The role of global health organizations in promoting innovation and driving ethics (YEL2023)
Date: 19 September 2023
Introduction
Despite great medical advances and scientific progress over the past century, one billion people globally still lack access to basic healthcare services [1]. Healthcare systems are under increasing pressure to cope with shifting demographics, the threat of chronic and noncommunicable disease, and rising health care costs – the uptake (or implementation) of “innovation” offers the global healthcare community a possible way to meet these challenges [2] yet the uptake of innovations to meet these challenges and to advance medicine and healthcare delivery is not as rapid as the pace of change [2]. Innovative care models are also cited as an effective solution that bridge the healthcare delivery gap, address equity, and create social value [1].
So, what is meant by “healthcare innovation”? The term healthcare innovation denotes new, better, more effective ways of solving problems and can describe policies, systems, technologies, ideas, services, and products [3]. The World Health Organization [4] explains that health innovation improves the efficiency, effectiveness, quality, sustainability, safety, and/or affordability of healthcare. At a global scale, innovation encourages new approaches to tackle issues of poverty, education, health, and other human development problems by making system-level changes, improving global responses to the issues described by Halpaap and colleagues [1]. The three components of innovation are that it: i) is a novelty, ii) has an applied component, and iii) has an intended benefit [5].
Innovative technology and improved clinical delivery techniques will have limited benefit to patients and healthcare systems if policies and structures are not in place to enable implementation and delivery [6]. Global health organizations, alongside governments, have a role in creating an enabling environment where innovations can more effectively integrate into health systems to maximize their impact and respond to global health challenges [1].
This article considers the role of global healthcare organizations in supporting the use of innovation, considers some of the ethical aspects associated with innovation use, and describes key contributions that global healthcare and private healthcare organizations can make to enable innovation healthcare solutions use.
Global health organizations
Global health organizations are entities that operate on a global scale. They aim to address health-related challenges that transcend national boundaries and improving healthcare systems worldwide. These organizations play a significant role in promoting global health, coordinating efforts, keeping the world safe, and serving the vulnerable through collaborating with governments, non-governmental organizations, healthcare professionals, and other stakeholders. To achieve this, they have a key role in driving forward the use of healthcare innovation.
Collectively, global health organizations’ missions include the following components [7]. The use of healthcare innovation can contribute to all.
Identify trends, issues, and events affecting global public health.
Develop public health policies and practices.
Provide healthcare through intervention and prevention programmes.
Manage communications and interactions required among various organizations to address world health concerns.
A focus on the World Health Organization (WHO)
The WHO is one of the, if not, the most prominent global healthcare organizations. The WHO was founded in 1948 with an ambitious objective: ‘The attainment by all peoples of the highest possible level of health’ – innovation is a core part of achieving this goal and the WHO has a dedicated focus on innovation. The vision driving behind the WHO’s Innovation in Health approach is to build a “global innovation in health movement” to accelerate the achievement of “health for all” and the health-related sustainable development goals [8]. WHO’s approach to innovation in health focuses on two strategic goals:
Scale and sustain innovations for impact: WHO facilitates a multi-partner approach aimed at linking the human health demands in countries with ready-to-scale innovations, while leveraging assessment throughout as innovations are scaled and sustained.
Harness a culture of innovation in WHO and countries: WHO is committed to making health innovation accessible to all, empowering champions across the Organization and in Member States to build innovation knowledge, capacity, and confidence to leverage innovation to accelerate impact in health.
Evidence shows that there are many barriers to adopting innovation in healthcare [9] [10]. The WHO has created a framework to illustrate the multi-partner collaborative approach it is taking to scale innovation by linking three dimensions: 1) the health demands and priorities of countries; 2) the supply of ready to scale innovations; and 3) assessment throughout from incubating (through partners) to implementing and sustaining innovations (Figure 1).
There is a big difference between using something innovative to support healthcare delivery and a truly innovative culture driving the continual and sustained use of innovative practices. To harness a culture of innovation for impact within WHO and at country level, WHO Innovation for Health is implementing four key initiatives: the LEAD innovation challenge; Eureka innovation space; building global capacity; and the WHO innovation network, with an ambition of driving innovation implementation globally. The implementation of disruptive innovation is leading to an increasing need for awareness and critical thinking about the potential unintended consequences and ethical dilemmas that may arise from use. Given the novelty of many innovations, many ethical issues arise post-implementation [11].
Ethics and policy
Global equity of access to healthcare
Innovation in healthcare holds immense potential to improve patient outcomes, advance medical knowledge, and address the evolving healthcare challenges worldwide [12] . However, it is crucial to maintain dedication to global equity as innovation progresses, regardless of socioeconomic standing, geographical location, or other factors influencing individuals’ health. This necessitates collaborative actions at local, national, regional, and international levels, all while respecting ethical integrity [13].
Although expanding access to healthcare services is crucial to achieve global health, challenges, such as the need for reliable internet connectivity, digital literacy, the respect of cultural diversity and the promotion of multilingual support needs to be considered [14]. Moreover, clear and consistent regulatory frameworks across different jurisdictions need to be established to ensure ethical practices, patient security, and data protection are in place as enabling factors for the use of innovation.
Nevertheless, it is important to note that ethical oversight in healthcare involves a collaborative effort across multiple actors, including those responsible for healthcare regulation, professional associations, research ethics bodies, and government agencies. Each country typically has its own medical regulatory authority responsible for licensing and regulating healthcare professionals. These authorities may conduct audits, investigations, and disciplinary actions to ensure compliance with ethical standards [15]. Such authorities need to be viewed as enablers and advocates of innovation, rather than barriers to use.
Case example – Telemedicine
Telemedicine represents an exemplary model of promoting global equity in healthcare. It has garnered significant attention, particularly due to its usefulness in efficiently managing COVID-19 pandemic [16]. By facilitating remote delivery of healthcare services, this technology effectively bridges geographical barriers, expands access to healthcare, and contributes to the reduction of healthcare costs through innovative ways.
In 2019, the WHO issued a 10-point guideline and recommendations for the equitable diffusion and use of telemedicine worldwide [17]. Two key points emphasize the significance of training healthcare professionals and the implementation of monitoring activities. To support the widespread use of telemedicine, the WHO has produced an application guide to accompany these guidelines, offering practical tools and methodologies to assist evaluators in monitoring the implementation and impact of telemedicine programmes, evaluating their effectiveness, and assessing their long-term sustainability.
Medical and healthcare professional associations, such as the American Telemedicine Association (ATA) or the Royal College of Physicians, UK (RCP), often monitor adherence to ethical principles and provide resources, training, and support to their members practising telemedicine to help ensure ethical use.
Ethical considerations in the era of AI for healthcare
“Let us learn from the cautionary tale of Frankenstein, reminding us to prioritize ethics and avoid the creator becoming a victim of their creation.”
Ms Tatiana Valovaya [18]
Artificial intelligence (AI) is rapidly expanding across multiple areas in healthcare [19], where AI algorithms analyse comprehensive patient data enabling disease prediction and diagnosis and facilitating the development of personalized medicine approaches.
Recognizing the transformative impact of AI in healthcare, the WHO is actively engaged in fostering ethical and legal guidelines and frameworks to govern the development and implementation of AI in healthcare and has released guidance to address several key groups involved in the use of AI in healthcare: AI designers and developers; ministries of health and healthcare institutions; and, not least, providers [20].
The guidance highlights the potential dangers of “technological solutionism” where technologies like AI are seen as a “magic bullet” to address complex pathologies, linked to societal, structural, economic, and institutional challenges that need thorough consideration. It also indicates that AI solutions should prioritize the following:
Enhancing transparency, explainability, and intelligibility for healthcare providers.
Promoting autonomy and emphasizing that AI’s role is to augment human capabilities rather than replace healthcare providers.
Ensuring inclusiveness and equitable use and access to AI technologies, regardless of age, gender, income, ability, or other characteristics.
Fostering responsibility and accountability among all stakeholders, encouraging them to act with integrity and minimize potential harm.
Simultaneously, to guarantee the confidentiality and integrity of patient data as it is utilized in AI applications, a collaboration between the WHO, the International Telecommunication Union (ITU), and the International Organization for Standardization (ISO) has resulted in the creation of the ISO/IEC 27001 series of standards [21]. The guidelines serve to safeguard sensitive patient data used in AI applications, emphasizing the paramount importance of privacy and security. A key challenge for global healthcare (supplier and providers) will be to ensure adherence to the standard(s).
Importantly, the actual impact of a new technology and the full extent of the ethical considerations required for use may not be fully understood until years after a technology implementation [11], or look considerably different to the ethical considerations made during innovation development or initial deployment.
Promoting and driving innovation
Global health organizations play a crucial role in promoting and driving innovation in healthcare – this includes the implementation process where there is need to consider relevant ethics, policy and regulation. The global health organization’s contributions fall under an array of disciplines – different organizations will offer a different portfolio of offerings. The collective contributions of global organizations are described in Table 1.
Table 1: Key contributions of global healthcare organizations in supporting innovation
While global health organizations have a significant impact, private healthcare organizations can also contribute through collaboration with global health organizations, governments, and other stakeholders to create a supportive and inclusive ecosystem for healthcare innovation. The portfolio of offerings provided by private organizations are described in Table 2.
Table 2: The role of private healthcare organizations in supporting healthcare innovation
Examples of innovation in supporting improved global health provision
Innovative technologies and approaches to care delivery are key drivers in providing patients around the world access to high quality and affordable healthcare [26]. In the ever-evolving healthcare landscape, innovative technology has been developed and leveraged in every aspect of the care continuum [27]. Table 3 provides illustrative examples of different realms healthcare organizations are applying innovation to improve healthcare access and outcomes.
Table 3: Examples of different realms healthcare organizations are applying innovation to improve healthcare access and outcomes
By embracing, investing, and strategically implementing these innovative approaches, healthcare organizations not only can improve the overall quality of care and patient outcomes, but also provide a larger and more diverse group of patients access to high quality medical care. It is paramount that there is a thoughtful approach to applying these innovative practices into care delivery and hospital management to ensure they are implemented in an ethical and equitable fashion, while maintaining the highest standard of patient privacy and safety.
Conclusion
Multilateral organizations and local and national governments have a critical role to play in creating an enabling environment where innovations can flourish [1]. This short paper has described the role of global organizations in supporting this agenda as well as considering some of the ethical issues that arise as part of innovation adoption. As more innovative healthcare approaches (whether that be technologies, processes, workforce plans) emerge, new ethical issues will also emerge too – global healthcare organizations must find a balance between aspiration for use, risk management and the ethics of use – both from a perspective of ethical access and ethical deployment. Unfortunately, many ethical issues arise post-implementation with consequences for healthcare staff, patients, and society to explore and navigate [11].
References
[1]
Halpaap, B., Peeling, R.W. & Bonnici, F., “The role of multilateral organizations and governments in advancing social innovation in health care delivery.,” Infect Dis Poverty, vol. 8, no. 81, 2019.
[2]
Kvedar J, Coye MJ, Everett W., “Connected health: a review of technologies and strategies to improve patient care with telemedicine and telehealth,” Health Aff (Millwood), vol. 33, no. 2, pp. 194-199, 2014.
[3]
Kimble, L. and Massoud, M.R. , “What do we mean by Innovation in Healthcare?,” European medical journal – Innovation, vol. 1, pp. 89-91, 2017.
Länsisalmi H, Kivimäki M, Aalto P, Ruoranen R., “Innovation in healthcare: a systematic review of recent research,” Nursing Science Quarterly., vol. 19, no. 1, pp. 66 -72, 2006.
[6]
Binagwaho A, Nutt CT, Mutabazi V, et al., “Shared learning in an interconnected world: innovations to advance global health equity,” Global Health, vol. 9, no. 1, p. 37, 2013.
[7]
USC, “A Guide to the World Health Organizations,” 2020. [Online]. Available: https://mphdegree.usc.edu/blog/world-health-organizations-guide/#:~:text=Some%20of%20the%20top%20international,States%20Agency%20for%20International%20Development.
[8]
C. Clift, “The role of the world health organization in the international system,” 2013. [Online]. Available: https://www.chathamhouse.org/sites/default/files/publications/research/2013-02-01-role-world-health-organization-international-system-clift.pdf.
[9]
Castle-Clarke S., Edwards N. and Buckingham H., “Falling short: Why the NHS is still struggling,” 2017. [Online]. Available: https://www.nuffieldtrust.org.uk/research/falling-short-why-the-nhs-is-still-struggling-to-make-the-most-of-new-innovations.
[10]
R. E. Herzlinger, “Why Innovation in Health Care Is So Hard,” 2006. [Online]. Available: https://hbr.org/2006/05/why-innovation-in-health-care-is-so-hard.
[11]
Gietzen LJ, Ogilvie SJ, Steerling E, Houston R, Nygren JM, de Ruiter H-P, “Ethics and New Health Technologies: An Innovative Descriptive Analysis of the State of the Literature,” Creative Nursing, vol. 28, no. 4, 2022.
[12]
Schiavone F, Ferretti M., “The FutureS of healthcare.,” Futures, vol. 134:, p. 102849, 2021.
[13]
Singh G, Owens J, Cribb A. , “What Are the Professional, Political, and Ethical Challenges of Co-Creating Health Care Systems?,” AMA J Ethics, vol. 19, no. 11, pp. 1132 – 1138, 2017.
[14]
Al Shamsi, H., Almutairi, A. G., Al Mashrafi, S., & Al Kalbani, T. , “Implications of Language Barriers for Healthcare: A Systematic Review.,” Oman medical journal, vol. 35, no. 2, p. e122, 2020.
[15]
van Daalen, K. R., Davey, F., Norman, C., & Ford, J. A., “Health equity audits: a systematic review of the effectiveness,” BMJ open, vol. 11, no. 11, p. e053392., 2021.
[16]
Lukas H, Xu C, Yu Y, Gao W., ” Emerging Telemedicine Tools for Remote COVID-19 Diagnosis, Monitoring, and Management,” ACS Nano, vol. 14, no. 12, pp. 16180-16193, 2020.
[17]
WHO, “WHO guideline: recommendations on digital interventions for health system strengthening,” 2019. [Online]. Available: http://apps.who.int/iris/bitstream/handle/10665/311941/9789241550505-eng.pdf.
[18]
T. Valovaya and D.-G. o. t. U. N. O. a. Geneva, “THE FUTURE OF MULTILATERALISM,” in Conférence :Evénement grand public’, 2023.
[19]
Li Y, Wang X, Zhang J, Zhang S, Jiao J. , “Applications of artificial intelligence (AI) in researches on non-alcoholic fatty liver disease(NAFLD) : A systematic review,” Rev Endocr Metab Disord, vol. 23, no. 3, pp. 387-400, 2022.
World Health Organisation, “Research and development to meet health needs in developing countries: Strengthening global financing and coordaition. Report of the consulative expert working group on research and development – Financing coordination,” 2012.
[23]
I. A. Nikolic and H. Maikisch, “Public-Private Partnerships and Collaboration in the Health Sector : An Overview with Case Studies from Recent European Experience. HNP Discussion paper series;.,” 2006.
[24]
World Health Organisation – Regional Office for Europe, “From innovation to implementation: eHealth in the WHO European Region,” 2016.
[25]
T. W. John, L.-S. Sherri , H. David and L. K. Amy, “Mayo Clinic Care Network: A collaborative health care model,” vol. 15, no. 1(B), pp. 167-172, 2018.
Abernethy A, et al., “The Promise of Digital Health: Then, Now, and the Future,” NAM Perspect, 2022.
[28]
Erasmus, et al., “Connectivity Strategies in Managing a POCT Service,” EJIFCC, vol. 3, no. 2, pp. 190-194, 2021.
[29]
Bestsennyy O, Gilbert G, Harris A, “mckinsey,” 2021. [Online]. Available: https://www.mckinsey.com/industries/healthcare/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality.
[30]
D. Roblyer, “Perspective on the increasing role of optical wearables and remote patient monitoring in the COVID-19 era and beyond,” vol. 25, no. 10, p. 102703, 2020.
[31]
Hölbl, M. et al., ” A Systematic Review of the Use of Blockchain in Healthcare,” Symmetry, vol. 10, no. 10, p. 470, 2018.
Authors
Saudi Commission for Health Specialties, Saudi Arabia
Dr Basma Ghandourah
General Manager of the Executive Directory of Business Partners
Young Executive Leaders 2023
IHF Member: Saudi Commission for Health Specialties (SCFHS), Saudi Arabia. General Manager of strategic relationships, she is an expert in international collaboration and strategic partnerships.
Mayo Clinic, USA
Benjamin Langholz
Senior Consultant
Young Executive Leaders 2023
IHF Member: Sheikh Shakhbout Medical City (SSMC) Mayo Clinic, UAE. Part of the Global Consulting team, he leads strategy and operation enhancement projects.
University Hospital of Geneva (HUG), Switzerland
Dr Giannina Rita Iannotti
Manager of the NeuroCenter
Young Executive Leaders 2023
IHF Member: University Hospital of Geneva (HUG), Switzerland. Manager of the NeuroCenter, optimizing patient clinical itineraries and supporting clinical research in neurological pathologies.
Wessex Academic Health Science Network, United Kingdom
Joe Sladen
Associate Director, Strategic Programmes
Young Executive Leaders 2023
IHF Member: NHS Confederation, UK. Leads the Nationally Prioritized Innovations Programme to support their spread and adoption, implementation and sustainability.
Mediker Healthcare, Kazakhstan
Dr Suhail Javed Khan
Physician, Medical Advisor & Healthcare Manager
Young Executive Leaders 2023
IHF Member: Mediker Healthcare, Kazakhstan. Head of the Mediker International relations department for cooperate organizations.
Reviewers: Leandro Luis (YEL 2021, Portugal), Dr Moustafa Abdelwahab (YEL 2022, United Arab Emirates), Rizza Jean Rivera (YEL 2022, Philippines)
