We are the system

If the question is, “What makes healthcare better?” Then the answer is meeting patients’ needs better. Simple. No one understands these needs better than the people who work with patients every day. So it makes sense that the most effective ideas will come from them. This is inclusive innovation. Here’s how it works in a doctor’s own words.


Innovation is not rocket science. But it is a new way
 of thinking and doing. It starts with considering problems from the patients’ perspective. Then it moves onto developing creative solutions that truly meet their needs.

All too often, when working at the coalface in hospitals and clinics, healthcare workers are overwhelmed by the challenges and limitations that prevent us from achieving our goals. But even if we can’t cure patients, we can still care for them. So I believe the potential for transforming healthcare in Africa lies with the dedicated frontline health workers who understand the needs of their communities best.

However small, if each of us uses our experience and empathy to develop
a solution for better delivery of care, the cumulative effect could be totally transformative. This is the thinking behind the Inclusive Healthcare Innovation (IHI) initiative at the Bertha Centre. It’s all about encouraging inclusive, effective and affordable solutions, developed by inspirational individuals and organisations to meet pressing health needs of patients or communities.

How iHI happened:

  • NOMINATIONS: In July 2013, we sent out an open call for nominations of South African healthcare innovations. The results were completely unexpected: we received more than 100 nominations!
  • CRITERIA: Solutions had to be inclusive (in equity and access), improving health outcomes and affordable (by being efficient or reducing cost).
  • SELECTION: All the remarkable health workers, social entrepreneurs and organisations were put before an External Review Panel of local and international experts in medicine, public health, innovation and design.
  • REVIEW: 15 solutions were finally chosen to be featured in the first Health Innovators Review. The innovations were divided into five sections, which outline the areas of interest and intervention that will help reimagine healthcare in South Africa.
  • WINNERS: One (or two) winners were chosen from each section – see here to find out which ones made the final cut.

But now, let’s examine the five areas of Inclusive Healthcare Innovation. It’s the first step towards finding, developing and nurturing solutions that will allow all Africans to receive equitable, accessible and human-centred healthcare. The journey starts here.

1. Needs and opportunities for innovation

The most exciting opportunities for innovation lie on the boundary of established theory and the unknown. But finding them requires an understanding of this new territory.

When you arrive in a new city, you might find your way just by walking around. Or you could be guided by a map. But far more effective is
to do both, combining ground-level experience with higher-level guidance. The same applies to healthcare innovation. We need to explore the needs of the territory, the potential stakeholders and the unknown places where new solutions lie.

To begin, ask yourself…

  • Who is involved in this project or field (hands-on and at higher levels)?
  • What are the specific needs of the community or people being served?

What are the possible opportunities for innovation by…

  • Health workers

  • Students

  • Community members

2. Collaboratively reimagining healthcare

Close your eyes for a moment, and conjure up
a picture of healthcare in South Africa and the continent. Perhaps you see a waiting room full of people, some in wheelchairs, some lying on the floor, all hoping to be seen, all desperate to be healed. Perhaps you see a tiny rural clinic built out of mud or a big state hospital where doctors and nurses battle long hours and scarce resources to provide quality of care and quality to life.

These are unsurprising pictures. In our country, on our continent, these problems are ubiquitous and vast. But, often, we get tangled in the problems of the here and now. This means we don’t see beyond them to what could, or should, come to be.

So we need to start by imagining – or reimagining – the idea. Only then will we able to focus our energies on making it an everyday reality. We also need to think, dream and plan collaboratively. Why? Because innovation calls for co-creation: people from all walks of life, sectors and disciplines uniting to develop bold solutions.

Better healthcare shouldn’t be a dream. That said, a dream is where the possibility of better healthcare begins.

To begin, ask yourself…

  • What does the ideal healthcare in South Africa and Africa look like – without the known obstacles, constraints and existing systems on the verge of collapse?
  • How would this system work to best benefit the patients, the healthcare workers, the community and the nation?
  • Now, what will it take to make this reimagining a reality?
  • Who do we need to consult with and involve in the process?

3. Transforming the system from the inside out

The healthcare system is more than just a collection of hospitals and institutions. It is also the people who work and seek help inside those buildings. This is why potential change resides within the system – within the people – particularly the healthcare workers who dedicate their lives to serving their patients and communities.

Yes, South Africa’s healthcare workers are a force to be reckoned with. But despite their noblest intentions and efforts, even the most basic healthcare tasks can be very complex in Africa. Resource shortages, poor management and system failures all contribute to challenging conditions that are demotivating and demoralising. It is a hard job. But still, there are those practitioners who endure and go beyond the call of duty to deliver the best possible care.

Then there are those who go even further, using their deep medical knowledge and experience to develop innovative solutions that empower, enhance and save patients’ lives, while also leading to greater efficiency and cost reductions. These extraordinary individuals are transforming healthcare from within. They are the system, bringing about positive change from the inside out.

To begin, ask yourself…

  • How many innovative healthcare workers do you think there are across the continent?
  • How could we, as citizens, experts, corporates and academics, support and enabled these individuals to convert their ideas into action?
  • If you are a healthcare worker, are you comfortable with the status quo of healthcare delivery?
  • Or do you have an idea – however simple – of how the needs of your patients and community could be better addressed?

4. Minding the gap

FACT: Africa carries 24% of the global disease burden, but has only 3% of the health workforce.

ANOTHER FACT: There are only 39 000 health workers in sub-Saharan Africa, a far cry from the 280 000 required.

This continental crisis can be compared to a leaking bucket of water. Why? Because health worker: patient ratios in Africa are only getting worse. A first response has been to pour more water into the bucket. But attempts to increase the number of health workers proved challenging.

In the 47 countries in sub-Saharan Africa, there are only 168 medical schools. Eleven of these countries have no medical schools at all, and 24 have only one. In addition, training African health workers according to western education models hasn’t produced enough professionals to meet the continent’s needs, or enough who have the social accountability and desire to heal their own communities.

The second possible response to this problem is to seal the gap and stop the leak. This does make sense, but halting the migration of health workers, or preventing them from leaving the healthcare system for other professions, cannot easily be enforced by policy-makers.

The thing is, there can be no health without a workforce to care for us. So here lies an innovation opportunity for us all to consider.

To begin, ask yourself…

  • Have we maybe been tackling this challenge in the wrong way?
  • Instead of trying to correct or fill the gap, can we find ways of transforming the system itself?
  • If programmes to increase the number of trained health workers are not enough, what kind of innovations will delve deeper, into shifting the very routines and beliefs of the social system?
  • Perhaps we need a completely alternative “water collection” system – or healthcare system – rather than a broken bucket?

5. Technology enabling inclusive care delivery

Today’s technology has the potential to enable healthcare delivery like never before. But we cannot be naive enough to assume that the impact will always be positive. As Gary Marsden states, quoting Melvin Kranzberg’s maxim: “Technology is neither good nor bad, but nor is it neutral.”

So how do we as innovators develop a technological consciousness? 
We need to learn from innovators who have harnessed the power of technology for greater inclusiveness. This “inclusiveness” refers to greater accessibility and affordability, as well as the way the interventions enable and empower more people to receive the care they need. In other words this tech is not elitist, expensive or out of reach.

With 253 million mobile phones across sub-Saharan Africa, the connectivity revolution is putting information in the hands of millions. But it is not the “what” but the “how” that really matters.

The message: technology can only be truly inclusive and effective when
it is inclusive, or “democratised”. And the best way to achieve that is through collaboration and co-creation.

To begin, ask yourself…

  • What healthcare needs can be answered using technology?
  • But how do we ensure that our information on these needs is contextually and culturally specific?
  • Are we designing tech products based on our perceived understanding, or out of empathy and deep knowledge of communities’ real needs and access?
  • How do we develop more simple, affordable, accessible products and services?
  • How can we work together to do this better?

Adapted from the 2014 Health Innovator’s Review, compiled by Inclusive Healthcare Innovation, a joint initiative between the Bertha Centre for Social Innovation & Entrepreneurship at the University of Cape Town (UCT) Graduate School of Business, and the UCT Faculty of Health Sciences.

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