Criteria to assess potential reverse innovations: opportunities for shared learning between high- and low-income countries

Onil Bhattacharyya,Abdallah Daar,Kathryn Mossman,Anita Mcgahan,Andrea Taylor,Diane Wu,Pavan Gill,Stanley Zlotkin,William Mitchell,Dilip Soman,Leigh Hayden,Christina Synowiec,Yu-Ling Cheng,Max Von Zedtwitz,Joseph Wong

doi:10.1186/s12992-016-0225-1

Abstract

BackgroundLow- and middle-income countries (LMICs) are developing novel approaches to healthcare that may be relevant to high-income countries (HICs). These include products, services, organizational processes, or policies that improve access, cost, or efficiency of healthcare. However, given the challenge of replication, it is difficult to identify innovations that could be successfully adapted to high-income settings. We present a set of criteria for evaluating the potential impact of LMIC innovations in HIC settings.MethodsAn initial framework was drafted based on a literature review, and revised iteratively by applying it to LMIC examples from the Center for Health Market Innovations (CHMI) program database. The resulting criteria were then reviewed using a modified Delphi process by the Reverse Innovation Working Group, consisting of 31 experts in medicine, engineering, management and political science, as well as representatives from industry and government, all with an expressed interest in reverse innovation.ResultsThe resulting 8 criteria are divided into two steps with a simple scoring system. First, innovations are assessed according to their success within the LMIC context according to metrics of improving accessibility, cost-effectiveness, scalability, and overall effectiveness. Next, they are scored for their potential for spread to HICs, according to their ability to address an HIC healthcare challenge, compatibility with infrastructure and regulatory requirements, degree of novelty, and degree of current collaboration with HICs. We use examples to illustrate where programs which appear initially promising may be unlikely to succeed in a HIC setting due to feasibility concerns.ConclusionsThis study presents a framework for identifying reverse innovations that may be useful to policymakers and funding agencies interested in identifying novel approaches to addressing cost and access to care in HICs. We solicited expert feedback and consensus on an empirically-derived set of criteria to create a practical tool for funders that can be used directly and tested prospectively using current databases of LMIC programs.

Highlights

Low- and middle-income countries (LMICs) are developing novel approaches to healthcare that may be relevant to high-income countries (HICs)
While the use of the term “reverse” is controversial, the opportunities for HICs to learn from LMIC innovation are compelling
The second part reviews the health challenge addressed by the innovation, the compatibility with infrastructure and regulations, the novelty of the innovation, and the receptivity for the innovation in the HIC

Summary

Introduction

Low- and middle-income countries (LMICs) are developing novel approaches to healthcare that may be relevant to high-income countries (HICs). The relevance of these innovations to HIC settings has only recently been acknowledged, due to a growing pressure to control costs and improve access for marginalized groups [4, 6, 7] This has increased interest in shared learning about innovations between low- and high-resource settings,[8] and the adaptation of LMIC innovations to HICs has been described as “reverse innovation” [4, 9]. While the use of the term “reverse” is controversial, the opportunities for HICs to learn from LMIC innovation are compelling This novel approach to harness LMIC inventions in healthcare and life sciences could rapidly generate promising options for developed countries, overcoming some constraints to innovation in highincome settings

Methods

Results

Discussion

Conclusion