From the desk of Anna Schurmann (Speaker on the panel for Techniques of Public Innovation)


annaA Space to Address Burning Questions on Systems Innovations…

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 – and I don’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 “we already know what works, we need to focus on implementation”. This argument has merit. Innovation is supposed to be disruptive, but do health systems really need any further disruption? Shouldn’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 – 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 “hack” 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 – thereby reaching those children who are most in need of nutritional support.

Outside the system

The “business as usual” of health systems functioning seeks to implement health programs, avoiding disruption as much as possible. Innovation is messy, disruptive, creative – all things that are discouraged in a smoothly functioning system. I have heard people say that innovation should not occur in the context of “business as usual”, it needs a special, dedicated space. It also requires a different mindset; focused on asking disruptive questions; seeking inspiration from people’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 anthropologists’ 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.

 

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