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Table 2 Applying the Reverse Innovation Criteria: Bloomberg Philanthropies Maternal Health Initiative (BPMHI)

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

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    
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.
  TOTAL SCORE 16 Conclusion: Move to Step 2
Step 2    
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.