Needed more than ever: 3 takeaways from the World Health Innovation Forum on why grassroots innovations are key to addressing NCDs

Noncommunicable diseases (NCDs) are among the world’s most urgent and complex health challenges. Cancer, diabetes, cardiovascular disease, chronic respiratory disease and mental health conditions account for over 74% of all global deaths, and their complex risk factors are often intertwined with the negative impacts of additional determinants of health. NCDs are also a matter of equity, as the vast majority of the 17 million premature NCD-related deaths every year occur in lower- and middle-income countries.

Contextualizing and scaling proven, cost-effective interventions such as the “NCD best buys” remains a priority, but innovative solutions are urgently needed to fast-track progress and avert millions of preventable deaths from NCDs.

The recent World Health Innovation Forum in Vizag, India explored strategies to sustainably scale health innovations through the public sector. Here are three takeaways on why and how grassroots innovations addressing NCDs can be a part of the solution.

1) The equity factor of grassroots innovations in global health innovation

Innovation is increasingly being seen as a driver of resilient, more responsive health systems. New products hit the market every day, from medical devices to mobile applications, and many respond to persistent gaps in global health policy and programmes. Consequently, policy discussions tend to focus on scaling such innovations and ensuring access to high-quality, safe and appropriate health technologies.

While essential, what is underserved in these discussions is the value of grassroots innovations in addressing health inequities. Designed by and for communities from low-resource settings who are close to the problem, grassroots innovations provide a clearer understanding of local needs, opportunities, interests and power dynamics. They can respond to health challenges in more equitable, efficient and culturally appropriate ways. Many such innovations addressing NCDs are social in nature, involving new, community-informed processes that cut across, in many instances, siloed sectors and address the root drivers of NCDs.

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Great ideas start with a spark– and grow from the ground up

The path to the much-needed scale and impact of these grassroots innovations requires different policy considerations, including closer attention to the socio-economic, political, cultural and institutional features and equity gaps of a country’s policy environment.

2) Health innovation ecosystems must connect meaningfully with health system needs

Countries urgently need novel and low-cost interventions to prevent NCDs, diagnose them earlier and treat and care for people living with NCDs more efficiently and effectively. Governments also require new forms of multisectoral collaboration to reduce the complex risk factors associated with NCDs, such as tobacco use, physical inactivity, unhealthy diets, harmful use of alcohol and air pollution.

Yet, the culture of innovation in global health has historically been weighted towards supply rather than demand, favouring costly, high-tech innovations over inexpensive, social ones. This has led to a tendency to “over-engineer” new products or services. This both reflects and worsens a misalignment between the realities of health system needs in countries and available innovations, which risk proving less effective than intended or neglecting the populations that need them the most.

In contrast, grassroots innovations are designed in direct response to priority health needs in resource-constrained settings. Much can be learned from this approach and applied to NCD responses, including concepts such as “radical simplification” (leaving out surplus features), or the processes of combination (bringing two unrelated ideas or disciplines together to create entirely new solutions), permutation (testing out different versions of an existing solution) and substitution (swapping around key components of a solution).

The principles of grassroots innovations can provide a valuable framework for reducing misalignments between health needs and innovations and, most importantly, ensure no one is left behind on the road to achieving global NCD targets by 2030 and sustaining momentum into future decades.

3) Aligning grassroots innovations with public sector demand and its scaling pathways requires capacity-building on both sides

Grassroots innovators and policymakers need to work together to ensure scale of novel solutions to persistent problems. Unfortunately, these actors often speak different “languages.” While innovators understand the health needs in their communities and can bring highly practical, applied knowledge to the problem, they can lack the know-how and capacity to expand their work beyond its original context. Meanwhile, governments need to be supported and incentivized to identify, engage with and scale health innovations in their countries.

The path to scaling grassroots innovations on NCDs hence requires capacity-building on both sides and from the very beginning. The needs highlighted by innovators must be reflected in government priority- and demand-setting exercises. Common spaces and platforms can help identify and assess innovations that are fit-for-purpose and scalable. A practical scaling pathway must be articulated with roles for innovators and policymakers alike, including strategies for sustainable financing, monitoring and impact evaluation, with the goal of institutionalizing innovative practices in national NCD programmes.

The “Mountain Model” provides a guide to common challenges and insights to government engagement of health innovations. To further enhance and contextualize this guide to the realities of scaling grassroots innovations on NCDs, the NCD Lab will launch a series of activities over the next few years, including workshops, case studies and expert dialogues to build knowledge on what a scaling pathway can look like for a grassroots innovators - from reducing obesity in rural Kenya or countering the commercial determinants of diabetes in low-income neighbourhoods in San Francisco.

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