Globalisation has created a number of public health challenges, but also some unexpected positives. Catherine Rushworth explores a concept challenging the dominant mindset that the technologically advanced North is the natural exporter of intelligent ideas to the South, their grateful receiver.
Healthcare innovation is typically thought of as a ‘north to south’ phenomenon. Scientific breakthroughs – both historic, such as the germ theory, or modern day genetic revolutions – have typically occurred in the Northern hemisphere. Similarly, the majority of drugs, diagnostics and the latest medical equipment are mostly all ‘innovated’ in the north and ‘exported’ to the global south. In the global health community the idea of reverse innovation has been gathering pace. It flips this concept – and our mindset – upside down and asks the question, what can we learn from the South?
Reverse innovation, or trickle-up innovation as it is also known, is a term referring to any innovation originating in the ‘developing’ world that then spreads to the ‘developed’ world. The concept originated from the for-profit sector in 2005, and by 2012 a reviewer of Chris Trimble and Vijay Govindarajan’s book, Reverse Innovation, dubbed it as ‘the new business idea everyone is talking about’. It has also been widely cited in the context of global health systems. Notably, Lord Nigel Crisp championed it in his book, Turning the world upside down, which he wrote after retiring from leading the largest healthcare organisation and the fifth biggest employer in the world, the NHS.
Encouragingly, there are already many successful illustrations of health-related reverse innovation happening across the globe. For example, Brazil has been developing a nationwide community health workforce for two decades. Rather than take on clinical duties, the health workers – who have had no previous healthcare experience or education – are trained to deliver a vast array of health promotion activities in their communities, including screening uptake, chronic disease management, sexual and maternal health, lifestyle and nutritional advice. They also collect census-quality data from community households.
The Brazilian model of preventative healthcare has resulted in significant reductions in multiple indicators, including infant mortality and hospitalisations for chronic disease. It has also been linked to improvements in breast-feeding, immunisation and screening uptake . Perhaps more importantly, it has built trust between a community and its primary care system (a system that has become increasingly depersonalised in the UK). Access to healthcare has also been streamlined for the patient (who has a single contact, instead of dealing with an array of allied health professionals), which has reduced inefficiencies and complexities within the system. The model was so successful that the UK is now working closely with the Brazilian Ministry of Health, the Federal University of Pernambuco and the Municipal Health Secretariat of Recife to set up a similar system, with the first pilot currently underway in North Wales.
This is not the only example of aspects of primary healthcare systems being copied by high-income countries (HICs). At the moment, New York’s Harlem is using a system developed with inspiration from multiple sub-Saharan African countries. The need for scalable, cost-effective systems to reach low-resource communities is becoming particularly prevalent in HICs, which are now characterised by the repercussions of recessions and a high burden of behaviour-related diseases that require early intervention from primary healthcare systems. Jeffrey Sachs, a leading professor of economics and a UN advisor was reported as saying:
In time, it will be natural to see exchanges and mutual learning between Community Health workers with health systems as different as Brazil, Nigeria, United States and India.
Health systems are not the only ideas are trickling up from LMICs (lower- to middle-income countries) though. Areas of research and development, such as prosthetics, diagnostics and multiple successful telehealth programmes are all benefitting from reverse innovation.
The future of reverse innovation needs to be solidified for countries to realise its full potential. The idea has been gathering pace within the academic sphere, with the journal ‘Globalization and Health’ recently running a full series on reverse innovation . However, more needs to be done to develop standards and avenues for this to occur on a practical level. This will include not only research institutions and academic bodies, but commercial companies, NGOs and charities: healthcare leaders across the board need to be convinced of the value of reverse innovation and have opportunities to foster the necessary connections. Further fields have already been identified that could benefit from learnings from the global south, one of which is the ‘global surgery’ movement. Dr Michael Cotton, a surgeon who practiced in Zimbabwe for over 20 years, has highlighted that:
Surgical innovations from LMICs have been shown to have comparable outcomes at a fraction of the cost of tools used in high-income countries. These innovations have the potential to revolutionise global surgical care. 
The days of development representing ‘what the West can teach the rest’ are ending and with healthcare systems stretched in HICs due to ageing populations, the economic downturn and increasing burdens of long-term, non-communicable diseases, learning from the global south is crucial. Increasing the exposure of reverse innovation as a concept and creating frameworks to enable learnings to occur will be the next steps for this exciting and essential movement.
- Johnson, C., et al., Learning from the Brazilian Community Health Worker Model in North Wales. Globalization and Health, 2013. 9(1): p. 25.
- Crisp, N., Mutual learning and reverse innovation-where next? Globalization and Health, 2014. 10(1): p. 14.
The views expressed in this article are those of the author and do not necessarily represent the views of Development in Action.
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