Understanding What Works: New Book Explores Health Innovations from Around the World

Drawing on the analysis of over one thousand organizations engaged in health market innovations, Private Sector Entrepreneurship in Global Health is a valuable resource for researchers and students in management, global health, medicine, development studies, health economics, and anthropology, as well as program managers, social impact investors, funders, and policymakers interested in understanding approaches emerging from the private sector in health care.

In this post, the editors of Private Sector Entrepreneurship in Global Health discuss the Toronto Health Organization Performance Evaluation (T-HOPE), a group they co-founded back in 2007. They reflect on the outcomes of that group, and discuss why ongoing commitment to improvements in human health is as important now as it was 50 years ago.


This book is the culmination of more than a decade of collaborative work conducted at the University of Toronto, in partnership with colleagues around the world through our group, the Toronto Health Organization Performance Evaluation (T-HOPE). The work published here began when co-editors Onil Bhattacharyya and Anita McGahan joined the faculties of Medicine and Management, respectively, in 2007. We engaged students from each of our disciplines to examine the medical and management innovations of pioneering organizations from the private sector – both social enterprises and non-profits. This led to insights about how some private sector pioneers applied management techniques in finance, operations, and marketing to achieve breakthroughs in health outcomes in resource-limited settings.

In 2010, Will Mitchell and Kathryn Mossman joined the team, and we partnered with Results for Development (R4D) to explore how broad health outcome measures contrasted with the organization-level process and profitability metrics that were customary in our fields of medicine and management. The field needed criteria that reflected differences in the strategies, sustainability, and scale of the innovative organizations that we sought to assess. We wanted to develop a reliable framework that was widely applicable to assess the effectiveness of organizational choices.

To accomplish this, we engaged with a committed, inquisitive, and capable group of students from medicine, social science, public health, management, and global affairs. The T-HOPE team worked on a series of projects focused on understanding how organizations around the globe are innovating to improve healthcare, particularly for the poor. In everything we did, we sought to adhere to strong scholarship while translating our research to findings that would be useful in practice and policy.

This book reflects the outcome of that decade-long effort. Key themes include:

  • Managing trade-offs between access, quality, and efficiency: Credible and feasible measures to guide strategy are essential to create health value in new ways and to apply innovative approaches.
  • Localization: New tools that reflect local needs and local resource constraints are available to support innovative organizations, especially those that seek to address the specific concerns of small communities.
  • Reverse innovation: There are growing opportunities to learn from different contexts and apply innovations from other parts of the world, including diffusion from resource-constrained contexts, in higher-income countries such as Canada.
  • Technological leverage: Digital health tools can improve access and empower patients and providers.
  • Sustainability: Sustaining impactful health innovations requires innovative financing, partnerships, and approaches to cost structure.
  • Scaling: Scaling up innovative approaches begins with generating demand, and is fulfilled by excellence in execution.
  • Management is central to healthcare: Many of the problems facing healthcare are management problems, creating the potential to revolutionize healthcare through innovative approaches to the central management issues of organizational processes, finance, and marketing.
  • Public-private complementarity: Critically, health innovators from the public and private sectors must work together to coordinate and integrate care to maximize impact.

 

Our core message is simple: private sector organizations, including for-profit social enterprises and non-profit NGOs, play a large role in delivering healthcare in many countries. Harnessing the capabilities and activities of these organizations can help achieve sustainable healthcare for those who need it most. A range of organizations in the private sector have implemented technical, organizational, and management innovations that provide healthcare and promote health in a range of settings. These innovations can inform healthcare in other settings.

While we see public sector agencies and initiatives as essential to the planning and sustainability of health care globally, we also acknowledge that public sector organizations face resource limits, political challenges, organizational constraints, and other barriers that can limit their impact. In turn, we highlight the value that private sector organizations can bring to health globally – by testing and scaling new models that fill gaps in care, and by acting as a source of replicable solutions in other settings. Private-sector organizations can extend the reach and impact of public organizations. Through greater coordination, collaboration, and integration, public and private providers can work together to ensure that quality care is accessible to those who need it most around the world.

Globally, a great deal has been accomplished during the past half century to improve healthcare and strengthen health systems. On average, average life expectancy has increased by 20 years since 1960, while infant mortality dropped by 35 children per 1,000 births since 1990. Despite this success, huge gaps in access and quality remain in all countries – both on average and in the lives of individuals. Indeed, improvements in many countries have plateaued, and in some cases even been reversed, during the past decade. Moreover, health challenges that once were isolable now have global implications – the cross-border diffusion of the Ebola virus is one obvious example. Ongoing commitment to improvements in human health is as important now as it was 50 years ago.


Anita M. McGahan is University Professor and George E. Connell Professor of Organizations and Society at the University of Toronto, where she is appointed at the Rotman School, the Munk School, the Physiology Department of the Medical School, and the Dalla Lana School of Public Health.

Kathryn Mossman is Associate Director of Research and Strategy at iD. As an anthropologist and research consultant, her areas of interest include global health, gender and immigration, knowledge translation, insights and strategy, and organizational effectiveness.

Will Mitchell is the Anthony S. Fell Chair in New Technologies and Commercialization at the Rotman School of Management of the University of Toronto. He studies business dynamics in markets around the world.

Dr. Onil Bhattacharyya is a family physician and the Frigon Blau Chair in Family Medicine Research at Women’s College Hospital. He is an Associate Professor in the Department of Family and Community Medicine and the Institute of Health Policy, Management and Evaluation at the University of Toronto.