From idea to scale: The missing pieces in health innovation adoption

By Jenny Lei Ravelo 11 October 2016

Dr. Francis Ngugi talks to patients at the premises of the Githurai-Langata health facility in Kenya. Photo by: Armstrong Too

The innovation marketplace is overflowing with ideas, from mobile apps that offer counseling services for students experiencing mental health issues to platforms that offer mothers incentives for positive health-seeking behaviors.

There are, however, no guarantees these innovations will be adopted by their intended clients and reach to scale. Just look at the number of promising innovations or initiatives that never go beyond pilot, or mobile health apps that never gain more than a few thousand downloads. In the mobile health space, only 12 percent of 27,000 apps available in the United States can be found in 90 percent of user downloads, according to a 2015 study by the IMS Institute for Healthcare Informatics.

The reasons for these poor uptakes vary. Some innovation experts point to design, others to financing. But there are other reasons, such as lack of understanding and foresight on the part of the provider or developer.

A number of innovations on maternal and child health, for example, may be developed with good intentions, but attaching an expensive price tag can defeat the original purpose, especially as such innovations are more likely required in cash-strapped health facilities serving underserved communities.

Knowledge gaps are another barrier. Health care workers in low-cost settings accustomed to doing things manually might find difficulties or resist adopting new technologies that would require a series of trainings.

“I’ve been working for seven years, I’ve been writing on a piece of paper, and then all of a sudden you want me to start typing. It might be easier for me at the end of the day, because at the end of the month I’m required to compile the reports of all the things I’ve been writing down on paper, and the machine will do that for me, but initially you’ll find people resisting the use of machines,” said Francis Ngugi, the only medical doctor at the Githurai-Langata health facility in Kenya. The facility is currently running as a model structure by Philips as part of the health and technology company’s Community Life Center project, in partnership with the local county government of Githurai.

Lack of follow up is also a factor. While most developers explain and demonstrate how a product works, Ngugi said providers often “disappear” after the first or second training. This results in health care workers reverting back to their old ways of working.

The medical doctor experienced this himself. Once the local government in Githurai introduced a fetal heart monitor for them to use at the facility, but did only one training. Worse, when the donor-funded paper for the machine started running out, the government didn’t have the means to restock.

To avoid these drawbacks, Ngugi said providers should have a specified schedule and period for follow up, quarterly or monthly, depending on the product being introduced.

Developers or providers should also help inspire behavior change among health care workers, helping them realize how beneficial a product is for their work, and not a burden for them to carry, as some colleagues and Ngugi himself have experienced.

Understanding the environment in which one is working is also key, according to Lane Goodman, senior communications associate for the Center for Market Health Innovations at the Results for Development Institute.

“If you see an organization come in, and there’s five similar organizations that are doing the same thing and sort of replicating that in the same exact location, then there’s not a very high expectation of success [based on our research],” Goodman said.

And for organizations struggling to attract users or patients, pairing up and seeking lessons from another organization could be a game changer.

Access Afya, a social enterprise providing basic clinical and prevention services in Nairobi’s slums, for example, learned a few simple but helpful techniques such as putting up billboards to attract patients after pairing up with Care 2 Communities, a nonprofit organization with clinics in Haiti and Namibia. It’s now exploring setting up smaller health posts nearer to some of the communities that it is trying to serve, Goodman said.

Devex recently visited Kenya as part of our Making Markets Work campaign with The Abraaj Group, Philips and PSI.

Making Markets Work is an online conversation to explore what’s being done to make global health care markets accessible to people at the base of the pyramid. Over 10 weeks, we will amplify the discussion around effective health financing, analyze key challenges blocking universal market access in the health care supply chain, and explore the key strategies to make markets more effective. Join us as we look at this important issue, and share your thoughts by tagging #MakingMarketsWork and @Devex.

About the author

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Jenny Lei Ravelo@JennyLeiRavelo

Jenny Lei Ravelo is a Devex senior reporter based in Manila. Since 2011, she has covered a wide range of development and humanitarian aid issues, from leadership and policy changes at DfID to the logistical and security impediments faced by international and local aid responders in disaster-prone and conflict-affected countries in Africa and Asia. Her interests include global health and the analysis of aid challenges and trends in sub-Saharan Africa.


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