6 Barriers to Health Care Innovation
in Developing Countries
“The practice of medicine is about fear and guilt. Fear for the mistakes you will make. Guilt for the ones you already have. This must be remembered as we build the health care of tomorrow. It is a value to be respected, because it protects patients. It is a value of concern, because it resists needed change.” James C. Salwit
The ultimate goal of health care is to ensure one’s health and well-being. The ultimate goal of innovation is to bring about advances in technology or processes. Thus, the ultimate goal of health care innovation is to pursue better ways of ensuring one’s health through constant improvement in technologies or practices. While this might seem reasonable, the harsh reality of developing countries makes progress and innovation an uphill struggle, as each step towards even minor improvement is greeted with skepticism, scrutiny or downright hostility. Innovation in health care is especially challenging, as it traditionally is one of the most heavily regulated, compliance-oriented, and risk-averse environments which tends to squash new thinking rather than foster it.
Photo by Ross Findon on Unsplash
Below are major obstacles to innovation developing countries face even as they find themselves at a stage in health care where so much is broken or dysfunctional that innovation is desperately needed to fix it.
1. Entrenched Biases Against Everything New
Habits are one of the hardest things to change and mindsets are often the main culprit when it comes to innovation. It takes a health care practitioner up to 10 years to become an independent practicing doctor and, as a rule, it becomes a lifelong occupation. One might even go as far as saying that doctors are a group of people most set in their habits and certain ways of doing things, and while they remain isolated in their silos, the world changes in leaps and bounds. So, the question is, why do these highly intelligent people resist change?
Given the fact that new practices may not turn out to be viable, being an early and active adopter would take great open-mindedness and riskiness. This is what health care professionals so often seemingly lack, sacrificing it in favor of safety and confidence in what they are doing. Yet, one has to remember that physicians do not learn their craft from books or lectures; instead, as James C. Salwitz deftly puts it, “they learn from long years of “practicing” medicine, one patient at a time. Personal, individual, painful, trial-and-error education. Do it “right,” and the patient feels better. Do it “wrong,” and the patient feels worse. Make a brilliant decision and the patient is saved. Make the same brilliant decision, but with a minor twist, and the patient dies. No doctor anywhere, ever, forgets the decisions that failed to save a life or, just maybe, resulted in death”. Whatever happens, the doctor is the one who must live on with the outcome. Thus, once he/she gets something right, no physician will easily change, as every step that has led to a successful outcome becomes hardwired into their every action. With doctors, rapid, dramatic innovation is nearly impossible, and it is a vital concept for health care change agents to understand.
2. A Culture of Risk Aversion
Transformations are painful. Failed transformations - even more so. Nations who have heard promises of a ‘bright future’ many times over only to see the grand plans crumble and collapse before their eyes are much less willing to engage in a kind of behaviour needed to fuel change. The history of living through tumultuous times weighs on the investment decisions, risk aversion, and beliefs of many. Unfortunately, this applies to individuals and businesses alike.
“Whenever external forces exacerbate society’s natural risk aversion, truly innovative and forward-minded people become hard to come by.”
Innovations call for a great deal of optimism, passion and drive, but most importantly they rest upon a belief that whatever it is - it can be achieved. Decades of economic instability promote anxiety and sap creative energy out of people, leaving them listlessly going through the motions. Whenever external forces exacerbate society’s natural risk aversion, truly innovative and forward-minded people become hard to come by.
3. Underpaid But Overworked Medical Professionals
There is a striking gap between compensation received by medical specialists in developing countries as compared to that in developed countries. In Mexico, for instance, the average medical specialist’s annual salary is $25,000, whereas in the Netherlands it comes to $253,000. There are countries with even lower figures, especially if we were to look into physicians’ or nurses’ salaries. Such a low income forces health care professionals in underdeveloped economies to seek additional sources of income and take on jobs that, when added to their primary employment, add up to a workload that is so exhausting it stifles any desire to think outside the box and do more than required.
4. An Industrial Paradigm of Education
“Our education system has mined our minds in the way that we strip-mine the earth, for a particular commodity, and for the future, it won’t serve us.” Ken Robinson
While education systems in a number of developed countries either already have or are now undergoing a rapid, albeit not necessarily painless, transformation that is supposed to adapt education routines and curricula to the needs of an information society, many a developing country is still stuck with an education paradigm conceived to meet the needs of industrialism. There is a plethora of evidence that suggests that as children grow progressively more educated, their capacity for divergent thinking shrinks, and even though divergent thinking is not the same thing as creativity, it is believed to be the prerequisite for creative thinking, hence, innovation.
Photo by Roman Mager on Unsplash
There are a few distinct features that distinguish highest performing developed countries on the Program for International Student Assessment, an important tool for measuring education systems worldwide. Among them are giving schools more autonomy over curricula and assessments, providing teachers with high quality teacher training, a high level of public commitment to education, and, perhaps most importantly, holding the teaching profession in high esteem.
Meagre pay, market mentalities placing great strain on the recognition of and respect for the teachers, as well as encouraging schools to find out what kids can do across the very narrow spectrum of achievement via the means of standardized testing as opposed to nurturing the students’ aptitude for critical thinking, problem solving, teamwork etc. by giving them a well-rounded education – all these create an environment where any success in educating the young happens not due to, but rather in spite of the circumstances as developing nations continue to educate the youth out of their creative capacities.
5. Technological Immaturity
Among the most prominent health care changes occurring these days is the adoption of eHealth and mHealth. EPrescribing is used by 32% of health care institutions across Europe and by 77% across the US, Electronic Health Record has been adopted by 29% and 17% of physicians in the EU and the US respectively. When it comes to developing countries, remote areas with poor or non-existent Internet coverage are obviously ill-equipped to adopt such innovations (take, for instance, Africa where only 35% of people have access to the Internet).
A different matter that is, nonetheless, as important in respect of adoption of eHealth initiatives is the cost of mobile and Internet usage, as well as the price of gadgets needed for eHealth to work. In China only 22% of the population can afford the Internet at its current price. While in the USA some 72% of people own a smartphone, in African countries the average percentage is only 25%.
It is also worth mentioning that the population most likely in need of treatment is, on average, older that 65. People of such age are usually traditional and conservative, used to hospital-bound face-to-face medical interventions. They are comforted by the personal component of health care and normally display reluctance to embrace digital health care. Given the number of such patients, they make up a sizable audience to win over, an endeavor that would take great creativity and patience.
Thus, technological immaturity, reflected in inadequate mobile and Internet coverage, unaffordability of devices and mistrust in digital health care, is yet another obstacle that hinders medical progress.
6. State-Funded R&D Is Virtually Non-Existent
The majority of developing countries spend less than 1% of their GDP on research and development compared to 4.3% in Israel and 3.2% in Sweden. There are only 0.2 researchers per million people in Zimbabwe compared to 1140 in Singapore. These striking disparities only explain what is evident: the lack of state-funded research means absence of affordable solutions and extremely selective support of innovations within the boundaries of what the state can afford to fund. In the end, private funds need to be raised for a new drug or procedure to go through clinical testing and see the light of day, which in itself leads to a broad spectrum of practical and ethical issues.
While these and other obstacles may seem daunting or even insurmountable, what distinguishes change leaders in developing countries from their somewhat luckier brothers and sisters in the developed world who have access to liquid financial markets and venture capitalists willing to fund big bets on technology, effective and enforceable copyright protection, or world-class research facilities, is the fact that they must innovate on a shoestring budget. Paradoxically, it is this setup that requires them to think outside the box and scour the globe for solid ideas. As the well-known adage has it, necessity is the mother of creation and, with health care, it might mean that, hopefully, trickle-up innovation is a phenomenon that will become the new norm.