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<h2 class="hd hd-2 unit-title">Co-Creation for Innovation</h2>
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<p>One of the central themes highlighted throughout is the failure of programs in global health settings to develop sustainable plans and models to ensure they both fit into the existing system of care and are maintainable and adaptable to meet local needs. To address these challenges, we encourage a mantra of "collaboration, co-creation, and capacity building"</p>
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<h4>Co-Creation</h4>
<p>Co-creation in the context of global health innovation is making sure to partner with collaborators from the local environment. For foreign innovators, it is crucial to develop a cultural sensitivity to what makes the locale unique. This includes knowing which problems are most urgent for the local community, accounting for wide differences in disease prevalence across borders and socioeconomic status. Co-creation is also required, since what works in one locale won’t necessary translate to a global location. Often there are local resource limitations, such as poor roads, limited power infrastructure, or lack of Internet access. More difficult to navigate are often-undocumented cultural differences, such as understanding who the primary decision maker is for a family. In the United States, it is biased toward the individual or spouse, but in many cultures outside the United States, there is a much more extended familial influence, in which parents or other relatives have a significant influence over the medical decisions of even other adults. Rather than having design driven by researchers from high-income countries applying their tools and processes to familiar problems, it is crucial to have core members of the team who are integrated with the target community and familiar with the specific local characteristics.</p>
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<p>Kenneth E. Paik, MD MBA MMSc<br />Research Scientist, MIT Lab for Computational Physiology<br />Co-Director, MIT Sana</p>
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<h3 class="hd hd-2">Co-Creation</h3>
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<div class="wrapper-problem-response" tabindex="-1" aria-label="Question 1" role="group"><p>What is meant by "Co-Creation" in the global health context?</p>
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<h2 class="hd hd-2 unit-title">Collaboration</h2>
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<h4>Collaboration</h4>
<p>Medicine and health systems are immensely complicated. With so many interacting fields along the entire health care vertical, it is a given that no group can solely control quality outcomes; even front-line clinicians directly treating patients are impacted by government regulations, medical supplies, and market forces. This calls for collaboration across fields, purposefully pulling together multidisciplinary teams. </p>
<p>While skills often overlap across fields for any individual, the following generalizes some simplified stereotypes for illustration. Clinicians should remain abreast of the latest developments in medical practice via continuous medical education, but generally are only aware of the latest well-marketed technology development. Therefore, clinicians should collaborate with the technologists who are aware of the limitations and constraints for what is feasible on a platform. Conversely, for the engineers who think their technology can solve every problem, they are usually unaware of the complexities and complications of delivering medical care, especially when focused on quality improvement. Only when clinicians and engineers work together can a team implement an intelligently designed and effective innovation.</p>
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Unit Exercise
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<div class="wrapper-problem-response" tabindex="-1" aria-label="Question 1" role="group"><p>Thought exercise: You have an idea for a mobile health project in a foreign country.</p>
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<legend id="9424fb0769a84d8ba47413624194bcf0_2_1-legend" class="response-fieldset-legend field-group-hd">Which collaborators might you strive to include for your innovation project?</legend>
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<h2 class="hd hd-2 unit-title">Capacity Building</h2>
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<h4>Capacity Building</h4>
<p>The overarching goal for any innovation should be a long-term sustainable impact. However, many global health projects currently are supported by governmental and nongovernmental organization and foundations. These are wonderful initiatives and lead to incredible work and progress in the public health; however, they are often time-limited and have restricted funding. This is one of the strongest culprits for “pilot-itis,” as many projects simply end once the grant period is over. In order for a project to be more sustainable, development resources and even the innovation itself should be at least partially derived locally, so that team members will retain a long-term view and commitment to maintain a sustained impact for their local community. To achieve this lofty goal, organizations will need to focus on local capacity building to build necessary skills and train the next generation of digital health innovators.</p>
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<h3 class="hd hd-2">Capacity Building</h3>
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<div class="wrapper-problem-response" tabindex="-1" aria-label="Question 1" role="group"><p>Thought Exercise: You have a global health innovation project in Uganda.</p>
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<legend id="d91852a75316452aa7a40c48f6de33dd_2_1-legend" class="response-fieldset-legend field-group-hd">Which of the following would be considered local capacity building?</legend>
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<input type="checkbox" name="input_d91852a75316452aa7a40c48f6de33dd_2_1[]" id="input_d91852a75316452aa7a40c48f6de33dd_2_1_choice_0" class="field-input input-checkbox" value="choice_0"/><label id="d91852a75316452aa7a40c48f6de33dd_2_1-choice_0-label" for="input_d91852a75316452aa7a40c48f6de33dd_2_1_choice_0" class="response-label field-label label-inline" aria-describedby="status_d91852a75316452aa7a40c48f6de33dd_2_1"> Participating in a Hackathon in Uganda
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<input type="checkbox" name="input_d91852a75316452aa7a40c48f6de33dd_2_1[]" id="input_d91852a75316452aa7a40c48f6de33dd_2_1_choice_1" class="field-input input-checkbox" value="choice_1"/><label id="d91852a75316452aa7a40c48f6de33dd_2_1-choice_1-label" for="input_d91852a75316452aa7a40c48f6de33dd_2_1_choice_1" class="response-label field-label label-inline" aria-describedby="status_d91852a75316452aa7a40c48f6de33dd_2_1"> Hiring a young engineer from the local university
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<input type="checkbox" name="input_d91852a75316452aa7a40c48f6de33dd_2_1[]" id="input_d91852a75316452aa7a40c48f6de33dd_2_1_choice_2" class="field-input input-checkbox" value="choice_2"/><label id="d91852a75316452aa7a40c48f6de33dd_2_1-choice_2-label" for="input_d91852a75316452aa7a40c48f6de33dd_2_1_choice_2" class="response-label field-label label-inline" aria-describedby="status_d91852a75316452aa7a40c48f6de33dd_2_1"> Publishing a paper on your project in a peer-reviewed journal
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<input type="checkbox" name="input_d91852a75316452aa7a40c48f6de33dd_2_1[]" id="input_d91852a75316452aa7a40c48f6de33dd_2_1_choice_3" class="field-input input-checkbox" value="choice_3"/><label id="d91852a75316452aa7a40c48f6de33dd_2_1-choice_3-label" for="input_d91852a75316452aa7a40c48f6de33dd_2_1_choice_3" class="response-label field-label label-inline" aria-describedby="status_d91852a75316452aa7a40c48f6de33dd_2_1"> Releasing your code with an open source license
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<input type="checkbox" name="input_d91852a75316452aa7a40c48f6de33dd_2_1[]" id="input_d91852a75316452aa7a40c48f6de33dd_2_1_choice_4" class="field-input input-checkbox" value="choice_4"/><label id="d91852a75316452aa7a40c48f6de33dd_2_1-choice_4-label" for="input_d91852a75316452aa7a40c48f6de33dd_2_1_choice_4" class="response-label field-label label-inline" aria-describedby="status_d91852a75316452aa7a40c48f6de33dd_2_1"> Submitting for IP protection with the United States Patent and Trademark Office
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<input type="checkbox" name="input_d91852a75316452aa7a40c48f6de33dd_2_1[]" id="input_d91852a75316452aa7a40c48f6de33dd_2_1_choice_5" class="field-input input-checkbox" value="choice_5"/><label id="d91852a75316452aa7a40c48f6de33dd_2_1-choice_5-label" for="input_d91852a75316452aa7a40c48f6de33dd_2_1_choice_5" class="response-label field-label label-inline" aria-describedby="status_d91852a75316452aa7a40c48f6de33dd_2_1"> Training community health workers to use your application
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<h2 class="hd hd-2 unit-title">Recommendations In Practice</h2>
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<h4>Partnership with Local Stakeholders</h4>
<p>We recommend initiating innovation projects by responding to a clinical need affecting care delivery in the local setting. One example of this is Sana, a volunteer organization hosted by the Computer Science and Artificial Intelligence Laboratory at the Massachusetts Institute of Technology, which begins each project, program, or venture with this approach. Over time, Sana has developed an open source mobile telehealth platform that allows for capture, transmission, and archiving of complex medical data such as ECG and EEG waveforms, in addition to patient demographic and clinical information to help meet needs in LMIC settings. Sana begins each of its efforts with a thorough discussion and identification of clinical needs by the interdisciplinary team, which includes international NGOs, universities, governments, and private ventures, with strong emphasis on local stakeholders.</p>
<p>Local organizations approach Sana with specific problems or 'pain points' to solve, and Sana utilizes their core, enabling mobile telehealth platform to address the specific local needs. The team moves ahead only when buy-in is established from clinical providers, informaticians, and engineering and public health experts at the local level who will be pushing the project forward themselves. Having local clinicians on the team is essential, as they have the connections and influence. Sometimes the local culture- often sequestered by paternalistic medical traditions- might not be ready for quality improvement movements, so ministries of health or medical associations may resist cooperating. These local clinicians serve as barometers by which the team can determine if the innovation may be successful.</p>
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<h4>Building Local Capacity</h4>
<p>Secondly, we recommend building the capacity of the local community using a co-creation pathway. Because resources are often constrained in LMIC settings, it is critical to amplify the existing resources using co-creation, further supported by enabling technological infrastructure. The Co-Creation Laboratories, administratively housed at Massachusetts General Hospital in partnership with a consortium of partners in Uganda and India, emphasize this iterative design process. Starting with the health needs identified by LMIC, the Co-Creation Laboratories work closely with local partners to tailor technologies through rapid prototyping and iterative creation. Utilizing Steve Blank's "lean start-up" and Bill Aulet's "disciplined entrepreneurship" principles, they emphasize creating a "minimum value product" or MVP, needed to test out a potential solution to meet the clinical need. This initial prototype is tested and validated in the local context and setting. In a process they term "role flexing"the end user becomes a designer, a physician, a policy advisory and anthropologist, and an engineer. These quick, iterative developmental cycles allow for the innovation team to obtain feedback in real time to propel the development of a solution that meets the unique needs of the community.</p>
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<h4>Multidisciplinary Collaboration</h4>
<p>The third and last recommendation emphasizes multidisciplinary collaboration. There are great untapped opportunities to further accelerate innovation in global health settings through crowdsourcing innovation directly from the users and embedding it in user-driven communities. Eric von Hippel speaks extensively about the concept of the "democratization of innovation". This is a paradigm that allows front-line users to 'develop exactly what they want, rather than relying on manufacturers to act as their (often very imperfect) agents. Moreover, individual users do not have to develop everything they need on their own: They can benefit from innovations developed and freely shared by others'. Embedding these user-driven innovations in communities (both online and in-person) can create connections that "short-circuit" the innovation process and increase the speed and effectiveness of disseminating new evidence.</p>
<p>This concept has been well documented in other industries. For instance, the Defense Advanced Research Projects Agency developed ARPAnet to create a network of researchers and defense contractors to accelerate the exchange of software and data, while Linus Torvalds developed LINUX in 1991 as free and open-source operating system that enabled anyone to contribute to its development. Global health brings a unique set of challenges, and a more democratized approach is needed.</p>
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<h3 class="hd hd-2">Take Home Messages</h3>
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