Table 1 Three examples and four steps of reverse innovation in health care
Example and WHO health system area | Step 1. Problem Identification | Step 2. LIC innovation and spread | Step 3. Crossover | Step 4. HIC innovation and spread | ||
|---|---|---|---|---|---|---|
Innovation | Description | LIC spread | ||||
1) Medical products, vaccines, and technologies | Need for low-cost, rugged, portable health diagnostics for use in resource-limited areas by non-specialist personnel | General Electric’s MACi EKG machine [9], developed in partnership with Indian leaders at GE for rural health clinics in India | Price point = $550 USD, >10 times less than standard EKG machines. Additional features: lightweight, durable, minimalist easy-to-use interface. | Viewed as a commercial success by GE leadership (No publically-available data on number of units sold) | Success in India prompted GE to develop MAC 600 and MAC 800, adaptations of the simple EKG machine for value-oriented US consumers | The slightly more sophisticated version was sold to primary care clinics around the US (no publically-available data on number of units sold) |
2) Health information | Need for gathering and sharing real-time information to map the impact and response to natural and man-made disasters | Ushahidi [10], developed in the aftermath of the 2008 Kenyan presidential election as a way to map eyewitness reports of violence | Uses crowdsourcing to gather critical and timely information from smartphones and map them in a central database | >50 projects in LIC countries ranging from mapping Zimbabweans’ opinions on door-to-door HIV testing to finding victims of Haiti’s 2010 earthquake | Recognition that crowdsourcing approach could be readily applied in HICs | US and Europe examples include: used in New Orleans to report health hazards and chemical spillages during hurricanes; used to promote situational awareness during the 2012 London Olympics |
3) Service delivery | Need to provide close-to-client services and address underlying social determinants of health in resource-limited areas | Partners In Health (PIH) [11] community health worker (CHW) and wraparound service delivery model, first applied to HIV patients in rural Haiti | CHWs visit patients at home, help overcome barriers to care, and provide psychosocial support. Food, transport, and housing support directly address root causes of disease. | Used by PIH in range of LICs and adopted by many others. Likely has passed tipping point, i.e., 2012 multinational campaign to train and recruit one million CHWs in Africa [12]. | Adapted to poor urban US populations by innovative PIH team, as the Prevention and Access to Care and Treatment (PACT) program [13]. | Among HIV-positive patients in Boston, PACT reduced inpatient hospital stays by 35% and decreased hospital costs by nearly 50% [13]. PACT’s success influenced similar models by other US innovators, including Iora Health [14] and Transitions Clinic [15]. |