cases

Consensus on safety &

quality standards

Consensus on role of
district level hospitals

Global Indicators:
Access, Workforce,
Volume, Safety, Financial
Protection

Support for National

Surgical Plans
 National Surgical Plans

6 Global Surgical Indicators

1.The geographic accessibility of surgical
facilities
2.The density of specialist surgeons,
anaesthetists, and obstetricians
3.The number of surgical procedures per
100,000 population
4. Perioperative mortality rates
5. The risk of impoverishing expenditure
when surgery is required
6. The risk of catastrophic expenditure
when surgery is required.
Facility & Equipment Challenges
Lacking Physical Infrastructure
(% Hospitals)
So How?
• Wait for public hospitals to be rebuilt.

• Supplement with private hospital chains

• Upgrade equipment while doing necessary

building repairs.

• Utilise existing modular hospital solutions

• Utilise compact mobile surgical solutions

Current Solutions are temporary, expensive, not scalable or
irrelevant to local settings
 Next Generation Facilities
Component 1 – Component 4 –
Physical Technical Medical
Infrastructure Equipment

Component 2 – Component 5 –
Compound Information
Communication
Technology

Component 3 – Component 6 –
Supply & Utilities Ventilation &
Disposal System

A turn-key infrastructure, equipment and supply-chain solution that enables rapid

provision and scale-up of surgical capabilities at district/first-referral hospitals through a
prefabricated, fully-equipped, rapidly-deployable, all-in-one operating theatre suite.
 Component 1 –
Game-Changing Construction Technique
Physical Infrastructure
Prefabricated Prefinished Volumetric Construction

Video illustration of PPVC at work: https://www.youtube.com/watch?v=_bzFIT08NAc

 Component 2 –
District & 1st-Referral Level Hospitals
Compound
Integration and Capacity Building

Number of Hospitals in Myanmar:

Type Beds Numbers Remarks

National 1000+ 3
NTU
State 300~500 Institute for
34
Health
District 100~200 Technologies
58
Laparotomy,
Township ~50 272 LUSCS
Many have NO
Station 5~10 0 surgery

easiOR - Fully-equipped theatre,

Reception, operating room, sterilisation,
storage, utilities & recovery rooms.
Component 3 – Green & SMART
Supply & Utilities Stable Energy, Clean Water and Gases Supply
Data for Optimal Usage
Component 4 – Standardisation & Optimisation
Technical Medical Maximal Intraoperative Utility, Minimal Wastage
Equipment

• Agreed procedures that district

hospitals should provide
• Standardized, procedure-specific
surgical instrument tray sets

Treatment
Caesarean open
Laparotomy
Delivery fractures

• Data analytics for optimal

consumables usage and minimal
wastage, and for equipment
maintenance feedback.
Component 5 – SMART Hospital
Information Communication Technology IT-Enabled, Data-Rich

Electronic
Health Records
Tele-Health
Remote
Diagnostics/Consultation
endless possibilities…
Internet
Component 6 –
Ventilation & Disposal
System
First Installation in Myanmar

Hinthada General Hospital

• 200-bed township hospital
in the Ayeyarwady Delta,
• approximately four hours’drive from Yangon
• 3 easiOR surgical theatres

North Okkalapa Hospital

1000+ bed teaching hospital on the outskirts of
Yangon City
• 2 easiOR general/emergency surgery theatres
Disruptive technologies will help health systems in
emerging economies leapfrog developed economies

From: Health Systems Leapfrogging in Emerging Economies, World Economic Forum 20

Alternative financing models

Can Business Drive

Development?

Universal access to safe,

affordable surgical and
anesthesia care when needed
Contact Details:
Prof Russell Gruen
Executive Director, NTU Institute for Health Technologies
Nanyang Technological University, Singapore.
rgruen@ntu.edu.sg