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Regional health innovation strategy for the Western Pacific

7 février 2024 Organisation mondiale de la santé

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Regional Health Innovation Strategy for the Western Pacific

Regional Health Innovation Strategy for the Western Pacific Regional health innovation strategy for the Western Pacific © World Health Organization 2024 ISBN 978 92 9062 034 1 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. 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The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Photo credit. Cover: WHO/Will Seal iii CONTENTS Executive summary �� iv 1. INTRODUCTION �� 1 1.1 Health innovation: what and why �� 1 1.2 Current situation in the Western Pacific Region �� 2 1.3 Rationale for the Regional Strategy �� 3 2. THE REGIONAL STRATEGY �� 5 2.1 Vision �� 5 2.2 Objectives �� 5 2.3 Guiding principles �� 7 2.4 Key areas of action �� 8 2.4.1 Governance �� 8 2.4.2 Capacity-building �� 9 2.4.3 Financing �� 9 2.4.4 Measurement �� 10 2.5 WHO’s role �� 10 References �� 12 Annex �� 14 Annex 1. Resolution �� 14 iv Regional Health Innovation Strategy for the Western Pacific EXECUTIVE SUMMARY Health innovation is the creation and implementation of novel processes, products, programmes, policies or systems that lead to transformations or improvements in health and equity. Much of the progress in public health historically has been driven by innovation. Over the past three years, COVID-19 has made health innovation more pervasive, involving a wider range of actors than ever before. However, the pandemic also hindered progress towards the health-related targets of the Sustainable Development Goals (SDGs) and heightened the vulnerabilities of fragile health systems. To regain momentum and effectively tackle persistent challenges and emerging threats while ensuring inclusivity, there is a pressing need for more and better health innovations. Health innovation in the Western Pacific is shaped by the Region’s geographic, cultural and socioeconomic diversity. Technological innovation has been a key driver of economic growth. Innovation ecosystems and adaptative governance demonstrate governments’ commitment to digitalization. Social innovations are fulfilling public health policy objectives and achieving equity in access to care. However, there is a disconnect between growth and well-being in many health innovations due to a misalignment of values and resources. Furthermore, the absence of comprehensive evaluations, evidence generation and utilization has hindered informed policy-making for scaling health innovations. Governments in the Region must lead health innovation and offer lessons for the world: redirect growth-driven innovation models to focus on well-being and equity while enabling economic success; scale social innovation to improve equitable access to health; and create spaces for learning and evidence generation for continuous improvement. Within the Region, opportunities exist for cooperation and mutual learning. The Regional Innovation Strategy for the Western Pacific, endorsed by the World Health Organization (WHO) Regional Committee for the Western Pacific in October 2023 (see Annex 1), invites political commitment to a regional approach that will facilitate collaboration and knowledge diffusion to bridge health disparities within and between countries and areas. The vision of the Regional Innovation Strategy is for governments in the Western Pacific Region to leverage health innovations to increase the impact of their efforts to solve problems and improve future health and well-being. Three objectives emerged from vExEcutivE summary extensive consultations with Member States: (1) set the value and direction for health innovation; (2) strengthen public sector capacity for health innovation; and (3) establish enabling ecosystems for health innovation. These goals can be achieved through four key areas of action: strengthening governance, innovating finance mechanisms, building innovation capacity and measuring the impacts of innovation. WHO will support Member States by developing and disseminating norms and guidance, demonstrating leadership, enhancing capacity-building in health innovation, shaping and influencing innovation ecosystems, understanding and prioritizing needs, assessing and selecting solutions, and facilitating implementation.

1introduction 1. INTRODUCTION 1.1 Health innovation: what and why Health innovation is the creation and implementation of novel processes, products, programmes, policies or systems that lead to transformations or improvements in health outcomes and equity (1). The process follows an iterative approach and can arise from new ideas or a combination of existing concepts. It can take the form of disruptive technological solutions that leverage scientific research and development or manifest itself as social innovation that promotes increased participation and empowerment to address public health needs. Much of the progress in public health historically has been driven by innovation. Over the past three years, COVID-19 has made health innovation more pervasive, involving a wider range of aspects and actors than ever before. Various entities, including health- care professionals, researchers, pharmaceutical companies, technology start-ups, governments, nongovernmental organizations and citizen scientists, have actively contributed. Their efforts span from genomic surveillance and data sharing for SARS-CoV-2 to the development of mRNA vaccines, telemedicine platforms, contact tracing and triage apps, clinical management systems, and chatbots aimed at combating infodemics (defined as excessive and typically unreliable information about a problem that spreads rapidly and makes solutions harder to achieve). However, the pandemic has also hindered progress towards the health-related targets of the Sustainable Development Goals (SDGs) and made fragile health systems even more 2Regional Health Innovation Strategy for the Western Pacific vulnerable. The stresses have chipped away at trust, funding and health workforces amid mounting pressures from noncommunicable diseases (NCDs), climate change and emerging health security threats. Diminishing returns on established interventions for long-standing problems pose more obstacles. To recover and address the challenges of today and tomorrow without leaving behind the most vulnerable populations, more and better health innovations are required. 1.2 Current situation in the Western Pacific Region Health innovation in the Western Pacific Region is shaped by its diversity in geography, culture and socioeconomic conditions. Technological innovation has been a key driver of economic growth in many countries in the Region. Many of these countries are now home to some of the top science and technology clusters, as recognized by the Global Innovation Index (2). Additionally, many are making significant investments in research and development. Regional research partnerships to address subjects of mutual interest, such as climate change mitigation and biomedical science, abound. Furthermore, larger economies have established innovation ecosystems to conduct social experiments and foster technological innovations for health. The Region has embraced digital transformation. Governments are implementing digital health strategies, establishing institutions, creating investment opportunities, and collaborating with and learning from other sectors to transform health systems. Institutional adaptation is also a regional trend: some countries have introduced a risk-based regulatory approach, partnering early with the digital health industry and allowing its limited operation within health systems; others are fostering communities to co-create principles and toolkits to govern data and artificial intelligence (AI) for social good. These policy responses to digital innovation allow the public sector to better understand and find appropriate ways to support health innovation while delivering care that prioritizes safety and welfare. Social innovation approaches have been applied across various areas to fulfil public health policy objectives and achieve equity in access to care. This collaborative effort involves the participation of governments, entrepreneurs, academic institutions and international organizations. In Fiji, the involvement of policy-makers in research design and implementation has contributed to the translation of evidence – using oxygen concentrators to improve access to life-saving oxygen – into policy (3). Through participatory governance, communities have been empowered to strengthen malaria elimination efforts in the Mekong subregion and to increase the utilization of primary health care in the Lao People’s Democratic Republic (4,5). Various other initiatives – such as the Seoul 50+ initiative in the Republic of Korea, dementia-friendly communities in Japan and smoke-free cities in the Philippines – demonstrate the potential of cities to 3introduction drive and scale health innovation The Victorian Health Promotion Foundation in Australia, the Tonga Health Promotion Foundation, SingHealth in Singapore and Yayasan Inovasi Malaysia (Malaysian Foundation for Innovation) exemplify the value of innovation institutions in building ecosystems that foster partnerships and mobilize societal resources. Notable changes arise when public health insights, culture, community, data and technology converge in a systems approach. Mongolia incorporated early detection examinations into national health insurance to promote health screening and utilized screening data for timely intervention. In the Lao People’s Democratic Republic, health and climate data are utilized to predict vector-borne disease outbreaks in different provinces. BruHealth (Brunei Darussalam) has evolved from a COVID-19 contact tracing app to a comprehensive healthy lifestyle platform (9). Viet Nam implemented a comprehensive one-stop digital platform to improve access to HIV testing. Across Pacific island countries and areas, climate adaptation strategies that combine traditional practices and cutting-edge science are being implemented, experimented with and scaled to protect the livelihoods and improve the resilience of island communities (10). Despite the Region’s diversity and abundance, many health innovations have had limited success tackling challenges or contributing to health outcomes and equity, particularly in the case of technological solutions driven by profit and governed by trade and industry. Areas with limited market appeal – such as neglected tropical diseases, antibiotic development, disease prevention and health promotion, and affordable maternal and child health – have been marginalized. In areas where economic growth and well-being are reconciled – such as digital innovations for health system strengthening – the lack of mature governance, long-term funding and support systems hinders the creation of market opportunities for entrepreneurs to make a wider and more equitable impact. Consequently, financially disadvantaged and vulnerable populations with the greatest needs are often left behind. The lack of evaluation and evidence to support institutionalization poses yet another barrier to health innovations with a potentially wider impact. There is a need for systematic collection and utilization of evidence to inform scaling decisions, as well as dissemination of lessons learnt from innovation processes and implementation. 1.3 Rationale for the Regional Strategy The time has come for governments in the Region to assume the leadership in health innovation and offer lessons to the world: redirect growth-driven innovation models with a focus on health outcomes, well-being and equity while still enabling economic success; scale social innovation to improve equitable access to health; and create spaces for learning and evidence generation for continuous improvement. (6–8). 4Regional Health Innovation Strategy for the Western Pacific Countries and areas should prioritize cooperation and mutual learning. Collaborative efforts can mitigate risk and uncertainty associated with health innovations. Larger economies can adapt advanced technological solutions for transfer to low-resource settings, while less affluent countries can share knowledge on social innovation, contributing to a more comprehensive and inclusive approach to health innovation. A regional approach is crucial in supporting countries and areas to foster a conducive environment for health innovation, leverage health innovations and establish an effective regional mechanism for collaboration and knowledge transfer to reduce health disparities between and within countries. 5thE rEgional stratEgy 2. THE REGIONAL STRATEGY This document presents a framework that can be used as a basis for country-specific health innovation policies. It builds on the WHO Thirteenth General Programme of Work (2019–2025) priority to harness innovation to accelerate health impact and the final report of the WHO Council on the Economics of Health for All, Health for All: Transforming economies to deliver what matters (11,12). 2.1 Vision Governments can leverage health innovations to solve problems, accelerate impact and shape the future of health and well-being. 2.2 Objectives The Regional Strategy aims to support Member States, as appropriate to country contexts: to set the value and direction for health innovations; to strengthen public sector capacity for health innovation; and to cultivate enabling ecosystems for health innovation. 6Regional Health Innovation Strategy for the Western Pacific An action framework diagram CAPACITYBUILDING MEA SUR EM EN TFINANCING GO VER NAN CE PRINCIPLES Mission-oriented Co mm on go od Collective intell igence Learning Ev ide nc e- ba se d AN ACTION FRAMEWORK DIAGRAM Vision Governments can leverage health innovations to solve problems, accelerate impact and shape the future of health and well-being. Objectives for health innovation 1. Set values and directions 2. Strengthen public sector capacities 3. Cultivate enabling ecosystems for health innovation ▪ Build monitoring and evaluation into innovation policies ▪ Create evaluation frameworks and metrics ▪ Perform health and social impact assessments MEASUREMENT ▪ Secure sustainable public funding/financing ▪ Structure new types of public–private collaborations ▪ Allocate resources to strengthen R&D and implementation research FINANCING ▪ Co-create a mission for health innovation through multisectoral collaboration ▪ Implement institutional arrangements ▪ Implement policies to create a health innovation ecosystem ▪ Ensure equitable access to health innovation GOVERNANCE ▪ Build common understanding and competency for health innovation ▪ Integrate health innovation into education ▪ Build try-and-learn networks ▪ Learning, adaptation and evaluation CAPACITY-BUILDING 7thE rEgional stratEgy 2.3 Guiding principles Mission-oriented: Solving complex public health challenges requires a mission-oriented approach. A well-defined mission articulates the problem to solve, the direction to go and the goals to achieve; engages investment and actors across the entire economy, beyond the health sector; and fosters a portfolio of health innovations. With this approach, governments can align innovation investment and industrial strategies and transform priorities into actionable policy instruments and initiatives that can be implemented by public institutions at all levels (13). Collective intelligence: Health innovation is stimulated and shaped by collective action. The leading public institutions must bring together diverse actors and sectors to define a shared mission and collaborate towards achieving it, broker the trust relationships between actors, formulate policies and create a sense of ownership among diverse stakeholders, and foster collective intelligence from the ecosystem. Learning: A crucial element for the public sector to lead health innovation is its institutional capacity to learn over the long term. This capacity encompasses a willingness to learn from the process of health innovation, which involves identifying problems, investing and exploring new ideas, rather than seeking short-term returns. It is important to gather knowledge from the communities that health innovations are meant to serve. Evidence-based: Health innovation policies should go beyond emphasizing the capacity to innovate based on input factors or intermediate outputs. Instead, they should prioritize an evidence-based approach that focuses on learning from and assessing the impact of health innovations. By doing so, these policies can optimize investment and governance decisions for health innovation. Common good: Humans are at the heart of all innovation narratives. Health innovation should be guided and governed by a sense of humanity, prioritizing the common good to ensure equitable access to its benefit. The public sector must ensure the diffusion of knowledge within and between countries to decentralize innovation capacity for greater public return. 8Regional Health Innovation Strategy for the Western Pacific 2.4 Key areas of action To achieve the objectives and vision of the Regional Strategy, Member States need to focus on four key areas of action: governance, capacity-building, financing and measurement. 2.4.1 Governance Placing health innovation policies at the forefront of policy agendas is crucial for fostering and scaling health innovation across all levels. This entails implementing supportive policies to anticipate future opportunities and challenges, investing in education and research, fostering collaboration and partnerships, ensuring a favourable regulatory environment, and cultivating inclusive and sustainable new markets for health innovations. Recommended actions include the following: Implement institutional arrangements to effectively guide, steer and coordinate innovation efforts and allocate resources. One possible approach is the establishment of a functional innovation task force operating within the ministry of health or council of ministers. Develop processes that facilitate collaboration among multiple ministries and sectors to collectively define missions, craft strategic plans for execution, establish measurable outcomes, and guide health research and innovation. For instance, Member States may prioritize the silver economy as a mission within national strategies and plans dedicated to promoting healthy ageing. Review and update policies and regulations that may impede health innovation for the common good. Implement policies to create an enabling ecosystem for health innovation. This can involve the establishment of platforms for knowledge exchange, encouragement of industry–academia–government collaboration, policies promoting impact measurement and social procurement, as well as regulatory approaches that support experimentation while maintaining effective oversight of safety and ethical concerns. 9thE rEgional stratEgy 2.4.2 Capacity-building Health innovation requires a combination of key capacities within government institutions: leadership, collaboration, research, data-driven decision-making, engagement with innovation stakeholders, creation of innovation ecosystems, a culture of learning from experimentation, change management and evaluation. Recommended actions include the following: Train public sector workers at all levels to develop a common understanding, skills and competencies to innovate for health. One potential approach is to implement health innovation training programmes aimed at improving awareness and knowledge. Adapt health and medical science education to equip the next generation with the knowledge and skills for cross-disciplinary collaboration in health innovation. A promising endeavour is the establishment of health innovation programmes in academic institutions that bring together interdisciplinary teams and drive research into innovation for public health. Cultivate a culture of health innovation by encouraging experimentation and sharing of best practices and lessons learnt. Build or join decentralized networks led by government innovation agencies and strengthen the capacity to try and learn. Evaluate progress, learning and adaptation in health innovation using new indicators and assessment tools tailored to its unique nature, aiding informed scaling decision-making. Implementation research is valuable in this regard, as it provides insights into the process, strategies and contextual factors that influence the impact. 2.4.3 Financing A long-term resource commitment is essential to scale up mission-oriented health innovations and create new markets. The role of public institutions is to provide longer lead times and financial stability to navigate uncertainty across the entire chain of health innovation, spanning from research to implementation, commercialization and health impact creation. By doing so, the negative impacts stemming from the short-term focus of private finance can be mitigated. Recommended actions include the following: Secure sustainable public financing for health innovations in areas with insufficient private capital. This fund should be dedicated to the entire chain of health innovation. Ensure that public investments align with expected returns through various mechanisms. For instance, the public sector can invest in early- stage antimicrobial resistance innovation and implement price capping for new antibiotics. 10 Regional Health Innovation Strategy for the Western Pacific Structure new types of public–private collaborations to actively create new markets for health innovation so that rewards are shared as much as risks taken. For instance, the government can collaborate with venture capitalists to jointly fund innovation missions and develop public procurement strategies and mechanisms, thereby sharing both risks and rewards. Strengthen research and development to provide a foundation for future breakthroughs in response to growing threats, such as antimicrobial resistance, climate change, NCDs and ageing. Allocate resources to support implementation research and the evaluation of health innovations. 2.4.4 Measurement The key to health innovation is learning. Measuring health innovations supports learning from experience, allows for policy and implementation strategy adjustments, strengthens the ecosystem, and ensures that stakeholders’ actions are cost-effective and efficacious. This approach entails examining processes, outputs and outcomes of health innovations in public and private sectors. Recommended actions include the following: Build monitoring and evaluation into the design of health innovation policies. Develop assessment frameworks to identify policy implementation outputs, outcomes and impacts. Develop learning frameworks and quantitative measures consistent with the nature of health innovations to evaluate health innovations for effectiveness, efficiency and impact. Engage all stakeholders to gather qualitative insights. Perform comprehensive impact assessments to measure the effects of health innovation on various aspects of the health system and society. 2.5 WHO’s role WHO will play an important role in supporting Member States in their pursuit of health innovation. This support will include developing and disseminating norms and guidance, demonstrating leadership, enhancing capacity-building in health innovation, shaping and influencing health innovation ecosystems and facilitating implementation. Develop norms and guidance and demonstrate leadership Advocate for the public sector to strengthen its leadership role in health innovation by emphasizing the importance of innovation ecosystems in systematically generating innovations. Develop technical guidance on health innovation ecosystems and governance frameworks for scaling health innovations. 11 thE rEgional stratEgy Formulate norms and standards for governing health innovation, particularly for technological innovations. Enhance capacity-building for health innovation Support countries in identifying strategic priorities with the greatest health impact, prioritizing problems for solving and shaping missions for health innovation. Support countries in assessing and selecting health innovations using a portfolio approach. Develop and implement innovation capacity-building programmes tailored to country contexts. Develop methodological guidance to support countries in their health innovation efforts. Shape and influence health innovation ecosystems Establish and sustain regional platforms that promote knowledge exchange, engagement with innovators and experts on innovation, and multisectoral partnerships to advance the regional health innovation agenda. Provide technical guidance to Member States in establishing health innovation ecosystems at all levels. Prepare case studies that explore health innovation ecosystems and extract lessons from other sectors on effectively fostering innovation in a systematic manner. Facilitate implementation Support countries in measuring health innovation and generating evidence to inform policy-making and planning. Facilitate collaborations among stakeholders, advocate for long-term public funding and explore new financing mechanisms. 12 Regional Health Innovation Strategy for the Western Pacific REFERENCES 1 Health innovation for impact. In: World Health Organization [website]. Geneva: World Health Organization; 2023 (https://www.who.int/teams/digital-health-and-innovation/ health-innovation-for-impact, accessed 5 June 2023). 2 Global Innovation Index 2022. Geneva: World Intellectual Property Organization; 2022 (https://www.wipo.int/edocs/pubdocs/en/wipo-pub-2000-2022-section4-en-cluster- ranking-global-innovation-index-2022-15th-edition.pdf, accessed 1 June 2023). 3 McAllister S, Thorn L, Boladuadua S, Gil M, Audas R, Edmonds T, et al. Cost analysis and critical success factors of the use of oxygen concentrators versus cylinders in sub-divisional hospitals in Fiji. BMC Health Serv Res. 2021;21(1):636. doi:10.1186/s12913-021-06687-8. 4 The ‘last mile’ of malaria elimination in Cambodia: health centre malaria workers play a pivotal role in eliminating the disease in malaria hotspots. In: World Health Organization [website]. Geneva: World Health Organization; 1 April 2021 (https://www.who.int/news- room/feature-stories/detail/the-last-mile-of-malaria-elimination-in-cambodia, accessed 5 June 2023). 5 Connecting communities in Lao PDR for better health during COVID-19 and beyond. In: World Health Organization [website]. Geneva: World Health Organization; 25 October 2021 (https://www.who.int/laos/news/feature-stories/detail/connecting-communities-in-lao- pdr-for-better-health-during-covid-19-and-beyond, accessed 13 June 2023). 6 Seoul 50 Plus Foundation [website]. Seoul: Seoul 50 Plus Foundation (https://50plus.or.kr/ org/eng.do, accessed 5 June 2023). 7 Aihara Y, Maeda K. National dementia supporter programme in Japan. Dementia (London). 2021;20(5):1723−8. doi:10.1177/1471301220967570. 8 Creating a smoke-free city – Balanga City, the Philippines. In: World Health Organization [website]. Geneva: World Health Organization; 29 November 2021 (https://www.who.int/ news-room/feature-stories/detail/creating-a-smoke-free-city-balanga-city-the-philippines, accessed 1 June 2023). 9 MoH to roll out new BruHealth features. In: The Scoop [website]. Bandar Seri Begawan.: The Scoop; 20 May 2022 (https://thescoop.co/2022/05/20/moh-to-roll-out-new-bruhealth- features/, accessed 13 June 2023). 10 Mcleod E, Bruton-Adams M, Förster J, Franco C, Gaines G, Gorong B, et al. Lessons from the Pacific Islands – adapting to climate change by supporting social and ecological resilience. Front Mar Sci. 2019;6:289. doi.org/10.3389/fmars.2019.00289. 11 Thirteenth general programme of work, 2019–2023: promote health, keep the world safe, serve the vulnerable. Geneva: World Health Organization; 2019 (https://apps.who.int/iris/ handle/10665/324775, accessed 4 July 2023). 13 rEfErEncEs 12 WHO Council on the Economics of Health for All. Health for All: Transforming economics to deliver what matters. Geneva: World Health Organization; 2023 (https://www.who.int/ publications/m/item/health-for-all--transforming-economies-to-deliver-what-matters, accessed 1 June 2023). 13 Mazzucato M. Mission-oriented innovation policies: challenges and opportunities. Ind Corp Change. 2018;27(5):803-15. doi.org:10.1093/icc/dty034. 14 Regional Health Innovation Strategy for the Western Pacific ANNEX Annex 1. Resolution WPR/RC74.R5 20 October 2023 HEALTH INNOVATION The Regional Committee, Recalling the WHO Thirteenth General Programme of Work (2019–2025) priority to harness the power of innovation as a critical enabler to achieving its Triple Billion targets; Recalling also the 2023 final report of the WHO Council on the Economics of Health For All, Health for All: Transforming economies to deliver what matters, which calls for the development of health innovation ecosystems that prioritizes the common good over short-term market profits to serve the health needs of all the world’s people, especially those in low- and middle-income countries; Noting the operational shift highlighting innovation – finding new approaches to meet future challenges – in For the Future: Towards the Healthiest and Safest Region, the Western Pacific Region’s implementation plan for the WHO Thirteenth General Programme of Work; Underscoring that successful health innovation is a complex process requiring a supportive environment, collective intelligence, values and direction and recognizing that effective implementation and scaling of health innovation for population impact necessitates the public sector to assume leadership and create supportive mechanisms; Recognizing also the crucial importance of a regional approach that fosters cooperation, knowledge sharing, and the creation of enabling ecosystems to bridge health disparities within and between countries and areas, 1. ENDORSES the Regional Health Innovation Strategy for the Western Pacific; 2. URGES Member States: (1) to adapt the objectives and actions of the Regional Strategy to their unique contexts to ensure effective implementation; 15 annEx (2) to foster cross-societal collaboration for health innovation at national, subnational and community levels; (3) to ensure adequate resources are available to implement the Regional Strategy; 3. REQUESTS the Regional Director: (1) to provide technical support for Member States to adapt and implement the Regional Strategy at national and subnational levels; (2) to disseminate the Regional Strategy and facilitate collaboration among stakeholders to support its implementation; (3) to report periodically on progress in health innovation in the Western Pacific Region.

18 Regional Health Innovation Strategy for the Western Pacific

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Organisation Organisation mondiale de la santé (OMS)

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Date d'adoption 7 février 2024

Source Organisation mondiale de la santé