What does innovation mean to health in the context of Who?
Innovation is essential for health development. Although the history of innovation in health is as old as of the history of health care, the use of the word innovation in health is relatively recent. “Innovation” has been used more in other sectors, for example, engineering and technology. Any new ideas, discoveries and developments in health sector have been bracketed traditionally with R&D rather than innovation. As the demand for health has risen and concerns about ever escalating costs and inequities in health have taken the center stage, the need for innovation and innovative solutions for improving access to health technologies and services and resolving other complex health system issues has also grown. Hence, innovation has gradually become more prominent in health policy and practice.
The simplest definition of innovation is “new ways of thinking and doing things”. However, Who Health innovation group has developed the following definition after a lot of reflection and discussion:
Health innovation at Who is an approach and a process through which existing or new health policies and systems, products and technologies, and services and delivery methods are developed to add new value to preventive, promotional, therapeutic and rehabilitative care with a special focus on the needs of vulnerable populations in the context of universal health coverage. Value addition can be in terms of improved efficiency, effectiveness, quality, safety and affordability.
What role can/should Who play in nurturing and promoting innovation for health?
Who, as a directing and coordinating authority for health within the United Nations system has a responsibility for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends. In the context of these constitutionally mandated responsibilities Who has to continuously develop new approaches to old and emerging problems. We are at the cutting edge of health development and innovation, which takes place in so many different forms and shapes.
The role of Who in nurturing and promoting innovation in health lies at the cross-roads of all the above mentioned functions. Needs based research highlights areas for innovation as well as promotes efforts directed at such innovation. One very important role with reference to norms and standards setting is to ensure the safety and efficacy of new products and interventions. This role is unique to Who as a Un special agency which has a mandate of all the countries in the world.
In 2008 the Member states of Who adopted Global strategy and plan of action on public health, innovation and intellectual property with a focus on building innovation capacities in developing countries in a comprehensive way including: institutional development; R&D capacity; regulatory development; human resource development; transfer of technology and local manufacturing; incentive systems and traditional medicine. One of the major emphasis of this strategy is that intellectual protection of medical products should not become barrier to the access especially for those Who cannot pay. It also focuses on innovative ways of financing and coordination research and development of new or improved treatment for diseases that disproportionally affect people in developing countries especially where there is no or little market. This is an important work which is continuously developing especially since 2008.
What are some of the priority areas of innovation that can improve health outcomes in low and middle income countries?
Priorities in innovation in health are guided in Who by our General program work (Gpw). The current Gpw extends between 2014-2019. There are six leadership priorities identified in Gpw that provide focus and direction to our work and these are the areas where it is vital for Who to lead.
The six priorities are:
- advancing universal health coverage (Uhc) i.e. enabling countries to sustain or expand access to all needed health services and financial protection, and promoting universal health coverage as a unifying concept in global health.
- Health-related Millennium development goals (Mdgs) – addressing unfinished and future challenges: accelerating the achievement of the current health-related Goals up to and beyond 2015. This priority has already transformed into pursuing 2030 Agenda for sustainable development since September 2015.
- Addressing the challenge of non-communicable diseases and mental health, violence and injuries and disabilities.
- Implementing the provisions of the International health regulations (2005) (Ihr-2005) and ensuring that all countries can meet the capacity requirements specified in the Regulations.
- Increasing access to quality, safe, efficacious and affordable medical products (medicines, vaccines, diagnostics and other health technologies).
- Addressing the social, economic and environmental determinants of health as a means to promote health outcomes and reduce health inequities within and between countries.
Quest for innovation in health is, and must be, underpinned by these priorities in global health.
What are some of the existing innovations that can be scaled?
The above mentioned priorities provide a framework to also zoom-in on existing innovations in these six areas from scale-up perspective. I will provide you one example from each one of these areas. In Uhc the idea of social health insurance for the poor and marginalized people and innovative ways of engaging with private health sector needs to be scaled-up without which Uhc will not be possible in most of low- and middle-income countries with high out-of-pocket expenditures on health. Since the world has moved from Mdgs to Sustainable development goals (Sdgs), the importance of inter-sectoral action has assumed a new importance and there is a lot of space for innovation and innovative partnerships (Sdg-17) in this transformative area. Non-communicable diseases and mental health and their integration at primary health care level in developing countries require innovative approaches. In the context of global health security and Ihr-2005 the Joint external evaluation scheme in countries with a view to strengthen their resilience is an innovative approach. On improving access to and development of new or improved medicines and health technologies is an area that requires continued innovation and many initiatives are already working in this space. And, on addressing social and economic determinants of health, the idea of Health-in-All-Policies is very innovative, one that also require vertical and horizontal policy coherence across sectors.
What are the key constraints that Who is facing in its attempt to foster and promote innovation within the organization?
Despite undertaking a lot of innovative work Who is not using the word “innovation” as much. We are not great promoters of our own work which in many cases is ground breaking. For example, one of the greatest innovation of recent times that Who led along with many partners is the development of MenAfriVac – a vaccine to protect against A strain of meningitis in the so called African meningitis belt. This was the first vaccine developed entirely with conditions in Africa in mind and was produced at one tenth of the conventional estimate for producing a new vaccine and since 2010 has effectively eliminated the epidemic of meningitis in sub-Saharan Africa. And yet we have not talked about this enough. Until recently, in Who there was no organization-wide health innovation forum where people could talk about their innovative ideas and work. Who Health innovation group is now trying to fill this gap.