The search for the holy grail: frugal innovation in healthcare from low-income or middle-income countries for reverse innovation to developed countries

Abstract

The healthcare sector stands to benefit most from frugal innovation, the idea that more can be done for less for many more people, globally. As a first step for health systems to leverage new approaches to offset escalating health expenditures and to improve health outcomes, the most relevant frugal innovations have to be found. The Institute of Global Health Innovation was commissioned by the US-based Commonwealth Fund to identify frugal innovations from around the world that could, if transferred to the USA, offer approaches for expanding access to care and dramatically lower costs. Our global scan was motivated by the need to extend the list of frugal innovations in healthcare beyond the impressive but oft-repeated examples such as GE’s MAC 400, a US$800 portable ECG machine, Narayana’s US$1500 cardiac surgery and Aravind’s US$30 cataract surgery. Our search involved (1) scanning innovation databases, (2) refining frameworks to identify frugal innovations and evaluate their reverse potential and (3) developing in-depth case studies. From 520 possible innovations, we shortlisted 16 frugal innovations that we considered as frugal and with potential for reverse diffusion into high-income country health systems. Our global search was narrowed down to three care delivery models for case analysis: The Brazilian Family Health Strategy around community health workers; Singapore-based GeriCare@North use of telemedicine and Brazil’s Saude Crianca community involvement and citizenship programme. We share core features of the three frugal innovations and outline lessons for practitioners, scholars and policymakers seeking to lower healthcare costs while increasing access and quality.

From Malawi to Middlesex: the case of the Arbutus Drill Cover System as an example of the cost-saving potential of frugal innovations for the UK NHS

“…In 2015 we conducted a global search of hundreds of cost-saving innovations including products, processes and policies that addressed all types and domains of healthcare 10 11. Key criteria used to evaluate frugality included affordability, adaptability and accessibility.…”

Together we unite: the role of the Commonwealth in achieving universal health coverage through pharmaceutical care amidst the COVID-19 pandemic

“…ICT offers many opportunities to increase access to healthcare and support everyday practice by pharmacists. Low-cost innovations such as Mobidawa and WelTel mobile phone technologies to disseminate health messages, for example specific information on how to take medication, supports communication with traditional 'hard-to-reach' communities in Kenya and Cameroon [18]; increasingly African network providers are sending public health information and alerts such as reminders to use malaria nets during national prevention week.…”

Transdiagnostic treatment approaches for greater public health impact: Implementing principles of evidence‐based mental health interventions

“…Clinicians often choose to use treatments in a modular or nonlinear fashion or both following training-picking and choosing elements from protocols. As an example of reverse innovation (Bhatti et al, 2017), CETA is currently being implemented in Washington state behavioral health agencies, with initial program evaluation data indicating high acceptability among community providers due to the CETA's simple, modular and flexible format (L. Berliner, personal communication, November 1, 2016). This research suggests that providers will modify interventionsregardless of whether the design allows for modifiability and flexibility-and that treatments that are modular and flexible may be more acceptable to providers and more likely to be adopted.…”

“…For example, if all child-focused mental health providers in the United States were immediately trained in a "first course" intervention like FIRST, with only five principles taught over 2 days, providers could more quickly begin addressing many of the presenting, comorbid problems they face in community practice. Applying reverse innovation (Bhatti et al, 2017), training providers in PM+ may also offer advantages in the United States, given its even greater reduced complexity.…”

“…As others have argued, alternative solutions to both the treatments and their delivery are needed. Building on National Institutes of Health (NIH) recommendations for collaborative efforts across countries and leveraging "reverse innovations" (Bhatti et al, 2017), in which the United States also benefits from innovations in LMIC, we highlight transdiagnostic approaches developed specifically for LMIC which may have high applicability in the United States. Our perspective is grounded in a public health approach, which emphasizes the importance of disseminating and implementing interventions with the potential for high overall population impact, that is, "beginning with the end in mind" (World Health Organization, 2011).…”