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Background
The COVID-19 pandemic has profoundly disrupted the provision of health services across the globe. Travel to hospitals is restricted and many health facilities have limited services, deepening financial problems for some clinics and hospitals.1 Vulnerable groups who are already marginalised by their gender, race or nationality have been disproportionately affected by COVID-19.2 In response, social innovations have been developed to protect vulnerable groups and rapidly pivot health systems towards COVID-19. Social innovations in health are inclusive solutions that meet the needs of end users through a multistakeholder, community-engaged process to address the healthcare delivery gap.3 Social innovation is particularly well suited for the COVID-19 response because it focuses on local needs, develops low-cost solutions and builds on community strengths (figure 1). In partnership with partner academic institutions, the Special Programme for Research and Training in Tropical Diseases launched the Social Innovation in Health Initiative (SIHI) in 2014. SIHI focuses on research, training and advocacy related to social innovation in health. In collaboration with partners, the network organised an online open event to discuss social innovation responses to emergencies.4 This piece highlights how social innovation has contributed to the COVID-19 response and presents three examples of social innovation projects that have adapted to the pandemic. These examples demonstrate how social innovation during COVID-19 has mobilised local communities, swiftly adapted existing health services and built strong partnerships.
Characteristics of social innovation that have facilitated its use during the COVID-19 pandemic.
Community mobilisation in Peru
COVID-19 responses suggest the importance of local community mobilisation and the flexibility of projects that may already be operating in the field to improve other health outcomes. Mamás Del Río is a community-based maternal and neonatal health programme operating in 84 remote Amazon communities in Peru and 30 communities on the Peruvian-Colombian border (figure 2). Local people are selected through community assemblies and receive training to become community health workers. The instructional focus is on traditional birth attendant support, strengthening healthcare facilities and comprehensive supervision. Empowered with a tablet application, the community health workers conduct home visits to pregnant women and their families, deliver health educational content and gather data to share with local government.5 During COVID-19 travel restrictions, the communities in the implementation area became isolated and health facilities suspended routine services. The programme rapidly adapted to meet the needs of local people, including delivery of materials and equipment for basic COVID-19 prevention, managing misconceptions through phone supervisions, developing video training for community health workers about COVID-19 and continuing home visits for people with COVID-19 symptoms.6 Since the start of the pandemic until December 2020, community health workers have conducted 1113 visits to pregnant women and provided 270 safe delivery kits. The project enabled the community to sustain maternal and neonatal health services while responding to urgent needs of the COVID-19 pandemic.
Social innovations responding to COVID-19 in Peru (left), Philippines (top right) and Malawi (bottom right).
Adapting existing services in Malawi
Adapting existing social innovations to shifting needs during the wake of a crisis can be effective in driving service uptake. Chipatala Cha Pa Foni, or Health Centre by Phone, is a toll-free health hotline in Malawi that provides health information and referrals on demand. The innovation was driven by the realisation that people in Malawi, especially those at the last mile, travel long distances to the nearest health facility to receive access to information. The hotline was iteratively co-created with local people to provide health advice, demonstrated to be effective, and then scaled up nationwide.7 In response to COVID-19, the government leveraged the platform’s capabilities to triage people with COVID-19 symptoms, identify and refer people experiencing violence, and clarify shelter-in-place policies. The hotline is now the official way to reach healthcare workers and get answers to COVID-19-related questions in Malawi. Between April and June of 2020, approximately 30% of all calls to the hotline were related to COVID-19.8 The community-driven access to free, timely, reliable and quality health information has enabled adaptation during the COVID-19 response. The hotline has provided a mechanism for the Ministry of Health to better understand local needs during the COVID-19 pandemic.
Multisectoral partnership in the Philippines
Multisectoral partnership is another key engine in driving sustainable social innovation programmes during COVID-19. The Seal of Health Governance is a multisectoral health partnership established in the Municipality of Del Carmen in the Philippines that empowers community leaders to ensure quality implementation and sustainability of health programmes.9 In 2012, the Del Carmen government joined a partnership with Zuellig Family Foundation and the University of the Philippines to co-create its health reform agenda and provide leadership and governance training to local leaders. This innovative multisectoral partnership brings together the strengths and resources from the private sector, academia and local government. In response to the COVID-19 pandemic, the local government of Del Carmen took action early and fast, rolling out an agenda that not only prevented local outbreak but also maintained local livelihoods. The specific points of focus were on addressing food shortages, ensuring continuum of services at the local health systems level and reducing COVID-19 risk. In response to the needs voiced by the community, through government and private sector partnership, a hunger management campaign on farming and sustainable fishing enabled distribution of food rations to 5000 of the most vulnerable families. A call centre was established to manage the entry of returning residents and prepare the local health system’s absorptive capacity. Taking into consideration the local context, both seaborne and land control were in place to administer COVID-19 testing and manage necessary quarantines. Training local leaders and promoting meaningful community participation in solving their own health problems helped the local government prepare and respond to COVID-19 challenges.
Social innovation during COVID-19
Many social innovations emerged in response to COVID-19 and have helped to address the healthcare delivery gaps in emergency settings through mobilising communities, adapting existing innovations and leveraging multisectoral partnerships. However, few of these programmes have been monitored or evaluated. A Social Innovation in Health Monitoring and Evaluation Framework10 and a Social Innovation in Health Research Checklist can help to increase rigour of social innovation research.11 More research is needed to examine the process and outcomes of social innovation in health during health emergencies. The United Nations General Assembly Resolution 71/27612 describes resilience as the ability of a system, community or society exposed to hazards to resist, absorb, accommodate to and recover from the effects of a hazard in a timely and efficient manner, including through the preservation and restoration of its essential basic structures and functions. Social innovation initiatives provide powerful means of mobilising communities to respond to emergencies that can complement and extend government and private sector responses and build more resilient societies.
Ethics statements
Acknowledgments
We would like to thank Ana Gerlin Hernandez Bonilla and Alfredo M Coro for comments on an earlier version of this manuscript. The work received support from the TDR, the Special Programme for Research and Training in Tropical Diseases co-sponsored by UNICEF, UNDP, the World Bank and WHO. TDR is able to conduct its work thanks to the commitment and support from a variety of funders. These include our long-term core contributors from national governments and international institutions, as well as designated funding for specific projects within our current priorities. For the full list of TDR donors, please visit TDR’s website at https://www.who.int/tdr/about/funding/en/. TDR receives additional funding from Sida, the Swedish International Development Cooperation Agency, to support SIHI. The ideas expressed in this correspondence are the authors’ own and do not necessarily reflect the decisions and policies of the TDR or the Pan American Health Organization. Special thanks to Mamas del Rio for their support.
Footnotes
Twitter @JosephTucker
PM and JL contributed equally.
Contributors PM, JL and JDT conceived of the presented idea. PM, JL and JDT wrote the manuscript with input from all authors.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.