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

Abstract

Background: Low- 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.

Methods: An 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.

Results: The 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.

Conclusions: This 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.

Keywords: Global health; Healthcare delivery models; Innovation; Low- and middle-income countries; Reverse innovation.

Fig. 1

Criteria Scoring System. 0 No information exists, or the criterion is not applicable. 1 Demonstration that this has not been achieved. 2 Uncertain or conflicting demonstration. 3 Some demonstration of achievement. 4 Strong demonstration of achievement. 5 Significant demonstration of achievement. Definitions of Individual Criteria. Accessibility: Innovation increases access of products or services through increasing financial, geographic and/or social access. Cost Effectiveness: Innovation improves cost effectiveness to payer, provider, or end user. Scalability: Innovation increases scope, geographic cover, or customer base. Effectiveness: Documentation of effectiveness of innovation using appropriate evaluative methods. Gap in Target HIC: Creating solutions for unsolved (or imperfectly solved) challenges or unaddressed health issues or service gaps. Compatibility: Compatible with healthcare infrastructure in the target HIC country. Novelty: Innovation is a novel approach or an established innovation used in a new way that has great promise. Receptivity: Openness and engagement of partners as well as those not considered partners but who may be impacted by the innovation