Please find below the link to our paper on how ideas of what makes a good POC diagnostic play out in practice, using the case of what is a good tomato to think this through. Feedback is most welcome!
We show how a certain definition of simplicity comes to dominate over others and what that does. And how contrary to a laboratory based diagnostic, for POC diagnostics, simplicity is part of what makes a good POC test. It helps if you can label a diagnostic as simple, it is performative in the sense that it attracts funders and aligns with global design standards, it legitimizes and adds value—simplicity is valorizing. Yet, simplicity is not enough value, it interacts and competes with other valuation registers of accuracy, cost, workflow, or patient pathways.
our study juxtaposes different viewpoints and valuation practices from actors across the design, development, and implementation spectrum. The case of developing POC diagnostics, therefore, also shows how the evidence underpinning these new technologies is framed from the top down and adapted or even ignored through the practices of end-users in their local therapeutic milieu. When making these therapeutic tools and diagnostics work in local practices, dominant understandings of simplicity are complicated and dominant, global valuation practices are also being challenged. Yet, in these top-down/bottom-up dynamics, local user practices cannot un-do entirely the design choices and selections that have been made earlier. Just like in the tomato case, where the competition between different actors’ registers might overrule the consumer’s values and lead to a tomato in the supermarket that is not particularly tasty, powerful global health actors, and donors dominate these valuation processes. They determine which innovations are being supported and how they are being developed and evaluated by defining design targets, funding mechanisms and setting market and evaluation standards.
We argue among others for the need for building different types of testing infrastructures, paying more attention to situation specific adaptations and broadening the criteria of evaluation. Regulatory authorities and procedures to evaluate new tests, which were established before POC diagnostics were available, should include these operational and contextual aspects [Palamountain et al., 2012]. Our analysis shows that this requires critical reflections on three key questions. First, where is simplicity in these value registers located? Is it inside the device, in the user steps or in other parts of the diagnostic process? Next, who are the users for whom these diagnostics need to be simplified? Lastly, what is the purpose of these innovations? Do these aim at widening access and providing greater equity of care or keeping costs of the device low and/or avoiding investments in infrastructure for delivering equitable healthcare?