As the countdown to the Millennium Development Goals begins, ideas are circulating for scalable solutions that improve lives at the base of the pyramid (the 4 billion people living below the global poverty line) and beyond. Several of the Millennium Development goals directly relate to healthcare and interest in reverse innovation is palpable.
Reverse innovation (also known as trickle up innovation) is first seen in the developing world before spreading to more developed markets. Reverse innovation, particularly in the healthcare sector, is not new- current antimalarials draw their origins from Chinese medicine. Variolation in Africa and Asia was a precursor to modern inoculation and vaccination.
According to Patricia Mechael, Executive Director of the mHealth Alliance, mobile health is a perfect example of reverse innovation, as "more people have prioritised mobile technologies than even the tech companies anticipated." The developed world was slow to adopt healthcare delivery through mobile because of prior investments in computers and electronic records. Developing countries had limited infrastructure in place and these lower barriers to entry helped mHealth take off. Mobile health has been used to provide services for a number of demographics and healthcare issues- from maternal health to ageing populations.
Barbara Bush, CEO and co-Founder of Global Health Corps, described the Global Health Corps fellowship program, which was deliberately designed to facilitate reverse innovation. Each US-based fellow is placed with a partner fellow serving internationally in the same organisation, creating a fellowship team that shares best practices from Burundi, Malawi, Rwanda, Uganda and Zambia with the United States. Through the fellowship, one organisation adopted a community health worker model in Newark, New Jersey, implementing a popular public health model across Africa.
Kirsten Gagnaire, Global Director of the Mobile Alliance for Maternal Action (MAMA), leads a public-private partnership that provides relevant information to pregnant women and local healthcare workers. After reaching over 530,000 individuals in South Asia and Africa, MAMA is gathering the attention of high profile partners from the developed world. MAMA is currently exploring a partnership with Sesame Street to provide joint messaging for families.
Both Gagnaire and Mechael shared best practices on facilitating reverse innovation. Mechael suggests moving away from pilots in an approach to thinking at scale from the outset. "While pilots were useful in the early days of mHealth, thinking in terms of pilots does not translate well to implementation at scale. We need to design for scale from the outset," says Mechael.
One of the keys to designing at scale from the outset is a participatory design process. Inclusive processes need to include beneficiaries to ensure relevance and buy-in. According to Mechael, "Whether or not people feel like a technology has been designed for them determines whether or not they will use it."
Gagnaire recommends rapid prototyping in order to adapt their model to local needs and account for nuanced differences. "We don't just translate- we localise the content and target local myths. We look at the literacy rate and the level of comfort with technology," says Gagnaire. Her organisation relies heavily on focus groups with their target audience. In these focus groups, MAMA tests variables such as content, tone of voice, and even background noises to understand what resonates best with local women in the target demographic. MAMA experiments with multiple iterations and is continuously updating its messaging.
The Millennium Development Goals’ deadline is 2015 and significant progress has yet to be made. Reverse innovation will be a key element of meeting those targets and help to improve healthcare for the developed world as well.