As populations increase, health resources shrink, and access and quality of life equity differences widen, the clarion call for innovation in healthcare is growing louder around the world. Both international groups such as the World Health Organization and national groups, e.g., ministry of health, continue to set aggressive goals and billions have been spent to design and implement global health innovations. Many global health innovations (GHI) have set high goals but had limited success in implementation or never scaled to serve a wider population. The barriers to implementing global healthcare innovations include policies or political priorities, lack of commitment, limited infrastructure, and limited healthcare staff. Some health entrepreneurs have overcome such barriers; Yet other, well intentioned and planned GHI have not met expectations. Although some articles provide suggestions for avoiding, overcoming and addressing these barriers, few offer new models for global health innovation. In this research, we offer a four component model that considers the adoptive community, implementation team, the delivery strategy and the delivery approach as key enablers for successful GHI. This model is supported by the literature and in-depth case studies in Uganda, Ghana, Mozambique, and Haiti.

1. Global Healthcare Innovation: A Framework for Implementation
Wiljeana Glover, Sthuthi Jebaraj, and Kate McKone-Sweet
Technology, Operations, and Information Management Division Schlesinger Fund for Global Healthcare Entrepreneurship
Babson College, Babson Park, MA wjglover@babson.edu
ABSTRACT
As populations increase, health resources shrink, and access
and quality of life equity differences widen, the clarion call
for innovation in healthcare is growing louder around the
world. Both international groups such as the World Health
Organization and national groups, e.g., ministry of health,
continue to set aggressive goals and billions have been spent
to design and implement global health innovations.
Many global health innovations (GHI) have set high goals but
had limited success in implementation or never scaled to
serve a wider population. The barriers to implementing
global healthcare innovations include policies or political
priorities, lack of commitment, limited infrastructure, and
limited healthcare staff. Some health entrepreneurs have
overcome such barriers; Yet other, well intentioned and
planned GHI have not met expectations.
Although some articles provide suggestions for avoiding,
overcoming and addressing these barriers, few offer new
models for global health innovation. In this research, we offer
a four component model that considers the adoptive
community, implementation team, the delivery strategy and
the delivery approach as key enablers for successful GHI. This
model is supported by the literature and in-depth case
studies in Uganda, Ghana, Rwanda, Bangladesh, Mongolia,
Mozambique, and Haiti.
Adoptive Community:
For the HRH program, at the
program initiation, there were 70
specialists. The desired number
was 565, creating a need of 495
specialists. (insert reference from
case). The need for physicians,
nurses and hospital managers as
targeted by the program was
evidence that the Government of
Rwanda had towards
improvements.
Implementation Team:
Partners In Health has developed
a long-term partnership with the
Ministry of Health (MSPP) in Haiti.
While many private health
facilities had been developed in
isolation, PIH knew the
importance of working MOH to
develop surgeons who could later
support other health care
facilities. MOH provided funding
to help build a state-of-the art
hospital that would provide
specialized surgical training. The
intention is to develop trained
surgeons to improve the overall
health systems.
Delivery Strategy:
Dr. Paul Firth and the Surgical
Quality Assurance Database team
at the Mbarara Regional Referral
hospital in Uganda created the
database based on Excel and later
Open MRS, ensuring an ease of
scalability of the technical
solution to neighboring hospitals
if desired.
Delivery Approach:
Dr. Ben Warf went through
multiple iterations of act-learn-
build in his development of a new
approach to treat hydrocephalus.
First, he found a more affordable
approach to the existing method
and later developed a new
method based on existing
technology.
LITERATURE
• Adoptive Community: Guidance on how to select an
appropriate existing intervention once a community has
been selected, but limited guidance how to select an
adoptive community when an intervention is novel
(Jacobs et al., 2011).
• Implementation Team: cross-functional and international
teamwork and collaboration broadened understanding of
the and impacted the team experience (Busse et al., 2014)
• Delivery Strategy: Developing acceptable and meaningful
ways to evaluate the short-term contributions for GHI and
to forecast its long-term impacts is a strategic priority
needed to defend decisions being in global health
development (Milat et al., 2015)
• Delivery Approach: Entrepreneurship literature provides
guidance on the iterative nature of innovation and
launching new organizations (Neck et al., 2017)
CONCLUSIONS & FUTURE RESEARCH
ACKNOWLEDGEMENTS
CASES
Eight case studies in partnership with the Lancet Commission
on Global Surgery and The Program for Global Surgery and
Social Change at Harvard Medical School.
Case writers and medical research fellows conducted
interviews with protagonists and other staff members and via
Skype
Case 1: National Surgical Quality Improvement Program
(NSQIP)-lite in Mozambique
Case 2: Surgical Quality Assurance Database (SQUAD) in
Uganda, Part A and Part B
Case 3: Treating Hydrocephalus in Uganda
Case 4: Human Resources for Health Program in Rwanda
Case 5: Surgical Systems Building in Haiti (in process)
Case 6: Formation of the Ghana College of Physicians and
Surgeons (in process)
Case 7: Surgical Referral Systems with BRAC in Bangladesh (in
process)
Case 8: Building Surgical Capacity in Laparoscopic
Cholecystectomy in Mongolia
REFERENCES
Bart Jacobs, Por Ir, Maryam Bigdeli, Peter Leslie Annear, Wim Van Damme; Addressing
access barriers to health services: an analytical framework for selecting appropriate
interventions in low-income Asian countries, Health Policy and Planning, Volume 27, Issue 4,
1 July 2012, Pages 288–300, https://doi.org/10.1093/heapol/czr038
Busse, Heidi, Ephrem A. Aboneh, and Girma Tefera. "Learning from developing countries in
strengthening health systems: an evaluation of personal and professional impact among
global health volunteers at Addis Ababa University’s Tikur Anbessa Specialized Hospital
(Ethiopia)." Globalization and health 10.1 (2014): 64.
https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-014-0064-x
Milat, Andrew J., Adrian Bauman, and Sally Redman. "Narrative review of models and
success factors for scaling up public health interventions." Implementation Science 10.1
(2015): 113.
Neck, Heidi M., Christopher P. Neck, and Emma L. Murray. Entrepreneurship: the practice
and mindset. SAGE Publications, 2017.
FINDINGS
This research was supported by the Schlesinger Fund for Global
Healthcare Entrepreneurship at Babson College, The Babson Faculty
Research Fund, the Lancet Commission on Global Surgery, and the
Kletjian Foundation.
We expect that the strength of this framework lies in the flexibility
and adaptability to global health contexts with a strong focus on
iteration in consideration of local users
• Applications: The framework can be utilized during the planning
stage, to keep track of implementation as well as to evaluate the
success on conclusion
• Practitioner Implications: Our aim is to help global health
practitioners understand where the gaps and challenges might
arise as they think about innovation. In a field where resources
are rapidly shrinking, this could potentially be life-saving.
• Future Research: Quantitative study of innovations to develop
quantifiable metrics for each component and determine impact
on four components on success and sustainability