What is global health reciprocal innovation?

Global health reciprocal innovation (GHRI) describes a distinct, mutually beneficial and equitable approach to global health research that is focused on the transfer and exchange of health innovations around the world. The term ‘reciprocal innovation’ in the context of global health research was characterised by Sors et al as harnessing a ‘bidirectional, coconstituted and iterative exchange of ideas, resources and innovations to address shared health challenges across diverse global settings’.1 While GHRI broadly covers exchange across any global setting, the goal of the BMJ GH Supplement ‘Reciprocal Innovation in Global Health Research’ is focused on examples of innovation first developed in low and middle-income countries (LMICs) and then applied to address similar health concerns in high-income countries (HICs). HIC settings have much to learn from health innovations in LMICs—a reality that has been obscured by a global health system and culture that has not historically viewed LMICs as originators of innovation.2 Although much of the research on transferring innovations described in this Supplement was not codeveloped, multidirectional and iterative, the authors seek to draw attention to the underappreciated fact that important and efficacious innovations are developed in LMICs, that their impact can be extended and adapted to address health challenges in HICs, and that the information exchanged through iterative research and learning cycles can benefit both LMIC and HIC partners. In fact, some of the examples presented of reciprocal innovation evolved organically and serendipitously during the process of researching and implementing LMIC evidence-based interventions and were transferred to a different setting, resulting in novel and effective approaches to meet the needs of the new location.3–5 The information and examples provided in the Supplement will hopefully inform researchers and funders of the opportunity to more systematically encourage and harness a GHRI approach to research. Because GHRI is an emerging concept in global health research, there are few programmes and publications that describe or incorporate the approach. The Supplement papers will begin to fill that gap by providing information about GHRI and examples of how it can be applied to innovation transfers and exchanges between LMICs and HICs.

The GHRI supplement papers

The publication of the GHRI Supplement was initially discussed at the NIH sponsored virtual GHRI workshop in 2022. The goal of the Supplement was to capture and expand on presentations made at the workshop; to provide in-depth case examples of the use of GHRI across diseases and public health needs and to identify barriers, facilitators, lessons learnt and research needed to enhance the use of this equitable approach in global health research.

In line with these goals, the Supplement paper by Ruhl et al describes challenges and lessons learnt from one of the few existing GHRI grant programmes and includes examples such as the exchange of innovations for caregivers of children with autism and preterm babies and infants exposed to opioids as well as a new device to test for faulty drugs.6 Another Supplement paper by Turan et al documents cases in which mental health and well-being interventions originating in or conceived for LMICs were implemented in the USA, including delivery of psychological interventions by non-specialists, HIV-related stigma reduction programmes, substance use mitigation strategies and interventions to promote parenting skills and family functioning.7 Notably, the field of mental health has been proactive and innovative by encouraging reciprocal learning through some of its research programmes, including, for example NIH RFA-MH22-130 and NIH RFA-MH-22–100. Patel-Larson et al describe in the Supplement a platform for innovation exchange between domestic and global health US HIV/AIDS programmes.8 Other Supplement papers describe barriers and facilitators for implementing a GHRI approach, which highlight the complexities inherent in exchanging health innovations between different sociocultural and structural contexts.4–7 Some papers include lessons learnt to guide the future use of a GHRI approach.4 6 7

Rid et al explore ethical, legal and regulatory considerations involved in implementing GHRI, including GHRI’s ethical commitment to equitable research partnerships as well as a concern that GHRI studies could displace funding for studies whose results have more immediate or significant benefits for populations in LMICs.9 Dearing et al introduce the idea of reciprocal coproduction as a basis for the diffusion of global health innovations and provide the example, among many others, of how a Kenya-based texting platform that facilitates personalised patient-provider communication was redesigned and adapted to address HIV prevention needs and gaps in the USA.4 Muddu et al describe the importance of training and informing the next generation of researchers on the use of GHRI through the unique pairing of domestic and global health training programmes.10

Together, the GHRI examples, lessons learnt, strategies and considerations discussed in this Supplement can be used to help foster equitable collaborations; accelerate, and expand the adoption of innovations and heighten the likelihood that health disparities and health challenges will be effectively addressed globally.

Operationalising GHRI

How do we make the leap from defining GHRI in principle to applying it to research projects? Figure 1 depicts some of the elements that may be considered in operationalising GHRI. The elements have been identified from our experience implementing global health research programmes, the 2022 NIH workshop on GHRI, and the papers in the Supplement.

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Figure 1

Suggestions for operationalising the GHRI approach.

A call to action

The GHRI approach can elevate our global capacity to better address seemingly intractable health concerns. LMICs have offered solutions such as better harnessing community health clinics3 and community health workers for rural populations12; repairing hernias with mosquito net mesh as an alternative to commercial mesh; inducing neonatal therapeutic hypothermia with phase change material mattresses as an alternative to incubator devices; and treating severe burns with tilapia fish skin,2 among numerous others. The Supplement papers describe examples of LMIC innovations for adaptation to HICs such as an HIV-related stigma reduction in-person workshop that was originally developed and tested in five countries in Africa, adapted and tested in Alabama, and then adapted and implemented in the Dominican Republic (DR), with ongoing efforts to incorporate lessons from the DR into future implementation in the southern USA.7 Dearing et al provide the example of WelTel, a bidirectional texting platform between patients and providers that was demonstrated to improve medication adherence and viral suppression in people living with HIV in Kenya and that has since been redesigned and adapted to support adherence to oral pre-exposure prophylaxis in the USA.4 A Colombian innovation, Ciclovia, periodically closes streets to automobiles, so that pedestrians can more freely walk, run, skate and pedal and has been adapted by municipalities in many countries over the past 50 years.4 To enable researchers to use the GHRI approach in innovation transfer and exchange, it is necessary to support the development of platforms and programmes that promote reciprocal learning and innovation exchange and foster equitable research collaborations. Education and training programmes in the GHRI approach are needed. In addition, publications of results from GHRI research and learning projects should be optimally shared and disseminated, with full credit given to the original innovation and innovator(s) and with full disclosure of the paradigms used to ensure equity between the researchers, input from the stakeholders and iterative and continual, mutually beneficial learning for the investigators. In this way, innovation can flow more rapidly and systematically around the world to improve health globally.

Key elements of GHRI research remain to be fully developed. Some of these areas are listed below and were discussed during the October 22 NIH GHRI workshop:

1. Develop platforms and programmes supportive of a GHRI approach to research and learning.

2. Refine funding models to accommodate the needs of a GHRI approach to research, such as allowing time for codeveloped iterative research planning and learning cycles, to identify and integrate stakeholders in the research; to support pilot projects and formative research and to address legal regulatory and ethical issues that may arise.

3. Develop frameworks, as necessary, to integrate a GHRI approach into research involving innovation exchange.

4. Create globally accessible repositories of existing and ongoing GHRI research, which can include lessons learnt, and innovations available from LMICs to address specific HIC health needs (such as the Global Innovation Exchange).

5. Work with journals to require inclusion of information about the original innovation when the research involves innovation transfer and exchange.

This editorial has outlined an important priority, applying the approach of ‘reciprocal innovation’ to global health research on innovation transfer and exchange and underscored the significant benefits that can be gained from the reciprocal exchange of knowledge developed in settings across the world. Novel and creative interventions developed to meet health challenges in diverse settings can be effectively adapted and implemented in different contexts, thus establishing broad efficiencies in health research. Figure 1 presented in this paper provides a starting point for operationalising a GHRI approach. Researchers and funders may examine and expand on items included for their GHRI approach to be fully realised. GHRI can be transformative in expanding successful approaches to meet the health needs of communities worldwide.