Techniques of Public Innovation: A Live Blog

How should the government rapidly curate, learn and pilot locally and globally successful case-studies and dynamically emerging best practices that have shown health impact? What kind of regulatory and decision making environment is required to further health innovation and mainstream the use of high impact health innovation and medical technologies in public health services delivery? These are some of the key questions addressed by the plenary, moderated by Dr. Prashant Jha, Postdoctoral Fellow-Stanford India Biodesign.DSC_0260

Panelists include Sita Shankar, Director Programs at the Antara Foundation, N J Aanand, General Manager Government & Alliances at GE Healthcare, Lysander Menezes, Health Systems Design Specialist at PATH, Debarshi Bhattacharya, Program Officer-Bill and Melinda Gates Foundation, Alkesh Wadhwani, Deputy Director integrated delivery at BMGF, and Anna Schurmann, Consultant-Public Health Specialist at MPTAST.

12 31: Given the profile of panelists, they have seen governments change, and have borne witness to the same, Prashant questions panelists regarding their thoughts on innovation through public-private collaborations. He cites the NESTA report, which mentioned that the success of labs can only measured based on the degree of impact and effect on governance. Prashant invites panelists to share their thoughts on this.

12:33 Sita Shankar  goes beyond labs to say that anyone who wants to impact government needs to develop an integrated, united front. Innovation players, whether labs or otherwise, are often viewed as the outsider by government, and therefore engaging with government must involve an approach that is collaborative at an early stage.

12:34 Prashant extends his question, and asks the panel to also talk a bit about how this change, of public-private innovation partnerships, has been happening over the last few years.

12:35 Lysander Menezes raises that to a great extent, design principles can be used to change what procurement is all about. The questions of how we can understand what demand is, and how can we ensure that procurement is done in a particular way, in response to demand. It is essential to link up the endogenous knowledge within the health system, and the exogenous knowledge brought on board by designers and innovators. The next potential change for the Bihar Innovation Lab is to design a procurement mechanism that will respond to this, and take innovation to the next level.

12:36 If you look at public health systems nationally, Debarshi notes that you will find states that are at either end of the spectrum. In fact, the Bihar state has engaged in innovation, and has coped with what they have. Rates of immunization, institutional deliveries, and ANCs, have increased. Government perhaps doesn’t celebrate this as they perceive innovation as a shortcut, or a way out devised in response to not being able to go about work as per usual. Often governments take more pride in doing routine work, than improvising, and sub-consciously innovating.

DSC_024812:37 Alkesh Wadhwani goes back to addressing procurement as a a challenge that warrants innovation. Basic things like gloves, the most basic requirements, whatever you are trying to achieve, will face innumerable road blocks. How do you innovate around procurement system? You could perhaps do what Tamil Nadu did with the TNFC, whether cooperation is good or not, if governance is good you will have successful procurement. Innovation around performance management that could increase accountability. For example, stock-outs could be mediatized,  along with their frequency and schedules on how often stock will be procured.

12:41 Anna agrees that a strong system will facilitate a strong supply chain. Often supply chains are neglected and is an after thought of various government interventions. Do you actually innovate for supply chain as well, is something that is entirely a separate thing?

12:42 Prashant adds that its essential you must know your user/consumer to innovate products. Is there a particular way to develop tenders to ensure that facilitates the best environment for innovation?

12:42 Lysander remarked that a dialogue needs to happen before tenders are developed. The signaling has to go before, in order to develop a tender request that responds to the tailoring of a particular solution, that is needed.

12: 44 NJ Anand adds that even now you have CMFTP Innovation around Procurement, where you go back to users, and inculcate the benefits. However the real clinical benefits of each product procured is essential.

12:45 Sita clarifies that the issue here is that those people who develop designs, they should have multiple expertise that enables them to think through whole chain. With the Bihar Innovation Lab, it is essential that capacities that can think right up to implementation and scale up, it would be nice if some government people are here we would know the barriers to scaling up. Not just for products, but for systems innovation.

12:47 Dr. Aditya Dev Sood, as an audience member, adds that the vision for the lab had been extremely systemic. Around the procurement point, the NESTA study suggests that any governmental or quasi governmental body that deals with government without tackling procurement fails. How does anything that happens in the lab impact governance?In a competitive modality there are different consortium that try and collaborate but at a pre-competitive and a competetive modality, is a more complex way of thinking how innovation can be integrated in to the procurement process. Through the 20% working through the BIL, across the next 18 months will perhaps challenge and expand some of the initial mandates of the lab.

12:50 Debarshi suggested that a way to go about this would be to get a precedent established. Perhaps thinking small is advisable, in case you want to make an impact with government.

12:51 Lysander points out that a considerable about of local content recognition is also essential. A device has to have a certain amount of components from a vendor that is within a locality. When designing a product, whoever will source components has to be produced by certain vendors who are growing the industry. Often a regulator is looking for what is good for a system. We need to look to other ministries, within our country, to look for techniques of enterprise architecture.

12:53 Anna states that regarding the purchase for a very high grade equipment, now comes the point that these equipments are going to CHCs and PHCs so they don’t need such high end equipment as doctors there are not so savvy. For systemic change there has to be sustained effort in education and in building capacity. What are the benefits that are coming out of the product.  In dialogues with state governments. We see that it is easily acceptable in Bihar.

12:55 Sita its not very easy to say bring in new systems and process in health. When it comes to supply it is easier, but for demand generation it is not the government’s responsibility as they are already understaffed. It is often easier in the case of products, and rather systems. It is important to see that the quality of these is also maintained.

12:57 Prashant adds that BIL plans to have such events and such conclaves in Bihar. He asks the panel about the possible nature of these events, and they key stakeholders who should be engaged, and from what level of the health systems.

12:58 Anna mentioned that in her prior work, they chose the district level to inculcate innovation. Even though there is a lot of interesting innovation happening at a village level, but there didn’t seem to be a capacities and human resources to scale these innovations or process them. Though we are hoping that inculcating this at a district level will scale up to other levels of government.

12:59 Alkesh points that it is not just about great data, but also about scale. To gather interest at a national level, you will have to show close to five or six districts as exemplary evidence.

1:00 Lysander suggests that data around procurement must also include mechanisms of how to aggregate demand, in order to procure effectively. Solutions from government districts, along with each district coming together to decide who is going to take the biggest chunk of procurement, and then a calculated bid should be made. There is an element of entrepreneurship in this to realize that data comes up at a strategic level to ensure that it influences actually bids of procurement.

1:02 Sita suggests that there is a lot of vested interest involved in procurement and about those who are passionate about it. One example lies in the way in which a product has to be introduced, through ‘Verbal Anesthesia’. It must go through the user, to the beneficiary, and the need of a product must be communicated, as well as the value that a doctor is going to get out of it, must be made clear.

1:04 At this point Dr. Prashant Jha opens the floor to the audience for comments and questions

1:05 Divya questions that government’s view of Innovation as a improvisation or deviance from the regular scheme of things, which is extremely threatening to the culture of Innovation. What can BIL do in response to that?

1:06 Debarshi responds to this by saying that the challenge is semantic. Perhaps language should be altered, and innovation should be communicated in a different way.

1:07 No public functionary is comfortable with the maintenance of equipment suppliers. Privates don’t give information on maintenance and there is no built in procurement for maintenance, no capacity building done, no training done. It is subverting the utilization of this equipment. Where there is a value addition, there is an equipment. These examples have to multiply with constant up-gradation of these systems.

1:09 Anna mentions that advocacy for replication and scale up is necessary as well, and people don’t really account for it a lot.

1:10 Lysander concludes saying that a change in the entire paradigm of infrastructure is necessary. We have grow within loopholes, as opposed to a paradigm where we come together to assess how impact takes place, bringing together various capacities that are both internal and external to the public health system.

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