Introduction

Low-cost healthcare innovations which are designed for economic reasons, popularly called frugal innovations (FI), are all about ‘doing more and better with less for more people’.1 Often synonymous with ‘work-arounds’ or ‘good-enough’ innovation, what FIs lack in sophistication or complexity they make up for in affordability, without scrimping on safety or effectiveness. Some good examples of FIs include the low-cost ECG machine GE MAC 400, Kangaroo Care, the Ponseti treatment for congenital clubfoot and mosquito net mesh used for hernia repair; each of which has a demonstrable evidence base for clinical effectiveness at extremely low cost.2–5 The philosophy of FI originates from grassroots, resource-constrained milieus, where most abundant of all-natural resources—human ingenuity—is used to optimise limited resources to solve problems.6 Any FI must result in substantial (at least one-third) cost reduction without compromising on its core functions and optimum performance level.7 Some FIs, although designed in the developing world, have been found useful for the developed world too and are labelled as ‘reverse innovation’, although this term is considered to be pejorative by some.8 9

Innovation, although central to the development of medical science, is a complex process and its definition continues to be debated.10 Its complexities are further reflected in challenges in its evaluation and reporting even though frameworks such as Idea, Development, Exploration, Assessment and Long-term monitoring, a widely accepted benchmark, are available.11 In a recent systematic review, the measurement and reporting of surgical innovations continues to be inconsistent, and there is a need for standardisation and guidance.12 FIs reporting is made even more complex for two reasons (1) that they are work-arounds and unconventional solutions for reducing the complexity and cost of an idea, oftentimes unpatented, not commercialised, without financial backing or simple changes in practice or technique, and …