Table 2 Applying the Reverse Innovation Criteria: Bloomberg Philanthropies Maternal Health Initiative (BPMHI)
Brief description: The program trains assistant medical officers and midwives in remote areas to perform life-saving procedures including caesarean sections and upgrades isolated health centers | |||
|---|---|---|---|
Step 1 | Â | Â | Â |
Criteria | Description | Score | Rationale |
 1. Accessibility | Innovation increases access of products or services through increasing affordability, geographic access, and/or social access. | 5 | The program has upgraded 9 remote health centers, increasing geographic access to services provided locally; prior to the program, patients had to travel 3-4 hours to the nearest hospital. |
 2. Cost Effectiveness | Innovation improves cost effectiveness to payer, provider, or end user. | 4 | Indirectly, the program has improved cost effectiveness by "up-training" midwives to perform more complex tasks such as c-sections, reducing the need for more costly healthcare providers. |
 3. Scalability | Innovation increases scope, geographic cover, or customer base. | 4 | Since inception, the program has increased its coverage from 9 sites to 12, and has been expanding to e-Learning platforms in 2013. Deliveries at all intervention hospitals have increased from 3,500 deliveries per year before the program to 9,000 deliveries per year after the program launch. |
 4. Effectiveness | Documentation of effectiveness of innovation using appropriate evaluative methods. | 3 | One district where the program operates experienced a 32% decline in maternal deaths after the program was implemented. However, information on evalulation techniques and reporting on impact for all sites is limited. |
| Â | TOTAL SCORE | 16 | Conclusion: Move to Step 2 |
Step 2 | Â | Â | Â |
Criteria | Description | Score | Rationale |
 5. Gap in Target HIC | Creating solutions for unsolved (or imperfectly solved) challenges or unaddressed health issues or service gaps. | 4 | Access to quality maternity care services, particularly in rural and northern areas, is an important healthcare issue in Canada. |
 6. Compatibility | Compatible with healthcare infrastructure in the target HIC. | 1 | Midwives and physician assistants play a limited role in Canada as of present. Implementation of such a program would challenging given current regulations and staffing levels. |
 7. Novelty | The innovation is a novel approach or an established innovation used in a new way that has great promise. | 3 | Midwifery and physician-assistant - performed c-sections are quite a novel concept; however refurbishing rural hospitals is not. |
 8. Receptivity | Openness and engagement of partners as well as those not considered partners but who may be impacted by the innovation. | 1 | This initiative does not involve Canadian partners or Canadian stakeholders. |
|  | TOTAL SCORE | 9 | Conclusion: Score is ≤10. Unlikely to be a reverse innovation. |