London School of Hygiene & Tropical Medicine

Global Innovation Pipeline To Accelerate Universal Health Coverage

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To learn more about – or provide significant funding to – this project, please contact Lever for Change.

Project Summary

3.6 billion people lack access to essential health services, underlining the need for UHC. Existing disease-focused funding streams have warped health systems and slowed the expansion of UHC. Accelerating UHC requires strong public input and local innovation. Building on our global network of social innovation hubs, we propose a pipeline to identify effective UHC programs, design pragmatic trials, and scale up projects in the Global South. Our approach uses open challenge contests to identify promising programs, implementation research to demonstrate impact, and crowdfunding to scale solutions. Key aspects of our approach have been demonstrated in randomized controlled trials to be effective and cost saving. The pipeline will increase Global South ownership of the process and outcomes of innovation, informing local policy. Our Social Innovation in Health Initiative network has led several global innovation calls. This project will elevate local health innovation and expand access to essential health services.

Problem Statement

A sick boy from a poor family in Blantyre, Malawi is more likely to have his family bankrupted from medical bills than to have complete access to health services. There are 3.6 billion people like this boy across the Global South who lack access to essential health services. This gap in services is related to expert-driven health systems, inadequate UHC research, and lack of local resources and accountability. Existing health systems have been distorted by top-down disease-focused interventions developed by experts who often do not understand the local context. Primary care service delivery approaches are frequently transplanted from high-income countries to low and middle-income countries, with little attention to local health systems, preferences, and priorities. Second, UHC programs are implemented in the context of local programs without rigorous external implementation research to evaluate them. These programs help us to better understand implementation issues, but do not advance the science of optimizing UHC. Finally, many countries in the Global South do not have sufficient health resources to support UHC programs. This crisis of funding is associated with a crisis of accountability. When a Malawian child’s family is destroyed by medical debt, there is no one that they can go to for assistance and no accountability from the global donors who have exited. These intertwined problems suggest how bottom-up innovation, high-quality implementation research, and locally accountable financial resources are key leverage points to expand UHC in the Global South.

Solution Overview

Crowdsourcing has a group of individuals solve a problem and then shares solutions with the public [5]. One fascinating example of crowdsourcing occurred a century ago at a county fair. The crowd at the fair guessed an ox’s weight. The median crowd estimate was more accurate than expert estimates and accurate to within two percent of the actual weight, demonstrating the power of crowdsourcing. Crowdsourcing can be particularly powerful in the setting of UHC because it relies on public wisdom and insight to improve local health services. This approach identifies solutions driven by the people and communities who are critical to implementing and sustaining them. Crowdsourcing has been shown to authentically engage local communities, increase local ownership, and spur innovation. Our global innovation pipeline will identify high-quality UHC pilot projects, increase our understanding of implementing UHC in diverse global southern settings, and provide funding for scale-up of effective pilot programs. We will measure the success of the global innovation pipeline based on the following: impacting regional, national and global health policy related to UHC; providing an evidence base from five pragmatic trials about implementing UHC; providing UHC at scale within five selected subnational regions; and creating financial resources for scaling up effective UHC programs in five countries. The primary beneficiaries of the project are people who lack access to essential primary care health services in low- and middle-income country settings.

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