title: Criteria to assess potential reverse innovations: opportunities for shared learning between high- and low-income countries.
abstract: Low- and middle-income countries (LMICs) are developing novel approaches to healthcare that may be relevant to high-income countries (HICs). These include products, services, organizational processes, or policies that improve access, cost, or efficiency of healthcare. However, given the challenge of replication, it is difficult to identify innovations that could be successfully adapted to high-income settings. We present a set of criteria for evaluating the potential impact of LMIC innovations in HIC settings.
  
  
  
  An initial framework was drafted based on a literature review, and revised iteratively by applying it to LMIC examples from the Center for Health Market Innovations (CHMI) program database. The resulting criteria were then reviewed using a modified Delphi process by the Reverse Innovation Working Group, consisting of 31 experts in medicine, engineering, management and political science, as well as representatives from industry and government, all with an expressed interest in reverse innovation.
  
  
  
  The resulting 8 criteria are divided into two steps with a simple scoring system. First, innovations are assessed according to their success within the LMIC context according to metrics of improving accessibility, cost-effectiveness, scalability, and overall effectiveness. Next, they are scored for their potential for spread to HICs, according to their ability to address an HIC healthcare challenge, compatibility with infrastructure and regulatory requirements, degree of novelty, and degree of current collaboration with HICs. We use examples to illustrate where programs which appear initially promising may be unlikely to succeed in a HIC setting due to feasibility concerns.
  
  
  
  This study presents a framework for identifying reverse innovations that may be useful to policymakers and funding agencies interested in identifying novel approaches to addressing cost and access to care in HICs. We solicited expert feedback and consensus on an empirically-derived set of criteria to create a practical tool for funders that can be used directly and tested prospectively using current databases of LMIC programs.
authors.affiliation: Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, Ontario, M5G 1V7, Canada. ob@cmwf.org.|Women's College Hospital, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada. ob@cmwf.org.
authors.forename: Onil
authors.initials: O
authors.lastname: Bhattacharyya
authors.affiliation: Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, Ontario, M5G 1V7, Canada.
authors.forename: Diane
authors.initials: D
authors.lastname: Wu
authors.affiliation: Women's College Hospital, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Mossman
authors.affiliation: North York General Hospital, 4001 Leslie St, Toronto, Ontario, M2K 1E1, Canada.
authors.forename: Leigh
authors.initials: L
authors.lastname: Hayden
authors.affiliation: Faculty of Medicine, University of Toronto, 1 King's College Cir #3172, Toronto, Ontario, M5S 1A8, Canada.
authors.forename: Pavan
authors.initials: P
authors.lastname: Gill
authors.affiliation: Department of Chemical Engineering & Applied Chemistry, Faculty of Applied Science & Engineering, University of Toronto, 200 College Street, Toronto, Ontario, M5S 3E5, Canada.
authors.forename: Yu-Ling
authors.initials: YL
authors.lastname: Cheng
authors.affiliation: Dalla Lana School of Public Health and Department of Surgery, University of Toronto, 155 College St., Toronto, Ontario, M5T 1P8, Canada.
authors.forename: Abdallah
authors.initials: A
authors.lastname: Daar
authors.affiliation: Rotman School of Management, University of Toronto, 105 St George St, Toronto, Ontario, M5S 3E6, Canada.
authors.forename: Dilip
authors.initials: D
authors.lastname: Soman
authors.affiliation: Results for Development, 1514 17th St NW, Washington, DC, 20036, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Synowiec
authors.affiliation: Innovations in Healthcare, Duke University, 324 Blackwell Street, Suite 960, Durham, North Carolina, 27701, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Taylor
authors.affiliation: Munk School of Global Affairs and Department of Political Science, University of Toronto, 1 Devonshire Place, Toronto, Ontario, M5S 3K7, Canada.
authors.forename: Joseph
authors.initials: J
authors.lastname: Wong
authors.affiliation: Department of Strategic Management, Kaunas University of Technology, Gedimino 50 - 414, LT-44029, Kaunas, Lithuania.
authors.forename: Max
authors.initials: M
authors.lastname: von Zedtwitz
authors.affiliation: Department of Paediatrics, Dalla Lana School of Public Health and Department of Nutritional Sciences, University of Toronto 555 University Avenue, Toronto M5G 1X8 Ontario, Canada.|Centre for Global Child Health and Research Institute, Hospital for Sick Children, 525 University Avenue, Suite 701, Toronto, Ontario, M5G2L3, Canada.
authors.forename: Stanley
authors.initials: S
authors.lastname: Zlotkin
authors.affiliation: Rotman School of Management, University of Toronto, 105 St George St, Toronto, Ontario, M5S 3E6, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Mitchell
authors.affiliation: Rotman School of Management, University of Toronto, 105 St George St, Toronto, Ontario, M5S 3E6, Canada.
authors.forename: Anita
authors.initials: A
authors.lastname: McGahan
mesh_terms: D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000145:classification / Q000191:economics / Q000379:methods*; D019049:Developed Countries; D003906:Developing Countries; D004059:Diffusion of Innovation; D006297:Health Services Accessibility / Q000145:classification / Q000592:standards; D006801:Humans; D038622:Internationality; D007858:Learning; D036301:Qualitative Research
keywords: Global health; Healthcare delivery models; Innovation; Low- and middle-income countries; Reverse innovation