Biomed Analysis: 'Frugal' innovation for good health
The developing world needs support for low-tech health innovations that do not compromise on effectiveness, says Priya Shetty.
The global economic recession has left many industries cutting costs, hitting science funding hard. International donors have had to tighten their purse strings too, while research and development (R&D) budgets in many developing countries have been meagre even at the best of times.
Against this backdrop, a new movement of 'frugal science' is taking hold, in which researchers are hunting for the most cost-effective health technologies for developing countries.
Poor nations have often had to provide healthcare on a shoestring, but this movement isn't just about doing things as cheaply as possible. Cost is rarely the only limiting factor; health technologies need to be 'low-tech' — as electricity supplies can be erratic, or hospital environments not always sterile, for instance — without being 'low-spec'.
Achieving this balance requires innovative thinking, which is why researchers from around the world are developing an evidence base for the most effective and innovative healthcare technologies for poorer countries.
Technological innovation in research has traditionally tended to create advanced methods of diagnostics or treatment, but the aim of the frugal science movement is to foster 'frugal innovation', also referred to as 'disruptive innovation', in which the goal is to find the simplest and cheapest way of doing something without compromising effectiveness.
Wealthy countries have an incentive to take an interest in this movement too. In countries such as the US people are finding it increasingly hard to access healthcare, because of spiralling healthcare costs and falling health budgets. So technology developed in resource-poor countries could be transferred to wealthier ones — the reverse of the usual direction of technology transfer.
Broad approach to innovation
A report in The Lancet on frugal technologies , which identifies the specific needs of developing countries, was published earlier this month at the launch of the Global Health Policy Summit, which is targeting health issues that developing countries currently struggle with, including maternal health, non-infectious diseases and ageing societies.
The summit is a collaboration between Imperial College, London, and the Qatar Foundation for Education, Science and Community Development, and is taking a broad approach to technological innovation — exploring, for example, the use of social media and mobile phones to improve healthcare delivery.
Innovation is too often thought of in narrow terms, such as improving a drug or vaccine by tweaking its molecular make-up. But a key point that the report makes is that health technology needs innovation in process (the way a vaccination programme is rolled out, say) as well in the product.
An example of a process innovator is Asm Amjad Hossain, a Bangladeshi immunisation officer who won the Gates Vaccine Innovation Award. He raised immunisation rates in his two districts from 67 to 85 per cent and 60 to 79 per cent in a year by registering pregnant women with their expected date of delivery, location and phone number, so that vaccinators knew when and where the children were born, and how to contact their mothers.
The report encourages health researchers to be holistic in their vision, incorporating innovation in agriculture (which can do much to alleviate health problems such as malnutrition) or road safety (traffic accidents are a leading cause of death in India, for instance).
Appreciating what works
Frugal innovation is already helping much of the developing world. In rural Africa, the eRanger is an ambulance that uses a motorbike and a stretcher sidecar, as poor roads make it hard for regular ambulances to travel, and motorbikes are common across Africa so maintenance is easier.
In India, the SaveLife Foundation has developed a network in which volunteers help those injured in road traffic accidents get medical attention quickly — the lack of ambulances mean this is often the only help that people get.
Because these innovations have largely been driven by snall-scale entrepreneurs, progress has been fragmented. However, governments and international organisations need to appreciate the benefits the entrepreneurs are pioneering if the approach is to make greater impact.
For instance, The Lancet report suggests that governments should assess new health technologies before funding them or agreeing to scale them up, to ensure that they are appropriate for the population.
Donors, meanwhile, should consider what medical devices are sent to poor countries —sending equipment that is difficult to use can be futile. A report by the WHO found that in some countries as much as 80 per cent of medical devices are donations from richer countries. But too often, hospitals are not able to use them properly because of a lack of training or an unstable power supply, and the machinery languishes unused. 
Universities and research institutes could play their part by helping to assess healthcare technologies through simulation and modelling techniques.
Innovation has much to offer the developing world, but the key is for it to be driven by the needs of the people whose lives it aims to improve.
Journalist Priya Shetty specialises in developing world issues including health, climate change and human rights. She writes a blog, Science Safari, on these issues. She has worked as an editor at New Scientist, The Lancet and SciDev.Net.
 Howitt, P. et al. Technologies for public health. The Lancet 380, 507–535 (2012)
 Medical devices: managing the mismatch. An outcome of the Priority Medical Devices project [3.12MB]. Geneva: World Health Organization (2010)