Knowledge Summary 10: Foster innovation
Innovation is one of the keys to accelerating progress in reproductive, maternal, newborn and child health (RMNCH).This includes finding new and creative ways to deliver services, apply new technologies, raise new money, and form new partnerships. All innovations, however, must pass through a robust process of testing and refinement before precious resources are used to scale up.
Science and technology continually yield new ideas for improving human welfare. Some prove successful when tested, while other less promising innovations may still feed back into the research pipeline, so advancing knowledge incrementally. Innovations are needed along the continuum of care to accelerate progress towards MDGs 4 and 5 and must be relevant to local health systems. Emerging creative solutions include those related to testing new models for service delivery, and those created through technology. Innovations in financing are referred to in Knowledge Summary. Here we highlight just a small selection of the many promising ideas currently at various stages of development.
Service delivery innovations
Several rural, remote and conflict-affected areas now receive healthcare through approaches that “take the care to the people”.These include mobile clinics, special health days and home visits. For example, teams of health workers visit villages in Afghanistan to deliver immunizations and insecticide-treated bednets (ITNs). Mobile clinics treated women, newborns and children affected by the flood crisis in Pakistan in July 2010 for illnesses such as diarrhea and malaria. Home visits by health workers after childbirth have helped to reduce newborn deaths in Bangladesh and Pakistan by 30% to 61%, and are now being recommended as standard practice. Child health days in Ethiopia have helped increase the coverage of Vitamin A.
Task-shifting (delegation to less specialized health workers) can help address shortages of health workers. Communities and civil society groups are getting involved in delivering health services or distributing commodities, such as contraceptives and anti-malarial drugs. Injectable contraceptives are being distributed in Malawi by health-surveillance assistants (frontline health workers) working with communities.6 Pneumonia case management in Nepal by community-based workers helped reduce child deaths by 28%.
Several new drugs, treatments, procedures and devices currently still in the research pipeline are expected to bring significant improvements to the health of women, adolescent girls, newborns and children.
Sophisticated technologies are often available in private sector hospitals in the urban areas of many developing countries. However, their use in rural areas is problematic because they are often too expensive and complex to apply. Some low-cost solutions have been tested, such as pre-filled syringes, pocket-size ultrasound devices and manual vacuum aspirators, and their suitability for different contexts is now being explored. For example, oxytocin to prevent heavy bleeding during childbirth, provided in pre-filled syringes (Uniject), has been tested in Angola,Vietnam and Mali for use by frontline health workers to improve women’s access to this life-saving drug.
Equipment to monitor fetal heart rates is not usually suitable for use in rural areas, where electricity and maintenance can be problematic. Simple, manually-operated heart rate monitors are now available. Similarly, a wider range of health workers can now practice neonatal resuscitation with a simple oral and nasal suction device. And for children, discoveries on the benefits of zinc supplements and oral rehydration salts (ORS) to reduce the severity of acute diarrhea and diarrhea-related deaths are being extended in countries such as Bangladesh.
New information and communication technologies (ICTs) have also contributed significantly. Telemedicine – the use of interactive audio-visual media, such as the internet, email, video-conferencing or telephony – is being used in several countries for clinical consultations and information exchange. Mobile phones have the potential to significantly change the ways in which healthcare is delivered and sought.
Ultimately, the benefits of all innovations depend on their availability at scale. Barriers to successful implementation of any new device or service-delivery innovation, such as rickshaw ambulances to transport women in labor, vary across countries. Knowledge of which efforts work (or do not) in specific contexts and conditions comes from robust implementation research. Such lessons not only help to strengthen health systems and the drive towards universal access (see Knowledge Summary 8), but also to optimize the benefits of service delivery and technology innovations.