1st Edition

Decolonizing Healthcare Innovation Low-Cost Solutions from Low-Income Countries

By Matthew Harris Copyright 2024
    272 Pages 5 B/W Illustrations
    by Routledge

    272 Pages 5 B/W Illustrations
    by Routledge

    This fascinating book offers a pathway for the NHS to adopt low-cost but effective innovations from areas of the world traditionally seen as beneficiaries rather than providers of help and support.

    In an era of increasing demand and dwindling resources, and where the COVID-19 pandemic has illustrated the structural limitations of the current system, the book provides examples of simple, frugal but high-quality alternatives to current practice. From orthopaedics to paediatrics, and mental health to plastic surgery, the book illustrates how low- and middle-income countries have found solutions to healthcare issues that are not only safe and clinically effective but also have the potential to save the NHS millions of pounds. Grounded in the contemporary debates of decolonization, it invites readers to question the culture and systems in global health that view low-income countries as solely passive recipients of aid.

    The volume will be essential reading for students and scholars across Public Health, Global Health, and Development Studies, as well as healthcare managers and policy makers in the UK and beyond.

    Section 1: Decolonisation and Why It Is Needed in Healthcare Innovation

    1. The Unwritten Rulebook of Global Health 

    2. UK Healthcare is Too Expensive, Frugal Innovation is the Answer

    3. Core and Peripheral Knowledge in Global Health

    4. False Dichotomies in Global Health: Us vs Them

    5. Coloniality in Global Health

    6. Reverse Innovation as a Decolonial Strategy

    7. Decolonizing Higher Education Curricula

    8. Decolonization, Decoloniality and Racialised Organizations: Praxis and Reflections

    Section 2: Low-Cost Solutions from Low-Income Countries

    9. A Structured Approach to Critical Analysis of Frugal Innovations from Low-Income Countries

    10. Mosquito Net Mesh for Hernia Repair

    11. Sayeba’s Method for Post-Partum Haemorrhage

    12. Phase Change Material for Neonatal Therapeutic Hypothermia

    13. Arbutus Drill System for Orthopaedic Surgery

    14. Tilapia Fish Skin for Severe Burns 

    15. Ponseti Technique for Congenital Club Feet Correction

    16. Conclusion and Next Steps


    Matthew Harris is a Clinical Senior Lecturer in Public Health Medicine, Honorary Consultant in Public Health Medicine, Director of Postgraduate Taught Courses in the School of Public Health, Imperial College London, and Theme Lead for Innovation and Evaluation in the NIHR Northwest London Applied Research Collaborative, UK. He has lived and worked in Brazil as a family doctor, in Ethiopia working for the WHO in immunization programmes, and in Mozambique as an HIV Technical Advisor, and served for two years as a Global Health Policy advisor to the UK government.

    'It is essential that all healthcare policymakers read Matthew Harris’s knowledgeable book on decolonising healthcare. Modern biomedicine has too long spurned many frugal innovations coming from low/middle income countries, that could be of enormous value and this book clearly unravels the historic biases that have led to this situation. It has been written clearly and from a wide knowledge-base, exhibiting the cultural humility required in decolonisation. This makes Harris as a white male European scholar, a valued member and ally of the decolonial planetary academe.'

    Dr Amali Lokugamage, Consultant Obstetrician & Gynaecologist and Honorary Associate Professor, University College London, UK


    'As already high healthcare costs continue to rise further in the West, Decolonizing Healthcare Innovation: Low-Cost Solutions from Low-Income Countries presents a bold new thesis about how to deliver quality care affordably. Author Matthew Harris, a medical doctor and lecturer in public health, argues that instead of imposing Western healthcare knowledge and ideas on the rest of the world, we should look to the developing world for ingenious and highly affordable solutions. At the heart of the book is the notion of frugal innovation: the art and science of doing more and better with less. From rethinking traditional business models to finding creative solutions to problems, this book offers both conceptual insights and practical strategies for Western healthcare organizations such as the NHS that are looking to serve ever more people with ever shrinking budgets and time. With ideas that challenge conventional thinking and real-world examples and actionable advice, this is a must-read for anyone looking to transform the way healthcare is conceived and delivered.'

    Prof Jaideep Prabhu, Professor of Business and Enterprise in the Judge Business School at the University of Cambridge, UK


    'Dr. Matthew Harris has written a must-read reference-book on ‘Decolonizing Healthcare Innovation’ which should be part of every global health curricula. As a recognized authority in the field, he enlightens us on the intersectionality of global health, decolonization, and low-cost solutions from low-income countries with several examples of Reverse Innovations. Readers can enjoy his elegant and compelling combination of prose and science - and learn from one of the best.'

    Prof Dhananjaya Sharma, Professor and Head of the Department of Surgery, Government Medical College and Allied Hospitals, Jabalpur, India


    'This book is a gamechanger for researchers, educators, policymakers, clinicians and students working in the healthcare field and beyond. It will change forever the way you view the world. The author takes the reader on a powerful journey of discovery, from the relevance, value and potential of frugal innovation through to exploration of the coloniality at the heart of Western healthcare and education. The book offers actionable tools to aid the decolonisation process and enable the critical thinking that is so vital to understand and address the urgent and deep-rooted challenges in healthcare and society at this unique time in our history.' 

    Dr Arti Maini, Director of Undergraduate Primary Care Education, Imperial College London, UK


    'Matthew Harris has translated his prodigious and comprehensive analysis of structural and cultural barriers to adopting "frugal innovation" into a practical framework and study guide. At the Institute for Healthcare Improvement, we say that an aim for an improvement program should answer the question, "How much will we improve XX by when and for and with whom?" Healthcare innovations designed by and for people living in under-resourced and marginalized communities can provide novel approaches to improving healthcare in all settings, but this will require curiosity, humility, respect, and profound structural and cultural change. Harris’ narratives about the fate of frugal innovations such as Sayeba’s Method for postpartum haemorrhage are powerful. I will be using them in my courses at Harvard to stimulate fresh thinking about our current neo-colonial models of pedagogy, healthcare, and innovation.'

    Dr Don Goldmann, Chief Medical and Scientific Officer at the Institute for Healthcare Improvement (IHI) and Professor of Immunology and Infectious Diseases at Harvard T.H. Chan School of Public Health, USA


    'This thought-provoking book is a must-read for anyone interested in exploring how colonialism has influenced medicine and innovation around the world while examining the impact of colonial legacies on global health more broadly. Matthew Harris explores the underlying historical and cultural biases that not only undervalue knowledge and innovation from low-income countries, but that keep this knowledge from improving the cost-effectiveness of medicine and solutions in the West. It is a book teeming with the reflections of a clinician who draws on his own lived experience and who, as an academic, employs an in-depth critical analysis to illustrate how we are all at a loss from Imperialism.'

    Steve Murigi, Chief Executive Officer, Primary Care International, UK


    'Innovation is integral to high-performing health systems. Harris lays bare how a colonial legacy and generations of bias have got in the way of adopting innovations that could help address challenges faced by health systems today – and offers thoughtful insight on how we can do better.'

    Layla McCay, Director of Policy, NHS Confederation, UK


    'Harris’s book takes a fresh look at the historical, cultural and institutional drivers of medical practice in the Global North and provides an invigorating and thoroughly evidence-based challenge to the status quo. Drawing on remarkable examples of ‘frugal innovation’ from low- and middle-income countries in the Global South, he offers a prescription for changes that could bolster the health of healthcare.'

    Prof Stephen Curry, Associate Provost (Equality, Diversity & Inclusion), Imperial College London, UK


    'This well written, thoughtful book serves as a useful repository of frugal healthcare solutions that the NHS could adopt, saving money without scrimping on effectiveness. The book draws on literatures from developments studies, medicine, decolonization, management studies and organizational behaviour, but is accessible, readable and littered with insights from across the globe. It’s a resource for managers and clinicians alike, providing creative solutions and many actionable insights.'

    Prof Sue Dopson, Professor of Organizational Behaviour, Said Business School, University of Oxford, UK


    'This important book should be required reading for everyone concerned about affordable access to healthcare. It challenges the pervasive inbuilt biases against using evidence from low- and middle-income countries to shape health policy and practice. It shows how, by challenging deeply-rooted colonialist attitudes, and through rigorous evaluation of promising interventions from resource-constrained settings, frugal innovation can yield benefits for health and equity worldwide.'

    Prof Sir Andy Haines, Professor of Environmental Change and Public Health, London School of Hygiene and Tropical Medicine, UK


    'Dr Matt Harris takes us through this complex intersectional issue of frugal innovation with offerings of important historical context and brings us home through practical solutions that we can all adopt in our collective thirst for a better and more equal world. Harris's brilliance and passion shines through every page. That he, a globally experienced white British doctor, should write on such a deeply contested topic is as important as our need to consciously come together and advance health solutions that originate from the unlikeliest places. A great book for our global health community and anyone who dares challenge themselves about where the best lessons for our patients could possibly come from.'

    Dorcas Gwata, Chair, Primary Care International, NHS Nurse of the Year, 2022, UK


    'This book should be read widely by all those who see value in engaging with, and learning from, other health systems, and especially those in the Low- and Middle-income Countries that Matt Harris writes so knowledgeably about. For some, like me, this book will be a necessary provocation which will help us to become more reflective and analytical about the unconscious bias and racism that frames our worldview. For others, such as the 1 in 6 staff working in the NHS who report a non-British nationality, the book will be a welcome endorsement of how they can apply their knowledge of other health systems for the benefit of patients and policy makers here in the UK. This is an exciting, and important read.'

    Ben Simms, Chief Executive of the Tropical Health Education Trust, UK


    'Despite the prevalence of decolonisation within academic and activist circles, the language and praxis of decolonisation has yet to take hold in the healthcare sector. In Decolonizing Healthcare Innovation: Low-Cost Solutions from Low-Income Countries, Matthew Harris problematises the implicit assumptions underlying healthcare innovation diffusion that has hindered adoption of ingenious, low-cost and safe innovations originating in low-income countries by high-income countries. Harris draws from post-colonial and decolonial critical work, social norms and behavioural studies, as well as scientometric evidence to demonstrate the colonial legacies and hidden biases in the sector, covering Eurocentric medical curricula, geographic biases in the publication of public health research, and discriminatory medical practices. Albeit being theoretically grounded, the book proposes "a number of frameworks that can be used to develop a structured, objective appraisal of frugal health innovations" from low-income countries, as opposed to rejecting them prematurely because they are not valued the same. Harris demonstrates this through numerous examples, including the case of the mosquito net mesh for hernia repair from India and the condom-catheter device used in post-partum haemorrhage, known as Sayeba’s Method, developed by a Bangladeshi obstetrician. As NHS Consultant in Public Health Medicine and a Clinical Senior Lecturer at Imperial College London, having practised in both the UK and Brazil, and with extensive experience in evaluating health innovations, Harris is well-positioned to speak directly to a UK audience and to encourage more productive engagements with low-income country healthcare innovations at both educational and policy level.'

    Dr Romina Istratii, UKRI Future Leaders Fellow, SOAS University of London, UK


    'This book challenges long-held assumptions: Eurocentric knowledge and technology is the best, and paying more is always better than paying less. A must for anyone looking to reduce costs in the healthcare sector.'

    Dipesh Gopal, GP, NIHR In-Practice Fellow, Centre for Primary Care, Queen Mary University of London, UK


    'Matthew Harris’ intellect and passion have culminated in this enlightening and inspiring book. Drawing from his personal experience and extensive research on the subject, he offers insights into the treasure trove of innovation that can emerge from the global South. Through his work, Dr Harris challenges conventional thinking and presents compelling arguments for a new approach to a better future. This book will give you a fresh perspective about how we, as a global community, can make meaningful changes that translate into improved health outcomes. He is truly a world leader in this field. This book is a ‘must read’ for anyone interested in global health.'

    Dr Greg Martin, Director of the Health Protection Surveillance Centre, Ireland


    'A rare combination of decolonial critique and practical guidance for redress, Decolonizing Healthcare Innovation fills an important gap. Clear, accessible and exceedingly relevant, it offers a critical yet constructive and – dare we say – hopeful challenge to anyone concerned with the growing cost crisis in UK healthcare. Crucial reading for scholars and teachers of global health, medical practitioners, healthcare managers, and policy makers alike.'

    Danelle van Zyl-Hermann, University of Basel, Switzerland


    'This wide-ranging and thought-provoking book is an accessible and fascinating introduction to the context and legacy of colonialism in western medicine. From philosophy through to ethics and pedagogies, this text is truly interdisciplinary. As a university educator - engaging with these challenging topics on a day-to-day basis in global health - this text has given me greater confidence in exploring these topics - recognising that there are no simple answers or solutions. Harris casts a critical eye on colonialism and his personal passion for frugal innovation. He then introduces concrete examples - providing analysis, and presenting important questions which we are all grappling with - whether we know it or not!'

    Dr Richard Pinder, Director of Undergraduate Public Health Education, Imperial College London, UK

    "Mathew Harris's "Decolonizing Healthcare Innovation: Low-Cost Solutions From Low-Income Countries" is a daring, ambitious and incisive exposition of the often less challenged, less scrutinised and 'taken for granted' values and norms that drive contemporary global health education, research and action. The book should be read by Global Health students at all levels, on three accounts: for the really comprehensive synthesis of the range of multidisciplinary literature that inform decolonial thoughts and works, for showcasing a range of truly compelling cases that bring the theoretical discussions home, and finally, for the skills of critical discourse analysis demonstrated across the book. Matt compels us to develop a reflective gaze that is sensitive to historical power imbalances and biases that condition our ways of thinking, working and attitudes."

    Dr Henock Tadesse, Senior Teaching Fellow and Course Director of the Masters in Public Health Programme, Imperial College London