#2 Summer 2014

Finding the healthcare solutions that are in plain sight

In the South African public healthcare arena, opportunities for innovation abound for those who dare to look past the problems and reimagine new ways of doing things.

Public healthcare in the developing world is not generally considered an inspirational topic. Daily reports of tragedies, failures, frustrations and resource constraints eclipse the efforts of many who work tirelessly to deliver basic care to millions of patients who need and deserve better.

Mired in this reality of treat and triage, the quest to innovate, to find new ways to eliminate obstacles, overcome constraints, reduce inefficiencies and make healthcare, public and private, better for the people it serves, seems like a luxury that the system cannot afford. And yet, if you look for them, there are dozens of stories of inspiration and hope – where healthcare workers in seemingly impossible situations have found creative ways to address their challenges.

These front-liners are ideally placed to drive innovation. No-one understands the challenges and the gaps in service delivery better than those who have to deal with the bitter reality of these gaps.

Like Clare Roberts, a doctor at Red Cross Children’s Hospital who, distressed at the chaotic and system of index cards and textbooks that served as the engine of knowledge about poisons, compiled AfriTox, an online database of toxins and toxic substances, which now provides easy, potentially lifesaving access to relevant and appropriate knowledge in emergencies. Or Dr Ashraf Grimwood who, in his quest for an AIDS-free generation, founded not-for-profit organisation Keth’Impilo that provides specialised training and mentoring for community healthcare workers to help HIV/AIDS patients and their families live more positive lives.

These ideas, two of many showcased in the inaugural edition of the Health Innovator’s Review, published by the Bertha Centre for Social Innovation and Entrepreneurship in January, show us that innovation is not just for scientists and techno buffs. We don’t all need to be Steve Jobs or Mark Shuttleworth to change things for the better.

The modern world has mythologised innovation, painting it as an act of alchemy that is born in thin air, ignited by the fusion of imagination and opportunity. But the truth is, innovation is born out of need. It grows from real problems in the real world, and from looking and re-looking at those problems in a way that can reveal a solution hidden in plain sight. It begins with a shift in mindset, a fresh way of looking at a problem, and seeing it, instead, as a possibility. The corrective mindset focuses on what’s broken, and tries to fix it. The transformative mindset says: “It’s broken? Let’s change it.” In that way, it’s not so much a mindset, as a setting free of the mind.

Often the answer to the most pressing medical problems are not high-tech gadgets or expensive new drugs, it can be as low tech or ‘no-tech’ as compensating for a lack of incubators by promoting skin-to-skin contact between mothers and newborn babies. Twenty years of research has proven that the latter boosts infant health in ways that technology cannot match, with clear evidence showing a 50% drop in deaths in premature newborns in developing countries. But despite isolated examples, many of these potentially lifesaving innovations are never recognised or, more importantly, scaled up to benefit wider numbers of people.

To allow these ideas to find their way into the mainstream, people in the system need to be given the opportunity to speak up and the confidence to push proposals and suggestions through the right channels. Frances Westley, the Canadian author, consultant and innovation activist says that: “Social innovation is an initiative, product, process or programme that profoundly changes the basic routines, resource and authority flows or beliefs of any social system.” What is called for then is a transformation of the whole system – from the bottom up and the inside out.

As with most bureaucracies, the health system is more used to a top-down approach. It is rules-bound and evidence based. How then do you create a climate and culture of social innovation and allow these bright ideas from the front line – no matter how small – to take root and grow?

The Inclusive Healthcare Innovation Initiative is an unprecedented collaboration involving the UCT GSB, and the UCT Faculty of Health, driven by the Bertha Centre for Social Innovation and Entrepreneurship, which seeks to do just this. Its aim: to rise to the challenge of re-imagining healthcare in Africa. The initiative champions a bottom-up ideology and seeks to transcend current challenges in the system to improve health outcomes for patients, but also to change the routines, responsibility and values of the healthworkers responsible for delivering the care. Its latest project has seen the launch of a first-of-its-kind Innovation Programme at Groote Schuur Hospital to help public sector health workers to become the innovators themselves. The programme will build innovation capacity in the hospital and create a network of frontline innovators and link these with policymakers in the Department of Health.

This kind of change does not come easily – or indeed quickly – but it is imperative. By seeing all people as potential innovators, we unlock boundless opportunities to pioneer solutions and business models that may allow for healthcare solutions that benefit millions more people.

The ancient art of healthcare has always been governed by the impulse to find new and better ways of promoting wellness, preventing and treating illness, and helping people live longer, healthier, happier lives. It is time to look past the daily bad news and create a new culture of reimagination and innovation in healthcare that benefits all South Africans and the economy as a whole.

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