Health innovations need much more than research

The challenges of developing and scaling up health innovations go beyond research. They need careful consideration.

Previously known as the Global Forum for Health Research, the Global Forum for Research and Innovation for Health, held last week in the Philippines, has been freshly rebranded to reflect the distinction between research and the development of innovation as a product or service.

This new title also acknowledges that health research is not the only research that affects health. Health outcomes are determined by a complex web of social, environmental and governance issues. A new multidisciplinary, cross-sectoral approach to research was referenced explicitly throughout the conference — often as a salutary example of the kind of collaboration that can help translate research into innovation.

There was another well-recognised aspect of good innovation practice shaping the new-look Forum: the notion of involving the ‘end user’ early on. The Philippines, for example, which hosted the meeting, had a substantive influence on the Forum’s agenda. This focused on discussing how to marshal support from influential people in policy and finance so as to get health innovations to large numbers of the mostvulnerable people.

Most chronically poor people now live in middle-income countries like the Philippines. So as, in his welcome address, the Filipino president said he was looking forward to solutions to the problems exercising his government, the organisers could argue they had aligned themselves to demand.

Although it is too early to tell whether this framing has supported the mainstreaming of innovations in any of the 72 countries attending the forum, the organisers’ emphasis did bring into focus health innovation issues that need to be carefully addressed.

Practical approaches

Firstly, there is little understanding among health researchers of the practicalities of ‘scaling’. The meeting participants assumed that any innovation worth developing is also worth scaling up — there was no considered discussion on the limits.

Glen Mays, of the University of Kentucky, pointed out that there is a science to scaling: a separate research protocol would be required for efficient rollout. Shelly Batra, of the NGO Operation ASHA, presented some interesting reflections on enabling conditions for scaling, and some instructive examples of failure.

“Technical innovation is needed to make these systematic review collections more dynamic. There also needs to be a form of systemic review to gather and assess innovations, not just research papers.”

Nick Ishmael Perkins, SciDev.Net

But overall, the body of knowledge on scaling up innovations was presented either as anecdotal and tacit, or as something tangential to the conference — ironic on both counts, in view of scale-up being central to how the event was framed.

Health professionals need to engage more strongly with knowledge systems like social innovations theory (which presents paradigms for analysing operating environments); complexity science (which offers insights for project planning in large dynamic ecosystems); and incubation management (which offers models for testing services and products).

Collaborative culture

Second, there was much reference to collaboration at the cabinet level. The joint leadership from the Forum’s hosts, which included the Department of Science and Technology and the Department of Health, may signal a significant collaboration. Indeed, you would expect science ministries to demonstrate the value of research through close and ambitious partnerships with other line ministries. This could prove particularly useful for healthcare systems, where delivery encounters many different and urgent pressures.

However, the development and health sectors have little experience of providing efficient and sustained support to ministries of science and technology. Too often, and too quickly, conversations turn to private sector partnerships or needs assessments for other ministries. The nexus of relationships among academics, layers of policy actors and service providers — which should characterise a functional science and tech ministry — was clearly under-examined.

For instance, how would a ministry of science and technology facilitate reforms for healthcare systems if that is the key catalyst for innovation? Or how do middle-income countries support their researchers and industries to produce diagnostic technology? Such questions seem fundamental to the Forum’s agenda, yet went largely unanswered. Perhaps the right people were not in the room — but I suspect more effort is required to consolidate the necessary experience and departmental support.

Unhelpful assumptions

Delegates and speakers certainly endorsed the value of policy engagement. There were also sessions addressing new modes of engagement like social media. Again, though, there were some assumptions that need to be challenged.

First, there was an overwhelming notion that speeding up peer review would be the most critical step in expediting the process of innovation. This may help to build the necessary body of knowledge, but it fails to listen to what end users want to know as well as how and when they seek that information.

More fundamentally, however, these discussions on policy engagement tended to revert to research as opposed to innovation — or to underplay the development process for services or products as distinct from academic research.

An example of this was the discussion on systematic reviews — very useful for the academic community and crucial for development policy. The Cochrane Library serves the health sector well in this regard; 3ie also provides valuable reviews. But most systematic review repositories face the challenges of visibility and versatility: you need to know they are there (they are not built for aggregator services, which would make it easier to find them online).

Also, systematic reviews themselves are effectively supply-led — a policy maker has little space to refine the question tackled by a review or adjust it to their context. Technical innovation is needed to make these systematic review collections more dynamic. There also needs to be a form of systemic review to gather and assess innovations, not just research papers.