A problem of two worlds
Imagine a state-of-the-art diagnostic test, engineered for precision in a German laboratory. Now, picture that same test in a small clinic in Nigeria, trying to survive 32°C heat, 80% humidity, and an unstable power grid. Does it still work?
This question reveals a fundamental knot in global health. To untangle it, we must move beyond simply delivering tools and start co-creating them with the communities they are meant to serve.
A recent collaboration between German and Beninese institutions exemplifies this approach. The NOMADIX project, supported by the GIZ Hospital Partnerships funding programme, aimed to transform a laboratory prototype into a lifeline. German technical expertise merged with Beninese clinical insights, turning a rapid molecular test into a streamlined, robust, and climate-resilient tool ready for evaluation at Bethesda Hospital in Cotonou, the administrative capital of Benin.
Such partnerships are not just beneficial to global health. They are its future.
Why good tests fail in the field
Diagnostic tools engineered for high-resource settings are often destined to fail in rougher environments. These tools are built to work within contexts that are very different from the ones where tropical diseases like malaria thrive. It is like taking a Formula 1 race car and expecting it to win on a muddy, rural road. The tool isn’t flawed; it was simply built for a different world.
In a low-resource region, the electricity grid can be unstable. This means that power interruptions can impact temperature-sensitive reagents, or even worse, halt equipment right in the middle of a critical procedure. And even when electricity is available, clinics rarely have perfectly climate-controlled laboratories. The result? A brilliant test becomes useless, its delicate chemistry ruined by the heat and humidity. A diagnosis is lost before the test can even begin.
Building a better test together
In the case of NOMADIX, early versions of the malaria test assumed access to controlled laboratory conditions for users. That may be a standard in German facilities, but it is an unrealistic assumption in Benin Republic’s underfunded clinics. This realization forced a critical shift in perspective. Instead of pushing a German standard, the team began to evolve the diagnostic test through key adaptations centered around robustness, informed by Benin’s realities.
For example, a pre-mixed, dry reagent mixture was formulated to ensure the diagnostic test could tolerate more variable storage conditions, addressing the issue of clinics without stable refrigeration. As a laboratory technician in the country noted, “We don’t have -80°C freezers, we have heatwaves.” Formulating this pre-mix, as well as developing a fully integrated, contamination-proof assay format, also helped streamline the protocol, cutting the number of steps needed to complete the test in half. For a busy technician, this means saving precious time and dramatically reducing the chance of error.
The project’s success was built on a true ecosystem of expertise. International partners like Fraunhofer IZI and Leipzig University brought manufacturing power and bioinformatics expertise, respectively. At the same time, local partners like RoK Diagnostics managed logistics while Hôpital BETHESDA and Oriental Medical Centre supplied vital clinical samples and feedback. But the most transformative role was played by the Beninese lab technicians. They were not treated as end-users. They became co-developers, using their daily experience to flag the crucial issues of reagent storage and workflow bottlenecks.
Three key lessons from the field
Our experience highlighted at least three lessons:
1. Test where the disease lives.
Consider the data - in a German lab, we might find 10 malaria samples in a year. In Benin, we found nearly 300 in just eight days (> 15 percent positive). This disparity underscores a universal lesson. High-prevalence regions like Benin are irreplaceable for rapid, real-world validation. The need is not just logistical, it is existential. Tools validated only in low-burden, high-resource settings, using spiked or standardized controls risk becoming orphan technologies. Although they will be precise in theory, they will be irrelevant in practice, because no one will use them.
2. Design for the worst-case scenario.
Assume higher temperatures and frequent power interruptions. Building for the toughest environments shows respect for the reality people face every day. Resilience cannot be an afterthought.
3. Make the local laboratory technicians co-developers.
Front-line workers are not mere end-users, but partners who hold essential knowledge. Their feedback exposes fatal flaws that are invisible in a controlled laboratory, transforming a prototype into a practical tool. As the difference between a research lab and a busy commercial lab is immense, their real-world expertise is not just helpful, it is irreplaceable.
Making collaboration the new standard
These lessons do more than show us a better way forward, they demand it. To make collaboration the new standard, we must intentionally change the systems that reward our work. The push can start with how we fund global health. Indeed, funding agencies hold the power to rewrite the rules. They can redesign grant reviews to prioritize and reward genuine partnerships, making collaboration the most attractive option. Universities must also redefine what success looks like within their own walls. They can update promotion guidelines to formally recognize the slow, essential work of building relationships and mentoring local scientists. Finally, scientific journals can serve as the gatekeepers for a new standard of excellence. They could encourage authors to include a 'Partnership Statement' with their research, making collaboration a visible and valued part of the scientific record. Together, these shifts create a virtuous cycle, ensuring the most collaborative science becomes the most funded, celebrated, and rewarded.
A vision for the future
If a test works in Europe but fails in Africa, it is not progress. It is exclusion. The true measure of innovation is not a solution that works in a sterile lab, but one that saves a life in a remote village. This will allow us to create solutions that function as brilliantly under a tin-roofed clinic as they would in a sterile laboratory.
The project outlined in this essay will lead to the production of a tool tailored to local realities, proving that cooperation can turn prototypes into lifelines. But this cannot remain an outlier. The era of parachute research (of dropping in and flying out) is over. To meet the challenges of a changing climate, we must fully commit to a rooted collaboration model.
If we do so, the next generation of breakthroughs will emerge not just from pristine labs, but from the humid, chaotic, and vital heart of the tropics. The choice, ultimately, is ours. Will our work save lives, or will it simply gather dust on a shelf?