Technologies that have been designed for use in high-income countries often fail to deliver their full potential when transposed to Low and Middle-Income Contexts (LMICs). The health sector is a case in point, as medical devices, whether donated or purchased, are generally short lived in those contexts. The mismatch between needs and available solutions originates from the inadequacy of both the technology and the business models. Essential medical technologies such as oxygen concentrators, neonatal incubators, anesthesia machines or diagnostic X-ray systems are classic examples. The case of diagnostic X-ray imaging is particularly striking: 125 years after its invention, up to two thirds of the world population still does not have access to radiology services, according to the World Health Organisation. This is despite the fact that X-ray radiology is one of the cornerstone of healthcare and a crucial instrument for diagnosing a variety of health issues ranging from trauma to tuberculosis and other lung diseases.We are presenting an integrated methodological approach, to develop innovative solutions adapted to the context of LMICs. The approach relies on three crucial pillars: cooperation, interdisciplinarity and entrepreneurship with a long-term sustainability perspective. We propose a set of four complementary tools that increase the chances of successfully developing and deploying the technologies at scale. The tools, while very practical, allow striking a balance between economic viability, environmental and social impact. We illustrate the use of these tools with the case of diagnostic X-ray imaging. We propose that using the approach and tools presented here could allow to rethink other complex technologies that have the potential to address social challenges, in the perspective of making them suitable for LMICs. We also believe that this approach to developing solutions addressing the needs of poorer communities, may lead to better products in industrialized contexts as well.

Vaccines need to be continuously stored between 2°C to 8°C, from their production to administration to beneficiaries. Every year, more than 25% of vaccines are wasted. One of the main reasons for this wastage is the lack of cold chain continuity in low-income settings, where electricity is scarce. Recently, several advances have been made in cooling technologies to store and transport vaccines. The current paper presents a review of refrigeration technologies based on scientific publications, industry white papers and other grey literature. For each refrigeration method, we describe its working principle, the best performing devices available as well as the remaining research challenges in order to obtain a very high degree of performance enhancement. Finally, we comment on their applicability for vaccine transport and storage.