Learning and Action Network: Adaptation and Diffusion of Innovations during the COVID-19 Pandemic

The panel was moderated by Dr. Diana Silimperi. Speakers included:

• Karabi Acharya, Global Ideas for U.S. Solutions, RWJF
• Matt Harris, Imperial College London
• Nowai Gray, Last Mile Health
• Shelley Saxena, Sevamob
• Jordan Lerner, Dimagi 

The first few questions focused on organizational response to adaptation and diffusion of innovations during the pandemic (7:23)

• To Mr. Matt Harris, how has the COVID-19 pandemic impacted the conceptual thinking of the adaptation of innovation of your favorite frugal innovation at the Imperial College, and more broadly in the UK? (7:39)

• Harris first explained that frugal innovation generally means doing more with less, for more people: finding ways to repurpose existing resources for new applications, simplifying products, or increasing the efficiency with which a product serves. He then listed many of the exciting examples of frugal innovation in the face of COVID-19, such as protective face visors from recycled plastic bottles, repurposing trains to become isolation wards, and distilleries that previously produced alcohol now producing hand sanitizer.

• As a result of the pandemic, Harris believes the world has innovated quickly and across sectors. This movement therefore reinforced the ‘bi-direction of learning’ or ‘double loop learning,’ as high income countries have increasingly more to learn from low income countries, particularly as they seek to do so frugally.

• To Ms. Karabi Acharya, what do you think has not changed during the pandemic? Moving forward, how do you think the pandemic may have changed the conversation of innovation in regards to adaptation of innovation at RWJF? (14:05)

• RWJF’s primary lens is one of health equity, as it aims to create a culture of health so that everyone is able to attain better health and access the healthcare they need. As COVID-19 has unveiled the severe inequities that people of color and low-income communities in the US face, Acharya spoke to how RWJF has worked to shift its conversation towards social determinants of health to address the underlying conditions that place people at higher risk. For example, it provided $50 million in humanitarian relief to provide food, housing, and income assistance. Their hope was to expand the conversation beyond immediate health responses such as PPE, to examine the relevance of other issues on inequitable health outcomes.

The panel then shifted to hear the experiences of innovators, asking them to each describe their innovation and the adaptations they’ve made to these innovations as a result of the pandemic. (19:48)

• Sevamob’s AI-enabled healthcare platform consists of three components: on-site pop up clinics, telehealth, and AI-based triage and point of care screening. By bringing these three components together, they are able to provide comprehensive primary care at up to 50% of the cost through a business-to-business model. During COVID-19, Sevamob created protection kiosks which protect frontline health workers and can reduce the cost of PPE by up to 90%, as less PPE is needed. They also shifted services to offer on-site only, hybrid, and telehealth options. Finally, they started a COVID-19 intervention that provides prevention, testing, consultation, referrals, and tracking services.

• CommCare is Dimagi’s open source data collection software that enables users to work in a non-code environment. As a mobile or web based application, it can be pushed to the frontline level. Reflecting upon knowledge gleaned from previous outbreaks, they knew that the best technology was likely that which could be utilized the quickest. Thus, they repealed barriers to access such as cost for governments, while developing free application templates designed to be used at any point during the pandemic. These applications offer decision-making support at the frontline level, such as lab tracking, health worker training and monitoring, facility readiness, contact tracing, and port of entry screening. Dimagi has also shifted many of its employees to focus on support for governments and organizations. Just one such example involves the company creating a new digital platform and dashboard for the Togolese government to track cases.

• To Ms. Nowai Gray, what was Last Mile Health’s most significant lesson learned in terms of adapting innovation to the pandemic? (27:54)

• Gray highlighted how the pandemic reinforced the value of community health workers’ use of mobile technology. It not only improves the effectiveness and availability of training materials and job aids, but also utilizes community health workers’ existing trust in the tool. Last Mile Health’s phones are preloaded with videos, and come with a power bank as well as a solar plate so they can be charged. 

• How have you introduced or expanded telehealth and/or digital programming to new settings in the context of the pandemic? (30:50)

• At Sevamob, many other healthcare providers have requested to license Sevamob’s platform for their own services, which now comprises a key component of their revenue stream. Saxena emphasized the strong pull for both telehealth infrastructure and service provision in the face of COVID-19, though a hybrid model is most necessary.

• Dimagi has focused on building tools that reflect best practices and make these protocols available to workers on the frontline while also facilitating contact tracing and data collection. For example, across Sierra Leone, CommCare used one of its template applications to disseminate the WHO protocol to conduct facility readiness assessments within just 24 hours.

• For all the innovators, how has the pandemic challenged the scale up of innovation, and what were your responses to those challenges? (35:36)

• Because many of the company’s regular services were placed on hold, Sevamob found many new opportunities through COVID-19. Just a few include, but are not limited to: providing testing, launching an awareness campaign along with sanitizer distribution, and on-site employee health services. Furthermore, they have expanded the types of clients they work for as more companies seek help combating COVID-19.

• Training has posed many barriers to Last Mile Health’s work, as trainers must divide participants into smaller groups and therefore hold more sessions whilst providing more materials, while also adhering to social distancing and mask guidelines that inhibit the ease of each session.

• To Mr. Harris, how might we think about embedding concepts of frugal innovation so that it becomes part of the landscape going forward? Additionally, what kind of research is needed to learn more about adapting innovation and scaling innovation from LMICs? (40:45)

• Harris emphasized the achievements coming from LMICs and the resistance that many HICs have to asking LMICs for help. In doing so, many approaches have used a very individualistic mindset and are missing opportunities that lie in learning from previous and/or concurrent initiatives. Thus, he challenged HICs to question what perceptions they have of innovation from LMICs, and to treat such innovation with equal respect in order to create a more level playing field.

• What one-sentence takeaway do you have for the audience? (45:30)

• Acharya: We must connect the dots and work to see how various innovations work in a larger context of healthcare, health equity, and the social determinants of health.

• Lerner: 1) Flexibility enables us to make urgent changes in real time, and 2), technology is not the end-all of responses, but it is important to assist frontline workers.

• Gray: Empowering community healthcare workers with mobile phones will enable them to achieve much of the necessary work they do.

• Saxena: While adjusting to the various challenges of COVID-19, we mustn’t forget that it also presents new opportunities.

• Harris: HICs have a market to implement solutions from LMICs, and we must work collaboratively to address the fragility of our health systems.

• How does one institutionalize different sanitation practices into places such as urban slums? (52:20)

• Gray: Work with the MOH to get them to engage with your idea and co-develop a protocol to create awareness with the general public. From there, work directly with the community so that they can be the one to disseminate and monitor the process.

• Acharya: Ensure that people can actually do the things that you’re asking them to do--for example, many cannot self-isolate because they do not have the means to. Because innovations from LMICs are designed for the most vulnerable people, there are many lessons to learn from them.

• To close the panel we asked Acharya, given what we’ve been hearing on the panel, how has this influenced your thinking, particularly in regards to bringing innovation from LMICs to the US? (57:20)

• Acharya highlighted that despite continued country of origin bias, she is still excited by the amount of learning across borders. Her hope is that countries will move beyond learning about epidemiology, to address social determinants of health such as income assistance, child care, and housing assistance.

Lastly, the webinar included two important announcements. At 49:47, Andrea Taylor announced GHIC’s development of a framework for adapting innovations into new contexts. The resource aims to outline essential tasks and common challenges at each stage of the process for each type of stakeholder (innovator, provider, policymakers, etc). The group is seeking feedback and input from innovators on the framework, so please reach out to her in order to do so. Lastly, the team would love to receive proposals for initiatives for the LAN to address.