Innovation for Resilient and Sustainable Systems for Health

Innovation and learning from experimentation are key to advance the 2030 Agenda and improve health and well-being. Supporting countries to harness innovations is central to UNDP’s approach to strengthening resilient and sustainable systems for health.

UNDP views innovation as a critical driver to do development differently and better. Innovation for development is about identifying more effective solutions that add value for the people affected by development challenges. UNDP’s approach embraces an expansive definition of innovation as a break from previous practice that has significant positive impact, shifting the focus away from gadgets and gizmos to helping partners identify, test, and scale new ways of working based on the sustainable and measurable impact brought about by the new technology or process.

Within its health and development portfolio, UNDP leverages innovation at the policy and programme level to help re-design inclusive service delivery and support countries to achieve universal health coverage.

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These efforts range from facilitating the use of behavioural science and new technologies for improved programmatic efficiencies to identifying innovative financing instruments in support of sustainable health outcomes.

In health as in other spheres of development, technology plays a tremendous role in leapfrogging development dividends. However, technology is part of a chain of dynamic collaborations among invested, trusted and diverse stakeholders. A mobile phone app for health logistics management is not enough to ensure more effective decision-making, nor is the development of a new health technology enough to guarantee increased access to medicines for key populations.

Recognizing that innovation is not just cutting-edge technology but requires changing the status quo, UNDP invests in an integrated approach to foster innovation as a means of scaling and sustaining positive impact. This is based on the understanding that:

  • innovation is not an end in itself. It is about using the most relevant and up-to-date concepts and means available to create better development results
  • innovation needs to have an impact and create value for the end-user
  • innovation is about continually examining our work as a development partner to make it more effective, legitimate, and nationally-owned
  • innovation also entails retiring concepts that do not provide clear evidence of impact
Impact from innovation: the result of a disciplined, planned and managed process.

With its wide country presence and role as an integrator, UNDP is uniquely placed to support innovation that goes beyond incremental improvements to those which help to drive broader systems change: a new model of innovation in which the “theory of change” cannot be restricted to singular services, but instead requires coordinated, collaborative and institutional innovation. This mission-driven focus and set of 9 principles underpins UNDP’s strategic approach to mainstreaming innovation for transformational change needed to achieve SDG 3 at scale.

UNDP’s entry points to support innovation for development

As outlined in its Strategic Plan, UNDP is focused on delivering creative responses to new and emerging development needs, recognizing that innovation is fundamental for countries to successfully address the increasingly complex and interconnected global challenges of the present and future. The updated Project and Programme Management (PPM) policies, further reinforces UNDP’s innovation readiness and agility.

UNDP’s investments in innovation can be mapped across four interconnected pillars:

Mission-driven innovation

Mission-driven innovation tackles complex development issues through concrete and measurable “missions” that are ambitious and foster multi-disciplinary collaboration. They motivate and unite diverse groups in society to work towards a big goal over time, that often transcends electoral cycles.
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Missions should be broad enough to engage cross-sectoral investment and action, though focused enough to achieve measurable success. Innovations that lead to large-scale, game-changing futures missions and bring together unprecedented talent, capital and agency to address challenges include turning cities into carbon-neutral places or ensuring safe and affordable housing for all. The newly launched UNDP Country Accelerator Lab network, champions mission-driven innovation.

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Improvement-oriented innovation

Driving new agile ways of working to improve the efficiency and effectiveness of development programmes, both within UNDP and with the partner countries. This includes experimenting with new capacities, tools and regulations that often lead to more cost, time and resource efficiencies in programme, policy and operation design and services.

Bottom-up solutions

Leveraging local collective intelligence about successful solutions to drive systems change and organizational learning. UNDP plays a key role in connecting, promoting and mainstreaming cutting edge ideas to decision-makers for large scale impact.

Anticipatory innovation

Addressing potential future risks and liabilities by designing experiments to explore them today. This is particularly relevant for frontier technologies and their impact on economies, on human freedom and our well-being.
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It also entails building new mental models and capacities (e.g. foresight, impact modeling, systems thinking) to understand emerging futures by shifting perceptions and creating future-oriented ambitious programmes.

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Innovation for health focus areas

UNDP’s continually evolving approach to help governments and other partners maximize health impacts benefits from the incorporation of multiple types of innovation.

Many of UNDP’s innovations for health are improvement-oriented, such as helping countries leverage mobile technology to strengthen real-time information systems for health service delivery, while underpinned by a longer-term focus on scale and sustainability.

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In supporting countries to test new technologies or approaches to health policy and programme implementation, UNDP helps to connect these project-specific innovations with longer-term impact by planning for and investing in transformative innovation.

In India, for example, UNDP’s support to pilot the electronic Vaccine Intelligence Network (eVIN) not only helped the Government to leverage a new technology to digitize the vaccine logistics management information system, but also instigated a broader culture shift in the perception and use of data as a tool for strengthening the National Immunization Programme. Through a focus on governance and capacity-building alongside the introduction of a new technology, eVIN has helped to empower and incentivize actors at all levels of the vaccine cold chain to make evidence-based decisions through access to actionable, real-time data.

At the same time, UNDP’s engagement to create enabling law, rights and policy environments for health is driven by an approach that helps countries to harness bottom-up innovation. UNDP supports innovative platforms, for example, that bring key populations and civil society together with judiciaries and policymakers in the design of law, rights and policy frameworks for health. Incorporating human-centered design principles into efforts to enhance legal environments for health helps to ensure that policies are designed according to the lived realities and needs of those for whom they are meant to serve.

UNDP likewise promotes the engagement of youth and other target populations to co-create solutions in disease prevention efforts, such as working with young people across the Pacific to design communication campaigns on the prevention and control of NCDs using video, street art, and other inventive media.

UNDP also embraces a systems innovation view in its approach to strengthening health systems’ resilience and capacity to deliver. This includes, for example, promoting models of sustainable health financing and investments that facilitate mutual gains across interconnected sectors. UNDP also works with partners to support new approaches to governance and policymaking based on experimentation and the scientific method. For example, in Tunisia, it has helped to improve institutional reforms to address corruption in the health sector through the use of a risk management approach that allows health workers and policy makers to identify sources of potential corruption and systematically apply mitigation measures.

Examples

The following examples further illustrate the multi-faceted ways through which UNDP leverages innovation for increased impact in health and development:

Improving health service delivery and outcomes

Behavioural experimentation to drive positive health behaviours in Zimbabwe

UNDP Zimbabwe will run a randomized controlled trial to test behaviourally informed interventions to reduce alcohol and cigarette use among tuberculosis (TB) patients, thereby improving TB treatment outcomes.

Testing behavioural insights and video technology to improve treatment access in Moldova

UNDP partnered with the ministry of Health, Labour and Social Protection, Act for Involvement (AFI), the Center for Health Policies and Studies (an implementer of Global Fund projects in Moldova), and the Behavioural Insights Team (United Kingdom) to test the effects of virtually observed treatment compared with directly observed treatment on patients’ adherence to the TB treatment regimens.
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Altogether, 175 people affected by tuberculosis were included in the research, with patients randomly assigned to one of two groups: the treatment of one group of patients was routinely directly observed (DOT—directly observed treatment) and the other group was observed remotely (VO—video observed treatment). Preliminary results show that the adherence level for VOT was 87%, double that of the control group, DOT—43%.

People who received VOT reported saving time and money compared with their peers who went to the local clinic to take the medicines in front of the medical staff. Results also showed that VOT reduced patients’ exposure to stigma. Thanks to the results obtained in the study and with the support of the Global Fund, another 10 districts will pilot video observance of tuberculosis treatment. Read more here.

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Leveraging mobile and digital technology

Leveraging mobile and digital technology to strengthen the effectiveness and transparency of public financial management, risk management, logistics management, and information and reporting systems for health. In Zimbabwe, for example, UNDP helped the government harness technology to develop more effective national platforms for:
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  • Public financial management: The Government of Zimbabwe Public Financial Management System (PFMS) had been in limited use by government ministries and did not have the capability for managing donor funding. As part of its support for implementation of Global Fund grants for HIV, TB, and Malaria in Zimbabwe, UNDP helped the Ministry of Health and Child Care (MoHCC) to develop a Grant Management Module in its PFMS to enable real-time reporting of MoHCC and donor-funded programmes. Further investment to fully operationalize the electronic PFMS for MoHCC reporting down to the district level will help to ensure that it meets national and international requirements. Go to case study
  • Health information systems: UNDP worked with the MOHCC to implement an electronic District Health Information System (DHIS2) i, in partnership with PEPFAR i and RTI i, to replace the mainly paper-based, multiple reporting systems previously in use at health facilities. The DHIS2 platform allows a diverse range of functions, from processing facility registers and service availability mapping to logistics management and mobile tracking of pregnant mothers in rural communities. Efforts are underway, with technical support from the University of Oslo, to integrate DHIS2 with Zimbabwe’s electronic Patient Management Systems (ePMS) and other health information sources, thereby enhancing the interoperability of data and fragmented reporting systems. The DHIS2 package has provided a dramatic improvement in data management and analysis for health programme monitoring and evaluation, leading to more informed decision-making.
  • In addition, UNDP has supported the development of a Weekly Disease Surveillance System (WDSS), which allows for weekly reporting on a mobile phone-based system that enables data collection through in-built frontline SMS messaging, ensuring timely transmission of surveillance data. Go to case study
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Instigating systems change

eVIN

UNDP supported the Government of India to pilot an electronic logistics management information system (eLMIS) that combines technology, effective governance, and strong human resources to strengthen the impact of its National Immunization Programme.
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The system, known as the electronic Vaccine Intelligence Network (eVIN), includes a smartphone-based application and online dashboards that enables end-to-end visibility of real-time data on vaccines stock levels, movements, and storage temperatures. The integrated solution has promoted more robust data collection and transparent data sharing for improved decision-making and supply chain management: a model now being adapted and scaled in other countries. Read more
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A risk-management approach to corruption prevention in the health sector

Corruption in the health sector remains a critical obstacle to the achievement of national development objectives, contributing to weak health systems and the diversion of fundamental health resources from those who need them.
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Mainstream approaches to corruption have tended to focus on generic, and generally technical governance reforms rather than explicit anti-corruption measures or have otherwise been characterized by an overemphasis on legalistic responses and law enforcement efforts. Recognizing the added value of risk management for corruption prevention, and the need for tools adapted to sector specific contexts and challenges, UNDP in the Arab States has defined new methodologies based on its experiences in operationalizing a corruption prevention agenda.

UNDP has helped numerous countries, such as Tunisia and Morocco, to successfully design action-oriented corruption risk assessments targeted to their political and institutional realities and unique needs. It has achieved notable results applying this approach at the sub-national level by testing small-scale, focused interventions in public hospitals, which have helped to inform national policy responses. This prevention-based approach using the language of “risk” and grounded in scientific method has also helped to shift attitudes towards corruption in the health sector by framing it as an institutional rather than ethical issue.

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Innovative finance

Tobacco control social impact bond

UNDP is conducting a feasibility study for the first-ever tobacco control social impact bond to support tobacco farmers in Zambia. The study aims to demonstrate the capacity of an innovative finance tool to help farmers switch from tobacco-leaf cultivation to alternative crops and livelihoods that are healthier, environmentally-sustainable, and more profitable, thereby attracting increased private investment in an issue threatening progress towards multiple SDGs.

Impact investing for planetary health

Impact investment is an important vehicle for the engagement and ownership of the private sector in the process of SDG implementation. UNDP’s work to support planetary health helps to address gaps and promote synergies between SDGs related to health and the environment. The positive impact of its Solar for Health initiative on health access and reductions in CO2 emissions, for example, illustrates the important social and environmental returns of investments that simultaneously address the health of humans and the planet.
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To build on these efforts, UNDP will conduct a feasibility study in Namibia, Zambia, and Malawi to identify sustainable business models and innovative financing options, such as blended finance or social impact bonds, that will support ministries of health and social services to generate increased private investments in Solar for Health.

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Investment cases for non-communicable diseases (NCDs)

As an intervention that can help countries realize significant health savings and development gains across multiple sectors, NCD prevention is a strategic area for mobilizing and targeting private sector investments. UNDP is working closely with WHO, the NCD Alliance, ministries of health and ministries of finance and other partners to develop national NCD investment cases, to prioritize action, mobilize resources and develop innovative solutions in different countries.
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This health investment approach is prevention-centred, focuses at the population level, engages all sectors, and identifies how economic gains accrue to private and public sectors. Supporting countries to develop ambitious, coordinated multi-stakeholder responses is crucial in preventing and controlling NCDs, and in staving off the harm that NCDs inflict on a country’s health, wealth and prosperity. The preliminary results from the 14 countries supported so far show a positive return on investment in NCD prevention and control.

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Scaling health impact through multi-sectoral innovation

UNDP’s leverages its role as a network facilitator to bridge sectoral initiatives and help different players invest in portfolios of parallel solutions that promote synergies and multiply impact across multiple dimensions of development. A catalytic area through which UNDP applies a “systems” innovation approach is at the nexus of health and environmental issues.

Solar for Health

A recent review by WHO shows that between a quarter and a third of health facilities lack a reliable supply of power. UNDP’s Solar for Health initiative supports governments to increase access to quality health services through the installation of solar energy photo-voltaic systems (PV), ensuring constant and cost-effective access to electricity, while also mitigating the impact of climate change and advancing multiple SDGs.
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Solar systems provide a stable, clean and reliable energy supply, even in the most remote locations, meaning more patients can access the health services they need. Quality healthcare requires a dependable source of power for multiple purposes, including temperature and hygrometry controls, adequate lighting systems, refrigeration, cold rooms and IT networks for efficient stock and management of information. In the current phase UNDP has supported the installation of solar systems in over 600 health facilities. Solar systems contribute to the sustainability and quality of health services by providing a stable, clean, economic and reliable energy supply, even in the most remote locations. This increases resilience of health systems to shocks and extreme weather events, while at the same time meaning more patients can access the health services they need.

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Sustainable procurement

UNDP works in partnership with manufacturers, freight forwarders, other UN agencies and partners on reducing the impacts of public health and climate change.
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UNDP is committed to reducing CO2 footprints in accordance with the call from the Lancet Countdown: tracking progress on health and climate change. As specified by the Lancet, climate change is the biggest global health threat in the 21st century and yet, it is evident that health procurement is paradoxically contributing towards the perils of climate change. Therefore, UNDP collects and reports on CO2 data from specified long-term agreements to measure, monitor and reduce CO2 impacts.

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Harnessing existing public sector innovation to enhance health outcomes

Innovative initiatives outside the health sector can also have important health outcomes. For example:

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  • In Bangladesh, the Access to Information (a2i) programme of the Prime Minister’s Office, with technical assistance from UNDP and USAID, has been looking at service delivery challenges, focused especially at meeting the needs of rural communities. One identified challenge is the limited number of medical personnel in rural areas, so a2i launched a telemedicine service that has improved access to health services for rural communities by introducing virtual consultations and connecting patients to doctors in urban settings.
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Measuring impact: a key enabler for innovation

A key focus of UNDP’s approach is supporting partners to take innovations to scale: to identify new tools or techniques that work and expand or adapt them to different contexts. The capacity to define and measure the impact of innovation is crucial to determining what works and what does not, allowing for quick iteration and the ability to shift courses along the way based on evidence. Strong mechanisms to continually evaluate the impact of innovation and monitor for unintended consequences not only help to ensure that initiatives are on the right track, but also help to de-risk investments in new solutions by starting small and testing their results before scaling. This emphasis on measurement and evaluation is reflected in the focus of UNDP’s innovation for health initiatives, from its investment in numerous feasibility studies to help partners understand the potential for new financing modalities, to its joint efforts with partners to define metrics for health interventions whose impacts are long-term and complex, such as legal reforms to protect human rights and health access.

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