Policy agenda

"We have to accept that west is not always best in healthcare and learn from others around the world"

The situation

Even before the current pandemic crisis, which has put healthcare services around the world under unprecedented pressure, health services in the west faced enormous challenges – to create efficiencies and learn how to do more with less. Research shows there are lessons to be learned from research outputs and health systems of low-income countries.

Traditionally, these countries have been passive recipients of expertise from developed nations, but now there is an opportunity to reverse the paradigm. “Existing western solutions to burgeoning healthcare demand are simply not working any more,” says Dr Matt Harris, Clinical Senior Lecturer in Public Health Medicine. “We have not only the opportunity but the moral duty to create a win-win situation by learning from low-income countries.”

The issue

Cognitive bias is slowing down the adoption of innovative practices from low-income models. A randomised, blinded, crossover experiment conducted by Dr Harris and colleagues among a sample of 347 English clinicians proved that changing the source of research from a low- to a high-income country significantly improved how it was viewed.

“There are many empirical studies demonstrating this bias exists, highlighting the fundamental, morally debatable issues at stake,” says Dr Harris. “A postcolonial attitude of ‘not invented here’ and ‘good enough for them but not for us’ still lingers. Western healthcare services still have work to do, particularly at clinician level, for example, to advance attitudes and accept solutions that may not be technically cutting edge but are safe and cost effective.”

The opportunities

The scale of the overall opportunity is enormous, with outcomes specific to each innovation: using basic orthopaedic drills developed in Malawi, for example, could save the NHS an estimated £100m; mosquito-net mesh provides a much cheaper alternative to the synthetic commercial material currently used for hernia repair and is equally effective; and the delivery of blood products and essential medicines by drone is used at scale in Rwanda with great potential for rural areas in the UK. 

“I first became interested in learning from other systems when I was working as a GP in a remote community in north-east Brazil,” explains Dr Harris. “Through the Brazilian Family Health Programme, community health workers provide the backbone of the local healthcare system. When I returned to the UK after four years, I was shocked to see how fragmented community care was in comparison, with a complicated network of different services.

"The systematic deployment of community health workers in the NHS along the lines of the Brazilian model would have the potential to address apparent problems of fragmentation and inefficiency, while improving clinical outcomes through improved uptake of appropriate services.” This, he believes, is just one example of the potential for reverse innovation.

Future uptake

Pilot studies are needed of innovations from low-income contexts. The NIHR Applied Research Collaborative in north-west London is an opportunity to translate innovative research into the local context.

“Overall, there are deeply entrenched attitudes to overcome,” says Dr Harris, “but I believe that we can get to a level playing field. The attitude must be: if it works and is safe, it doesn’t matter where the idea comes from.”

Dr Matthew Harris is an Honorary Consultant in Public Health Medicine in the Imperial College Healthcare NHS Trust.