Originally posted on HaCIRIC website: 20 April 2012
By James Barlow
Low and middle income countries (LMICs) offer some of the most interesting examples of healthcare innovation. Some of this involves adapting solutions from richer countries but it also involves developing local, ‘bottom-up’ innovations to achieve cost-effective outcomes.
What lessons, then, do they offer us in richer countries? Alas, it is not as simple as saying: ‘Let’s do here what they do there.’ Innovation can sometimes be easier in LMICs because of different payment systems as well as less historically complicated healthcare and different regulations. Perhaps the most useful learning they can offer to wealthier countries springs from bottom-up initiatives, placing healthcare users at the heart of system redesign. This reduces risk of innovation failure, common in so many advanced health systems.
So, in what way are less well-off countries excelling? Disruptive innovations, useful to richer nations, are being achieved, for example with the use of mobile phones to deliver low cost support and advice. Highly specialised hospitals are driving down costs but not at the expense of quality. Meanwhile, ‘frugal’ innovation in LMICs is producing much cheaper versions of existing technologies to increase accessibility.
There is also useful organisational and business model innovation in LMICs. Interesting examples are around marketing, financial strategies and operational activities such as the highly focused Indian hospitals addressing specific health conditions.
Many LMIC innovations are about supporting empowerment and self-help, allowing citizens to be co-creators and co-producers of health. Users of healthcare are being successfully incorporated, more centrally, in the design of the systems, helping to take the risk out of innovation.
That said, scaling up innovations from pilot projects is a big problem in LMICs, just as it is in wealthier countries. ‘Mainstreaming’ an innovation means many things, including increasing its population and geographic coverage, and institutionalising the change. It can be difficult in LMICs partly because of unorganised health markets, but there are also problems similar to those that occur in Britain – lots of pilot projects, though successful, are not rolled out.
Can we hope to transfer some of this innovation to wealthier countries? There are, unfortunately, factors that may limit transferability. For a start, the predominance of out-of-pocket payment models in LMICs can make it easier there to introduce innovations because there aren’t the payment /reimbursement problems you find in more complex health systems. Secondly, in Britain, complex care processes, embedded legacy cultures and piecemeal development of different systems can make integration of innovation more difficult than in LMICs where systems may be organisationally simpler.
Finally, differences in regulatory frameworks in LMICs may allow greater experimentation. In the UK, it is possible that GP-led commissioning may produce more innovation, with more emphasis on home care and preventive care. But regulation remains very important and will play a big role in how much innovation occurs in Britain.