Caregivers in low-resource settings do their best to mimic practices considered optimal despite challenging environments. The creative innovations they develop may not be as effective as those used in high-income settings but often represent alternatives with excellent cost–benefit ratios adapted to their contexts. Of note, these innovations are not and should not be confined to developing countries. For example, accessible low-cost diagnostic tools such as urinary reagent strips for analysis of synovial fluids could be used by physicians in ambulatory care for rapid diagnostic orientation and may avoid the referral of patients to crowded emergency departments. This idea of “reverse innovation” (i.e., the flow of ideas from lower- to higher-income settings) is increasingly garnering attention and has resulted in fruitful partnerships between developed and developing countries .
Yet, several challenges remain for frugal innovations.
First, people should remain aware that some bottom-up innovations may be developed on mistaken beliefs and cause more harm than good. For instance, Cola drinks were recommended for rehydration with acute diarrhea for several years before evidence showed that these drinks had low electrolyte content and extremely high osmolality, which may actually worsen diarrhea . Because frugal innovations seek to provide solutions to common healthcare problems, they must be scientifically evaluated before widespread utilization.
Second, frugal innovations may offer effective and cheap solutions to healthcare problems in low-resource settings but may not be adopted. For instance, despite flash heating of breast milk (i.e., heating breast milk by using a glass jar placed in a pot of boiling water) being able to reduce mother-to-child transmission of HIV infection , the process is not well implemented in African countries because it requires frequent, unpractical boiling of water and because it indicates that the woman is HIV positive, exposing her to stigma in the community . As with all medical interventions, adoption of medical innovations depends not only on their effectiveness or costs but also on how they can be integrated in patients’ daily lives and/or physician practices.
Finally, many frugal innovations, especially bottom-up innovations, stay local, “below-the-radar” and rarely spread to otherswho might face similar challenges. For instance, a method to perform auto-transfusion when no blood donor is present was developed in South Africa , but our discussions with doctors in Democratic Republic of Congo revealed that most of them neither knew nor used this method, which could have saved some patients’ lives.
Examples in this paper represent the tip of the iceberg – just a few of the ingenious practices across the world that have been evaluated and published. Thus, we argue for the creation of a “Compendium of Good Ideas” at http://frugal-innovation-medicine.com, whereby doctors, inventors, patients, and others can share ideas and inventions of frugal innovations for consideration in relevant contexts, scientific evaluation and/or inspiration.