Abstract
Background: While responsible innovation in health (RIH) suggests that health innovations could be purposefully designed to better support health systems, little is known about the system-level challenges that it should address. The goal of this paper is thus to document what is known about health systems’ demand for innovations. Methods: We searched 8 databases to perform a scoping review of the scientific literature on health system challenges published between January 2000 and April 2016. The challenges reported in the articles were classified using the dynamic health system framework. The countries where the studies had been conducted were grouped using the human development index (HDI). Frequency distributions and qualitative content analysis were performed. Results: Up to 1391 challenges were extracted from 254 articles examining health systems in 99 countries. Across countries, the most frequently reported challenges pertained to: service delivery (25%), human resources (23%), and leadership and governance (21%). Our analyses indicate that innovations tend to increase challenges associated to human resources by affecting the nature and scope of their tasks, skills and responsibilities, to exacerbate service delivery issues when they are meant to be used by highly skilled providers and call for accountable governance of their dissemination, use and reimbursement. In countries with a low and medium HDI, problems arising with infrastructure, logistics and equipment were described in connection with challenges affecting procurement, supply and distribution systems. In countries with a medium and high HDI, challenges included a growing demand for drugs and new technology and the management of rising costs. Across all HDI groups, the need for flexible information technologies (IT) solutions to reach rural areas was underscored. Conclusion: Highlighting challenges that are common across countries, this study suggests that RIH should aim to reduce the cost of innovation production processes and attend not only to the requirements of the immediate clinical context of use, but also to the vulnerabilities of the broader system wherein innovations are deployed. Policy-makers should translate system-level demand signals into innovation development opportunities since it is imperative to foster innovations that contribute to the success and sustainability of health systems
Highlights
What System-Level Challenges Should responsible innovation in health (RIH) Address RIH “ calls for the involvement of multiple stakeholders, including the publics, but it argues in favour of a deliberate and continuous ex ante consideration of what is collectively expected from innovation.”[61]. Through anticipatory, reflexive, inclusive and responsive innovation development processes, RIH could enable policy-makers to proactively address health system equity and sustainability by steering innovation towards these important goals.[4,62]
While the strengthening of governmental capacity is beyond the scope of RIH, our findings suggest that RIH should acknowledge that when oversight and transparency are compromised in a given health system, health innovations may become valuable commodities in informal or corrupted markets.[48,68,69]
Concluding Remarks Since the late 1980s, new health technologies increased global inequalities, but they undermined the sustainability of health systems in rich and poor countries alike
Summary
Health services and policy researchers generated knowledge on the individual, clinical and organizational barriers and facilitators that affect technology adoption patterns in primary care and university teaching hospitals.[14,15,16] This literature underscores the importance for healthcare managers to foster strategic and continuous change management, to devise a broad set of integrated innovation governance strategies and to actively support the in-house production and use of evidence on the effectiveness and cost of these new technologies.[17,18,19,20] Yet, scholars and practitioners of health technology assessment (HTA) often document the extent to which new technologies are misused or overused, emphasizing an “epidemic of waste”: there is an inflexion point at which overused therapeutic and diagnostic technologies stop benefiting patients and only divert healthcare spending toward potentially lowbenefit or unnecessary applications (so-called low value care), limiting our ability to provision consistent, broadreaching healthcare to society.[11]. The definition of RIH highlights the importance of supporting sustainable health systems, which are defined as: (1) affordable for patients, families, employers and the government acknowledging that “employers and the government rely on individuals as consumers, employees, and taxpayers for their resources”; (2) acceptable to “key constituents, including patients and health professionals”; and (3) adaptable since “health and healthcare needs are not static” and health systems “must respond adaptively to new diseases, changing demographics, scientific discoveries, and dynamic technologies in order to remain viable.”[12]
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