Comment
Offline: Aung San Suu Kyi goes to Doha
What do the Duke of York, Aung San Suu Kyi, and Her
Highness Sheikha Moza bint Nasser have in common?
They were all guests of Lord Ara Darzi last week in Doha.
The reason for coming together, along with around
800 lesser celebrities, was Lord Darzi’s first WISH—the
World Innovation Summit for Health. (Full disclosure:
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the organisers of the meeting paid for my travel and
accommodation. The Lancet was an “academic partner”.)
The subject of the gathering was innovation: “we want to
foster the take-up and adoption of health innovation and
ideas from across the world”. WISH ignited debates based
on eight reports, all led by leaders in their respective fields
(Sally Davies on antimicrobial resistance and Vikram Patel
on mental health, to take two examples). There was an
“innovation showcase”, displaying 15 ideas that ranged
from Operation Hernia (pioneering mosquito netting
for groin hernia repair) to Primary Care 101 (translating
evidence into practice in rural South Africa). The meeting
sought to be much more than a talking shop.
Richard Horton
*
The principal product launched at WISH—and advertised
in the Financial Times as “ground-breaking”—was a report
entitled Global Diffusion of Healthcare Innovation. It
was a collaboration between a market research agency
and Imperial College London. The report concluded that
countries (the study focused on eight high-income or
middle-income nations: Australia, Brazil, England, India,
Qatar, South Africa, Spain, and the USA) were taking
different approaches to innovation, that they share
some common characteristics of success (such as having
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champions of innovation), that more could be done to
improve conditions for innovation (eg, creating time
and space for learning), and that there are some clear
priorities for the future (technology, vision, investment,
and commitment). The report was interesting but
perhaps failed the test of common sense. In its evaluation
of England, for example, it rated the funding of research
and development as a less important determinant of
innovation diffusion over the past 5 years. Given the
enormous investment into innovation diffusion by the
National Institute for Health Research and the National
Institute for Health and Care Excellence, this conclusion
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seems mistaken. And the report missed an opportunity
by excluding low-income countries, where some of
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the most important innovations are taking place in
global health today. In Bangladesh, large gains in health
have been achieved through innovations that have
included rapid increases in community health workers,
partnerships with NGOs, and the quick adoption of,
among others, family planning and oral rehydration
therapy programmes. In Rwanda, the introduction of
performance contracts between the Ministry of Health
and providers, together with intensive audits of health
outcomes, have had similar effects.
*
But the meeting in Doha was successful not because
it celebrated innovation, but because it punctured its
hubris. Innovation is a fashionable word today. It has
become something of an ideology, linking academic
research to commercial exploitation. Innovation has
been embraced by governments trying to embed an
entrepreneurial culture into their societies as they face
down forces of globalisation over which they have little
control. Innovation has become a crucial goal in and of
itself for policy making. Aung San Suu Kyi disagreed
with that approach to innovation. She said her country,
Burma (Myanmar), was on “a road to a new society”.
A new culture of democracy was being born. What
mattered most in creating this new society were the
values the government and the people lived by. “It’s
not a matter of just money”, she emphasised. “What we
need is the human spirit to help ourselves and to help
others.” Aung San Suu Kyi spoke about a “revolution of
the spirit”, the ability and the courage to change oneself.
Innovation is important principally as a means to create
new and better values. “Please do not look at health-
care innovation only in terms of technology, training,
and medical education, but in terms of poor societies,
nurturing, and creating a healthy society in the best
sense of the word.” “We must learn to live with one
another, not just tolerate one another.” The goal for our
societies should not be the abstract notion of innovation.
It should be a kind of serenity, where “spiritual health is
as important as physical and mental health”. The task of
innovation is to serve that human objective.
Richard Horton
richard.horton@lancet.com
www.thelancet.com Vol 382 December 21/28, 2013