Article Text

Download PDFPDF
Original article
The search for the holy grail: frugal innovation in healthcare from low-income or middle-income countries for reverse innovation to developed countries
  1. Yasser A Bhatti1,
  2. Matthew Prime1,
  3. Matthew Harris1,2,
  4. Hester Wadge3,
  5. Julie McQueen4,
  6. Hannah Patel5,
  7. Alexander W Carter1,
  8. Gregory Parston1,
  9. Ara Darzi1
  1. 1Institute of Global Health Innovation, Imperial College London, UK
  2. 2School of Public Health, Imperial College London, London, UK
  3. 3Department of Health, United Kingdom Government
  4. 4Ernst and Young LLP, London
  5. 5The Health Foundation, London
  1. Correspondence to Dr Yasser A Bhatti, Division of Surgery, Imperial College London, Institute of Global Health Innovation, St Mary’ s Hospital, London W2 1NY, UK; yasser.bhatti{at}


The healthcare sector stands to benefit most from frugal innovation, the idea that more can be done for less for many more people, globally. As a first step for health systems to leverage new approaches to offset escalating health expenditures and to improve health outcomes, the most relevant frugal innovations have to be found. The Institute of Global Health Innovation was commissioned by the US-based Commonwealth Fund to identify frugal innovations from around the world that could, if transferred to the USA, offer approaches for expanding access to care and dramatically lower costs. Our global scan was motivated by the need to extend the list of frugal innovations in healthcare beyond the impressive but oft-repeated examples such as GE’s MAC 400, a US$800 portable ECG machine, Narayana’s US$1500 cardiac surgery and Aravind’s US$30 cataract surgery. Our search involved (1) scanning innovation databases, (2) refining frameworks to identify frugal innovations and evaluate their reverse potential and (3) developing in-depth case studies. From 520 possible innovations, we shortlisted 16 frugal innovations that we considered as frugal and with potential for reverse diffusion into high-income country health systems. Our global search was narrowed down to three care delivery models for case analysis: The Brazilian Family Health Strategy around community health workers; Singapore-based GeriCare@North use of telemedicine and Brazil’s Saude Crianca community involvement and citizenship programme. We share core features of the three frugal innovations and outline lessons for practitioners, scholars and policymakers seeking to lower healthcare costs while increasing access and quality.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors All co-authors contributed equally to different aspects of the study, including research, review and revision of paper. Specifically, YB wrote the first draft of article and submitted; YB, MP, JMQ and GP planned the study; MP, HW, HP and AC conducted field trip data collection and YB, MP, MH, HW, HP, AWC, GP and AD wrote the case studies. AD was the Principal Investigator and led the study.

  • Funding This research was funded by the Commonwealth Fund, USA.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.