What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review

Document Type : Review Article


1 Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, Montreal, QC, Canada

2 Institute of Public Health Research of University of Montreal (IRSPUM), University of Montreal, Montreal, QC, Canada

3 Department of Family Medicine, University of Montreal, Montreal, QC, Canada

4 Canada Research Chair on Patient and Public Partnership, Montreal, QC, Canada

5 School of Public Health, University of Montreal, Montreal, QC, Canada


While responsible innovation in health (RIH) suggests that health innovations could be purposefully designed to better support health systems, little is known about the system-level challenges that it should address. The goal of this paper is thus to document what is known about health systems’ demand for innovations.
We searched 8 databases to perform a scoping review of the scientific literature on health system challenges published between January 2000 and April 2016. The challenges reported in the articles were classified using the dynamic health system framework. The countries where the studies had been conducted were grouped using the human development index (HDI). Frequency distributions and qualitative content analysis were performed.
Up to 1391 challenges were extracted from 254 articles examining health systems in 99 countries. Across countries, the most frequently reported challenges pertained to: service delivery (25%), human resources (23%), and leadership and governance (21%). Our analyses indicate that innovations tend to increase challenges associated to human resources by affecting the nature and scope of their tasks, skills and responsibilities, to exacerbate service delivery issues when they are meant to be used by highly skilled providers and call for accountable governance of their dissemination, use and reimbursement. In countries with a low and medium HDI, problems arising with infrastructure, logistics and equipment were described in connection with challenges affecting procurement, supply and distribution systems. In countries with a medium and high HDI, challenges included a growing demand for drugs and new technology and the management of rising costs. Across all HDI groups, the need for flexible information technologies (IT) solutions to reach rural areas was underscored.
Highlighting challenges that are common across countries, this study suggests that RIH should aim to reduce the cost of innovation production processes and attend not only to the requirements of the immediate clinical context of use, but also to the vulnerabilities of the broader system wherein innovations are deployed. Policy-makers should translate system-level demand signals into innovation development opportunities since it is imperative to foster innovations that contribute to the success and sustainability of health systems.


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Commentaries Published on this Paper

  • Who is Responsible for Responsible Innovation? Lessons From an Investigation into Responsible Innovation in Health; Comment on “What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review”

          Abstract | PDF

  • The Need for a Dynamic Approach to Health System-Centered Innovations; Comment on “What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review”

          Abstract | PDF

  • Innovation, Demand, and Responsibility: Some Fundamental Questions About Health Systems; Comment on “What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review

          Abstract | PDF

  • Innovation Strategies and Health System Guiding Principles to Address Equity and Sustainability in Responsible Innovation in Health; Comment on “What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review”

          Abstract | PDF

  • Nurturing Societal Values in and Through Health Innovations; Comment on “What Health System Challenges Should Responsible Innovation in Health Address?”

          Absrtact | PDF

  • The Co-Constitution of Health Systems and Innovation; Comment on “What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review

          Abstract | PDF

Authors' Response to the Commentaries

  • Revisiting the Relationship Between Systems of Innovation and Health Systems: A Response to Recent Commentaries

          Abstract | PDF


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Volume 8, Issue 2
February 2019
Pages 63-75
  • Receive Date: 12 March 2018
  • Revise Date: 08 November 2018
  • Accept Date: 10 November 2018
  • First Publish Date: 01 February 2019