Yasser Bhatti

7 – Frugal innovation

: This chapter highlights the creative use of frugal innovation by South Asian organizations in their attempts to stay competitive in an intensely global environment. We discuss how globalization has affected South Asia, the ways in which South Asian organizations have responded to contradictory global and local challenges, and what MNCs can learn from the experience of South Asian organizations. Some of the lessons for South Asian organizations include developing partnerships regionally and internationally and for MNCs to venture into South Asian markets for business prospects with an open mind, in order to engage in learning so as to better address changing circumstances not only in South Asian markets but also in their respective home markets globally.

The Emerging Market for Frugal Innovation: Fad, Fashion, or Fit?

There is growing interest among both private and public sectors to serve the underserved in emerging or developing countries leading to, what we call the market for frugal innovation. This paper is divided into two parts. First, we discuss the rhetoric surrounding frugal innovation and attempt to understand the discourse surrounding it as fad, fashion, or fit. Second, we seek to map the emergence of this market by suggesting drivers and the making of a social movement involving different actors pursuing both contentious and complementary approaches to achieve the same outcome, i.e. one of creating value for underserved populations. An understanding of how the rhetoric and market for frugal innovation has emerged will be useful in opening a research agenda. Consequently we cover opportunities and challenges to growth of the market as well as draw implications to academic theory and practice.

Does the Country of Origin Matter in Health Care Innovation Diffusion

There is no shortage of US health care research centers advocating the adoption of innovations from other countries. The Institute for Healthcare Improvement (Boston, MA), the Commonwealth Fund (New York, NY), Innovations in Health at Duke University (Durham, NC), and the Network for Excellence in Healthcare Innovation (Cambridge, MA) are all promoting innovations from low-, middle-, and high-income countries for potential adoption into the United States. However, does it matter to patients if a proposed innovation is from India, rather than from, say, Sweden; or from Rwanda, rather than from, say, the United Kingdom? Very little is known about whether and how the country of origin of a proposed innovation matters in its diffusion.

Do International Health Partnerships contribute to reverse innovation? a mixed methods study of THET-supported partnerships in the UK

BackgroundInternational health partnerships (IHPs) are changing, with an increased emphasis on mutual accountability and joint agenda setting for both the high- and the low- or middle-income country (LMIC) partners. There is now an important focus on the bi-directionality of learning however for the UK partners, this typically focuses on learning at the individual level, through personal and professional development. We sought to evaluate whether this learning also takes the shape of ‘Reverse Innovation’ –when an idea conceived in a low-income country is subsequently adopted in a higher-income country.MethodsThis mixed methods study used an initial scoping survey of all the UK-leads of the Tropical Health Education Trust (THET)-supported International Health Partnerships (n = 114) to ascertain the extent to which the IHPs are or have been vehicles for Reverse Innovation. The survey formed the sampling frame for further deep-dive interviews to focus on volunteers’ experiences and attitudes to learning from LMICs. Interviews of IHP leads (n = 12) were audio-recorded and transcribed verbatim. Survey data was analysed descriptively. Interview transcripts were coded thematically, using an inductive approach.ResultsSurvey response rate was 27% (n = 34). The majority (70%) strongly agreed that supporting LMIC partners best described the mission of the partnership but only 13% of respondents strongly agreed that learning about new innovations and models was a primary mission of their partnership. Although more than half of respondents reported having observed innovative practice in the LMIC, only one IHP respondent indicated that this has led to Reverse Innovation. Interviews with a sample of survey respondents revealed themes primarily around how learning is conceptualised, but also a central power imbalance between the UK and LMIC partners. Paternalistic notions of knowledge could be traced to partnership power dynamics and latent attitudes to LMICs.ConclusionsGiven the global flow of innovation, if High-income countries (HICs) are to benefit from LMIC practices, it is paramount to keep an open mind about where such learning can come from. Making the potential for learning more explicit and facilitating innovation dissemination upon return will ultimately underpin the success of adoption.

Global Lessons In Frugal Innovation To Improve Health Care Delivery In The United States

In a 2015 global study of low-cost or frugal innovations, we identified five leading innovations that scaled successfully in their original contexts and that may provide insights for scaling such innovations in the United States. We describe common themes among these diverse innovations, critical factors for their translation to the United States to improve the efficiency and quality of health care, and lessons for the implementation and scaling of other innovations. We highlight promising trends in the United States that support adapting these innovations, including growing interest in moving care out of health care facilities and into community and home settings; the growth of alternative payment models and incentives to experiment with new approaches to population health and care delivery; and the increasing use of diverse health professionals, such as community health workers and advanced practice providers. Our findings should inspire policy makers and health care professionals and inform them about the potential for globally sourced frugal innovations to benefit US health care.

Low-cost innovation in healthcare: what you find depends on where you look:

Professional groups such as clinicians are homophilus and so they tend to be drawn to the same knowledge sources. On the one hand, trusted knowledge networks are useful to ensure agreed-upon techniques and guidelines, but, on the other hand, these can become self-reinforcing, preventing the introduction of new ideas, technologies and solutions. There are some standout examples where remarkable healthcare innovations have arisen specifically from exploring very unusual knowledge sources. The success of the Aravind Eye Hospital in India arose from applying the principles of mass production to ophthalmic surgery. The impressive innovation to improve telemetric patient monitoring in intensive care services in Birmingham Children’s Hospital was the result of examining Formula One technology. Close examination of the airline industry and the exhaustive cockpit checks that are required before, during and after air travel led to the World Health Organization surgical safety checklist which has helped to prevent countless ‘Never Events’ (serious, preventable incidents) in preand postoperative care. Clearly, cross-fertilisation between industries is important to develop applications that reduce cost in healthcare. Looking to other countries is also important. Frequently, low-income countries develop frugal innovations, where the need for low-cost models of care is critical and necessary. Low-cost innovations, such as the use of mosquito net mesh to repair hernias (see Box 1), the use of sterilisable bags to replace the need for expensive, sterilisable surgical equipment, mobile phone platforms to integrate decision-making support systems for community health workers and community health workers’ models of primary care, offer exciting potential to improve the efficiency, equity and cost of health systems in both lowand high-income countries alike. To what extent do healthcare professionals and decision-makers look to other industries and other countries to find those innovative low-cost models of care that benefit the system without compromising on quality? Where do people on the frontline of healthcare look for innovative solutions to the clinical and organisational problems that they and their patients face? This is important, because what you find depends on where you look. The Global Diffusion of Healthcare Innovation study recently explored which are the dominant sources of ideas for Frontline Healthcare Workers in the health systems of six countries (USA, England, Brazil, Tanzania, Qatar and India). The study drew on quantitative surveys of more than 1350 Frontline Healthcare Workers and asked them where, in terms of industry, media and country, did their main idea to improve clinical practice in their health system in the last 12 months come from. The study found that the majority of Frontline Healthcare Workers (ranging from 91% in India to 82% in the US) stated that their ideas to improve healthcare practice or delivery were derived from their own clinical specialty. Only 5% of Frontline Healthcare Workers report that their idea was influenced by sectors unrelated to healthcare. Only 11% of Frontline Healthcare Workers reported that their ideas were influenced by practice in other countries, although higher proportions do so in Brazil (18%), Tanzania (12%) and, to a lesser extent, India (10%). Organisations that have the useful function of curating under-the-radar innovations from around the world (such as the Center for Health Market Innovations, the US Commonwealth Fund, in India the Centre for Innovations in Public Systems, in England the NHS Journal of the Royal Society of Medicine; 2018, Vol. 111(2) 47–50

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

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

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

800 portable ECG machine, Narayana’s US

Frugal and Reverse Innovations in Surgery

1500 cardiac surgery and Aravind’s US

What is Frugal, What is Innovation? Towards a Theory of Frugal Innovation

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.