Reverse innovation in global health systems: towards global innovation flow

The global flow of knowledge, skills, and ideas has been a defining feature of human progress. Different regions and peoples have contributed to and, indeed, led innovation development at various times in human history. From Africa to Asia, Latin America, and the Middle East, the current body of knowledge on these diverse contributions to human science and medicine is expanding [1]. For example, written a thousand years ago in the Middle East, the Qanun fi-l-tibb (Canon of Medicine) of Ibn Sina is an immense encyclopaedia of medicine that served as the chief guide to medical science in Europe for over six centuries [2]. Prior to vaccination, eighteenth century Europeans were eager to learn about and adopt innovative ideas to combat smallpox, including through variolation, which was long practiced in Africa and Asia [3]. The current global use of artemisinin anti-malarials as a standard treatment saving millions of lives is based on knowledge harnessed from Chinese medicine [4]. Indeed, it is hard to imagine a world without such noteworthy contributions; the health systems of today represent the culmination of centuries of global innovation flow. The development paradigm in recent history has chiefly focused on promulgating ideas and health systems solutions that have been developed in rich countries with the expectation that a grateful and deferential “South” blithely adopt them. In contrast, there has lately been a growing realization that the prodigal and often extravagant “North” has something to learn from innovations that emerge from resourcechallenged settings. Out of necessity, poorer countries have had to rethink processes, interventions, and overall systems to ensure the best value for money is attained at every turn. In a time of global austerity there is a growing appreciation of the need for bidirectional exchange of ideas to be the new adage of global dialogue. The view that businesses in “developed” countries could create opportunities from innovative products and services arising from emerging economies was highlighted by John Hagel III and John Seely Brown, through a term defined as