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Table 1 Three examples and four steps of reverse innovation in health care

From: A model for ‘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].