Health innovations are generally oriented on a techno-economic vision. In this perspective, technologies are seen as an end in themselves, and there is no arrangement between the technical and the social values of innovation. This vision prevails in sanitary crises, in which management is carried out based on the search for punctual, reactive, and technical solutions to remedy a specific problem without a systemic/holistic, sustainable, or proactive approach. This paper attempts to contribute to the literature on the epistemological orientation of innovations in the field of public health. Taking the Covid-19 and Ebola crises as examples, the primary objective is to show how innovation in health is oriented towards a techno-economic paradigm. Second, we propose a repositioning of public health innovation towards a social paradigm that will put more emphasis on the interaction between social and health dimensions in the perspective of social change. We will conclude by highlighting the roles that public health could play in allowing innovations to have more social value, especially during sanitary crises.

Introduction : Malgré leur importance dans la réduction de la mortalité maternelle et néonatale, l’utilisation des soins prénatals demeure non optimale au Burkina Faso. Cet article propose de documenter les motifs de non-recours aux services de soins prénatals en s’intéressant aux femmes qui y renoncent ou qui y recourent tardivement. Méthodes : La collecte des données qualitatives a eu lieu d’octobre 2013 à janvier 2014 dans la commune rurale de Kokologho. Différentes méthodes de collecte ont été utilisées : l’observation participante, vingt-deux entrevues individuelles semi-dirigées avec des femmes qui sont en recours tardif aux soins prénatals et huit entrevues informelles avec des informateurs-clés identifiés dans la communauté. Résultats : L’analyse thématique en continu révèle quatre barrières qui entravent le recours effectif aux soins prénatals par les femmes rencontrées : (1) le manque de connaissance du calendrier et des objectifs des soins prénatals, (2) la perception de la grossesse et des soins prénatals, (3) les barrières socio-économiques : paiement direct des consultations prénatales et manque d’autonomie des femmes, et (4) la perception de la qualité des soins prénatals. Discussion : Ces résultats sont discutés au travers des différents types de non-recours de la typologie explicative adoptée pour cette étude, dont la non-connaissance , la non-demande par choix ou par contrainte et la non-réception des soins. Cet apport théorique dévoile que les défaillances dans le système de soins de même que la dichotomie existante entre les représentations sociales et celles médicales de la grossesse et des soins prénatals, participeraient à exclure certaines femmes des services de soins prénatals.

The scale-up and sustainability of social innovations for health have received increased interest in global health research in recent years; however, these ambiguous concepts are poorly defined and insufficiently theorised and studied. Researchers, policymakers, and practitioners lack conceptual clarity and integrated frameworks for the scale-up and sustainability of global health innovations. Often, the frameworks developed are conceived in a linear and deterministic or consequentialist vision of the diffusion of innovations. This approach limits the consideration of complexity in scaling up and sustaining innovations. By using a systems theory lens and conducting a narrative review, this manuscript aims to produce an evidence-based integrative conceptual framework for the scale-up and sustainability of global health innovations. We conducted a hermeneutic narrative review to synthetise different definitions of scale-up and sustainability to model an integrative definition of these concepts for global health. We have summarised the literature on the determinants that influence the conditions for innovation success or failure while noting the interconnections between internal and external innovation environments. The internal innovation environment includes innovation characteristics (effectiveness and testability, monitoring and evaluation systems, simplification processes, resource requirements) and organisational characteristics (leadership and governance, organisational change, and organisational viability). The external innovation environment refers to receptive and transformative environments; the values, cultures, norms, and practices of individuals, communities, organisations, and systems; and other contextual characteristics relevant to innovation development. From these syntheses, we proposed an interconnected framework for action to better guide innovation researchers, practitioners, and policymakers in incorporating complexity and systemic interactions between internal and external innovation environments in global health.

Community health workers (CHWs) are key players in providing primary healthcare in low- and middle-income countries. However, their absence from the formal health system in many of these countries often presents a challenge to their remuneration. The objective of this scoping review is to document programs implemented at both small and large scales in low- and middle-income countries, the remuneration strategies they have established, and the effects of these strategies on the work of CHWs. In total, we included 50 articles in this review. We have identified four types of compensation: fixed compensation, performance-based compensation, compensation based on income-generating activities (IGAs), and combined compensation. We identified the strengths and weaknesses of each type of compensation. A common strength for most models was improvement in motivation and performance. A common weakness for most models was irregular payments. The results of this review highlight the need to consider the economic, social, and cultural settings of the countries or environments at hand, and to include CHWs in discussions regarding the selection of a compensation model.

Background: Digital health technologies (DHTs) have expanded exponentially since the COVID-19 crisis and have prompted questions about their impact across all levels of health systems. Because health organisations and systems play a central role in the success or failure of the transition to more equitable and sustainable societies, the concept of Responsible Innovation in Health (RIH), focused on aligning the processes and outcomes of innovation with societal values, is gaining interest in research, policy, and practice. This study aims to explore enablers and constraints to the development, procurement and/or utilisation of responsible DHTs in health organisations. Methods: Semi-structured interviews were conducted with 29 stakeholders concerned with the development, procurement, and/or utilisation of DHTs in a large Canadian academic health centre. Data were thematically analysed through a mixed deductive-inductive process using the RIH framework. Results: Our findings highlight that the consideration of RIH principles in the development, procurement, and/or utilisation of DHTs depends mainly on organisational and systemic factors and conditions, namely: (1) the presence of an organisational culture that promotes RIH in its innovation-related practices and processes; (2) availability of material and financial resources as well as expertise in certain fields (eg, environmental sustainability); (3) the evolution of health technology assessment (HTA) practices to include other dimensions beyond effectiveness, safety, and costs; (4) the scope of the regulatory and legal frameworks that govern the approval and use of DHTs; and (5) the role of the market (eg, venture capital) in the design of federal and provincial innovation policies. Conclusion: This study provides insights on practice, policy, and political issues that health organisations may face in the development, procurement, and/or utilisation of responsible DHTs. It can help scholars, practitioners, decision-makers, and industry to create the conditions for a better integration of RIH principles into health organisations and systems.