Health ecosystem innovation: Context is king

November, 2017
By Chris Lawer

I thoroughly recommend a short paper - "Health systems, systems thinking and innovation" - by Rifat Atun, now Professor of Global Health Systems at Harvard.

In it, he makes a clear and concise case for the need for more systems thinking in health innovation, citing examples of multiple barriers that have prevented faster and wider adoption of much-needed HIV and tuberculosis interventions in low- and middle-income countries.  Despite the presence of adequate resources (Arun makes no mention of this as a factor), these barriers include:

  • The way the health problem is perceived by decision-makers and health workers
  • Poor attention given to the health problem
  • Poor knowledge of the targeted patient group
  • Socio-cultural stigma and incompatibility of the intervention
  • Varied interpretation and application of policies within health systems
  • Vertically designed health systems which hindered appropriate care
  • Weak political leadership or low political commitment
  • Health system management weaknesses
  • Restrictive guidelines
  • Low performance and knowledge of health workers
  • Mismatched health worker or patient capability to access, administer and deliver the intervention

Prof. Atun concludes:

"Reductionist and linear approaches that provide technical solutions alone are not adequate to mount effective responses, as the adoption and diffusion of innovations which underpin responses are influenced by complex health systems, the socio-political context within which the health systems are embedded and the innovation adoption system."

And then later...

"... a broader and more sophisticated analysis of the context, health system elements, institutions, adoption systems, problem perception and the innovation characteristics within these will enable better understanding of the short- and long-term effects of an innovation when introduced into health systems. A simplistic situational analysis may result in barriers and enablers to innovation adoption being overlooked, and risk unforeseen consequences and policy resistance. One way to reduce this policy resistance is to adopt systems thinking to look at all interacting elements within the complex adaptive health systems in a holistic manner to devise effective responses."

For us, the article is shouting out a powerful conclusion. When innovating in health ecosystems, context is king. Failing to understand context and the dynamic interplay and nuances at play within health ecosystems amongst multiple actors can lead to innovation failure. 

The implication? Superficial technology-focused approaches just won't cut it in these contexts.

The paper (pdf) can be downloaded from here (no fee/sub): Arun, R. (2012) "Health systems, systems thinking and innovation" Health Policy and Planning, 27 iv4-iv8