There are many different questions I am looking forward to hearing discussed at the Health Public event on August 22nd.
As a public health consultant with experience conducting scalability assessments on health systems innovations, advising on capacity building for innovation at the state level, and experience in monitoring and evaluation of innovations; there are a lot of questions raised by my work â€“ and I donâ€™t typically have a platform to address them, or even think them through. I am hoping that this event gives us an opportunity to discuss our experiences, share lessons learned, and develop a shared agenda around innovation.
For example, one of the questions I am hoping we can address is: what is the best location for health systems innovation?
A common critique of the current focus on innovation is that â€œwe already know what works, we need to focus on implementationâ€. This argument has merit. Innovation is supposed to be disruptive, but do health systems really need any further disruption? Shouldnâ€™t we all focus on the less glamorous work of implementing well? Taking this into account, there are two ways to locate innovation:
Within the system
I think one of the hidden and under-acknowledged benefits of innovation is that it can increase health worker motivation and engagement â€“ the lack of which is a huge barrier to good implementation. The innovation need not be ground-breaking, it can be a local solution to a local problem. But in the process of health workers identifying the problem and finding a solution, they become more engaged in their work, and morale improves.
In such a scenario, innovation should be part of business as usual. Health workers â€œhackâ€ solutions to commonly encountered problems, and these solutions are celebrated and scaled, where possible.
An example of this that I have seen in Madhya Pradesh is anganwadi workers partnering with self help groups to package up food for children who do not attend the anganwadi centres â€“ thereby reaching those children who are most in need of nutritional support.
Outside the system
The â€œbusiness as usualâ€ of health systems functioning seeks to implement health programs, avoiding disruption as much as possible. Innovation is messy, disruptive, creative â€“ all things that are discouraged in a smoothly functioning system. I have heard people say that innovation should not occur in the context of â€œbusiness as usualâ€, it needs a special, dedicated space. It also requires a different mindset; focused on asking disruptive questions; seeking inspiration from peopleâ€™s stories; and testing solution prototypes.
For this reason, a model such as the Bihar lab is perfect. Innovation occurs in a parallel space to normal health system service delivery. Disruption is not minimized, but contained, until a solution is well-tested.
These two different locations for innovation recall the anthropologistsâ€™ debate on the advantages of insider and outsider perspectives. Obviously, the two approaches have their advantages and ideally, any attempt to nurture innovation would incorporate both.