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2020 Year in Review: Crisis, Change, and Community

Dec 14, 2020

COVID-19 has demanded transformation and growth that could only have been achieved through a community’s commitment to deliver. Here are some of the moments of commitment and collaboration that touched, shaped, and improved our work this year as well as a video message expressing our gratitude to everyone who went above (and continues to go above) the call of duty.




Focusing for Greatest Impact: Infrastructure & Relationships

From the onset of the COVID-19 pandemic, we’ve taken seriously our position as one of the only medical technology organizations with a specialization in anesthesia and critical care support in Africa and Asia. Gradian’s offerings are designed to fill the most pressing gaps in provider practice and patient care, which is why as the coronavirus spiked, the Gradian Comprehensive Care Ventilator (Gradian CCV)—with its long battery life, ability to support multiple oxygen sources, and provision for invasive and non-invasive ventilation—was selected by several governments to expand national critical care capacity. It was this long-term capacity building orientation—a demand born of COVID-19, but a need present for decades—that drove Gradian’s decision to focus its efforts in fewer than 10 countries, where our infrastructure for technical support and clinical training could serve as a basis to build capacity to both combat COVID-19 and serve long-term critical care needs. Specifically, we formed large-scale, strategic partnerships with the governments of Uganda, Kenya, Tanzania, and Sierra Leone to expand country-level capacity at regional referral hospitals to respond to the state of crisis that the pandemic highlighted.


Building to Last: Manufacturing, Supply Chain & Logistics

For Gradian, our work starts with introducing high-quality medical equipment that can meet the needs of the provider. While overburdened by the pandemic, our manufacturing, supply chain, and logistics partners continued to diligently support Gradian’s mission. The stories of hard work and kindness are innumerable, but we’d like to take a moment to highlight those efforts, organizations, and individuals that put products in the hands of providers:

  • We want to recognize all our manufacturing partners—large and small—for accelerating and expanding production capacity, while increasingly facing barriers to in-person work. Notably, the team manufacturing the Gradian CCV increased production 10-fold to meet the spike in demand for mechanical ventilation.
  • Comprising more than 100 component parts, the Gradian CCV’s full configuration relies heavily on small parts suppliers, who also found themselves as severely affected by the pandemic as large manufacturers. Two of Gradian’s CCV suppliers, Big Blue Saw and iMakr, produce components using innovative methods and went above and beyond to deliver much needed parts: Big Blue Saw uses waterjet and laser cutting and iMakr uses 3D scanning and printing to create small, custom parts for the Gradian CCV’s stand, which is critical for the provision of bedside care. Despite facing a spike in demand for their services at the height of COVID-19, both partners reconfigured their production processes to deliver parts in 48 hours, rather than the typical weeklong production timeline.
  • Once the manufacturing and supply chain partners did their part, Gradian’s logistics partners—facing the most complex global logistics environment in modern history—transported and delivered more than 425 ventilators and pulse oximeters, respectively, alongside hundreds of airway kits to meet the needs of COVID-19 response. Partners like DHL and the World Food Programme—who early this year was awarded the Nobel Peace Prize for its logistics support for coronavirus response—and local partners, like clearing agents, truck drivers, and even boat captains, helped us route, re-route, move, and deliver critical shipments.


Connecting to the Customer: Distribution, Installation & Service

Gradian’s network of over a dozen distributors play a critical role in connecting customers to healthcare solutions. Whether the need is high-quality medical equipment, critical consumables, or essential accessories, these distributors are the bridge to healthcare service delivery. More importantly, our distribution partners ensure Gradian medical equipment is properly installed and maintained to maximize proper use and minimize downtime. Since April 2020, more than 40 Gradian-certified biomedical technicians based with our distribution partners embarked on the largest equipment installation effort in our history, fortifying the fight against COVID-19 at the frontline.

  • From April onward, Gradian-certified BMETs installed Gradian CCVs across nearly 60 facilities in more than 10 countries.
  • Early in the pandemic, PPE shortages persisted and ministries of health established care centers to manage the most severely ill patients, making equipment installation particularly precarious and unpredictable. Furthermore, due to limited equipment availability and scarce human resources needed for COVID-19, ministries of health at times shifted equipment and trained personnel, which increased the need for re-installations and training of facility-based biomedical and clinical staff.
  • 2020 also highlighted the critical importance of strong relationships between customers, BMETs, distributors, and manufacturers. These relationships enabled rapid identification of supply chain challenges for parts and user errors, both of which spiked in 2020 due the pace of equipment distribution. The robust communication chain from customer to distributor (and the technicians within), and then back to Gradian, enabled us to rapidly work with manufacturers to deploy additional parts, when needed, and communicate directly with customers to enhance user knowledge, better supporting providers’ ability to operate with confidence.
  • This year also demonstrated the criticality of consumables and accessories in the optimal use of medical equipment. As more equipment was installed, the demand for consumables and accessories—such as bacterial filters, breathing circuits, non-invasive ventilation masks, and blood gas analyzersgrew in parallel. Distributors and technicians not only became a central source for identifying these trends, but led efforts to fill these customer needs as well.
  • And while distributors and technicians were stretched thin supporting COVID-19 response activities, they also continued to install, maintain, and repair new and existing Universal Anaesthesia Machines (UAMs)—which in many facilities serve as a critical piece of equipment in the delivery of emergency obstetric services and C-sections. Like all our partners, they found innovative ways to conduct these services virtually, working closely with facility or district technicians to ensure optimal equipment oversight.


Expanding Workforce Capacity: Training & Mentorship

2020 saw the coming together of meaningful partnerships between ministries of health, professional societies, and academic institutions. These partnerships enabled Gradian’s network of clinical trainers and staff to develop and deliver training to more than 1,900 healthcare providers, including physicians, nurses, and clinical officers. The contributions of our clinical trainers—who at the time were also providing care on the frontline—have led to innovations and improvements in our training model we know will have lasting effects on trainees.

  • In response to the pandemic preparedness efforts, many of Gradian’s 70 clinical trainers provided Gradian CCV product, clinical refresher, and COVID-19 response training to more than 1,500 users. This amounted to trainees receiving approximately 27,000 hours of product, clinical refresher, and COVID-19 trainings, the latter covering topics such as ventilation, oxygen therapy, and personal protection.
  • Our family of clinical trainers and advisors also played a critical role in helping the global care community quickly interpret, adapt, and disseminate the rapidly evolving clinical guidance on COVID-19. This helped healthcare workers stay informed of protocols, safety measures, isolation techniques, and treatment regimens while supporting health system leaders make decisions about limited resources.
  • Many within the Gradian clinical training network also helped rapidly review and provide counsel on our own materials, as we converted our trainingswhich are usually delivered in person and across multiple days—into high-quality online trainings available through the Gradian Training Resource Center. These trainings now consist of 12 offerings that can be accessed globally.
  • This year, physician teams from Johns Hopkins University, the Association of Anesthesiologists of Uganda (AAU), and the Kenya Society of Anaesthesiologists (KSA), also helped pioneer the next evolution of training programs supported by Gradian. These months-long training programs seek to leverage existing Gradian infrastructure—from online trainings to simulation-based scenarios—to provide healthcare providers more frequent and ongoing training opportunities. Specifically, these longer form trainings aim to offer key skill building opportunities, and in some instances, incorporate real-world cases into instruction. We’re excited to report that our early evaluation of this work found that following these trainings, facilities reported increased ability to receive higher volumes of critical care, with greater case complexity.
  • Similarly, in Tanzania, local senior anesthesia and critical care specialists are helping Gradian develop tailored mentorship plans for in-service providers to offer customized learning experiences for care teams, with a focus on leadership and communication.


Forming Community: Coalitions & Partnerships

This was a year marked with the formation of new and strengthened partnerships to overcome challenges presented by both the pandemic and systemic healthcare inequity. These networks helped foster sharing critical information, raising common challenges, and focusing attention as needs around COVID-19 grew and changed.

  • Networks such as the Every Breath Counts Coalition and the Southern African Development Community (SADC) Technical Experts Working Group on Surgical Healthcare served as important spaces for sharing country-level experiences with global-level inputs from organizations like the WHO. These spaces convened partners from various sectors—multilaterals and bilateral organizations, large and small NGOs, academic institutions, and private industry—who together, continue to work toward effectively responding to COVID-19. For Gradian, these fora helped foster important connections with other organizations in the countries where we work, workshop solutions to emerging challenges, learn from the experiences of others, and focus our efforts for more impact as a result.
  • Funders like Grand Challenges Canada, UBS Optimus Foundation, and ELMA Philanthropies also joined forces to provide Gradian funding that enabled us to conduct more robust, ongoing trainings in Kenya, Sierra Leone, and Uganda. Grant support like this served as a critical addition to enable Gradian to adapt and refine our training model and better serve the needs of healthcare providers.
  • And as we focus on funders, we want to recognize longstanding and new partners that invest in global health innovations like ours. They do so through traditional grants; flexible financing instruments (offered by the US International Development Finance Corporation); and the use of their platforms and relationships to shine a light on the work, models and best practices of innovators. Additionally, it’s the work financed by past traditional grants—like Grand Challenges Canada’s 2018 Saving Lives at Birth funding, which aimed to strengthen emergency obstetric services in Zambia—that contributed to supporting service delivery during COVID-19, supporting the resilience of maternal health services even as lockdowns slowed healthcare delivery in Zambia. Lastly, robust innovation networks supported by partners like USAID helped connect us to the WHO efforts aimed at identifying technologies best suited to support COVID-19 response.


Looking Ahead

As we look ahead, we know the challenges presented by COVID-19 will continue to grow. But we are also confident that the immense strength, resilience, and capability demonstrated by the entire healthcare community—from facility, district, national, regional, and global levels—will grow as well. For Gradian, we know 2021 will bring a renewed focus on refining and strengthening our model to deliver greatest impact. We will continue to listen, remain flexible, and keep the provider at the center of our decision-making, while investing in local priorities and homegrown solutions, to serve a wider range of needs in our markets. And through this work, we will share more insights on the impact of Gradian’s model; where we’re able to effect change and where we—as an organization as well as a community—need to work harder.