Why COVID-19 strengthens the case for a dedicated financing mechanism to scale up innovation in women's, children's, and adolescents' health
Authors: Flavia Bustreo, Mario Merialdi, Rachael Hinton, Renuka Gadde
Journal: The Lancet Global Health (2020)

The disruptive effects of pandemics on the delivery of health services is increasingly recognised as a global threat to maternal and child health.1Roberton T Carter ED Chou VB et al.Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study.Lancet Glob Health. 2020; 8: e901-e908Summary Full Text Full Text PDF PubMed Scopus (727) Google Scholar The COVID-19 pandemic has further highlighted the need to not only rapidly develop health-care innovations but to also make them equitably available.2The LancetGlobal collaboration for health: rhetoric versus reality.Lancet. 2020; 396: 735Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar In this context, innovations that contribute to maintaining coverage of essential interventions, such as by facilitating task shifting, simplifying service delivery, or both, are crucial. Therefore, we argue that the case for a dedicated financing mechanism for scaling up innovations in women's, children's, and adolescents' health is stronger than ever. The global health community reacted rapidly to the need to develop COVID-19 vaccines and to plan for their equitable distribution.2The LancetGlobal collaboration for health: rhetoric versus reality.Lancet. 2020; 396: 735Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar Such coordinated and prompt action was possible because established organisations, such as the Coalition for Epidemic Preparedness Innovations and Gavi, the Vaccine Alliance, were already providing long-term financing channels to governments, academia, industry, and non-governmental organisations for the development, testing, and procurement of vaccines at a country level. By contrast, we do not have a similar financing system to rationalise and accelerate progress from the development to the adoption of innovations for reproductive, maternal, newborn, child, and adolescent health (RMNCAH). This gap represents a constant reminder of the unfinished agenda to address the health needs of these populations, especially in times of crises. Without a commitment from the global RMNCAH leadership to shift from fragmented efforts, such as calls for proposals with limited scope issued by individual organisations, to a dedicated financing and procurement system to foster and scale up RMNCAH innovations, it is unlikely that technological progress will benefit individuals most in need. This situation is not only an argument for innovation scale up but also one of equity and social justice in preventing the avoidable deaths of women, children, and adolescents. The Saving Lives at Birth Grand Challenge has built a strong pipeline of over 100 innovations for maternal and newborn health over the past 7 years.3Grand Challenges CanadaSaving Lives at Birth.https://www.grandchallenges.ca/programs/saving-lives-at-birth/Date accessed: November 13, 2020Google Scholar Despite these efforts, a large chasm remains between the innovative pipeline and the generation of impact, as only 18 of the 110 innovations are transitioning to scale.3Grand Challenges CanadaSaving Lives at Birth.https://www.grandchallenges.ca/programs/saving-lives-at-birth/Date accessed: November 13, 2020Google Scholar Innovation scale-up requires particular elements to succeed, such as generation of the evidence base to show potential for impact and ensuring financial support in resource-limited settings for procurement and adoption. RMNCAH innovations have specific and considerable barriers to fulfilling the requirements for scaling up. This situation often generates an avoidable delay in the implementation of innovations in resource-limited settings, compared with a streamlined adoption in high-income countries. The reasons for these challenges over the past decade relate to an absence of global advocacy and innovation prioritisation, limited resources for implementation research, scarce demand creation and provider training, and fragmented donor commitments to procurement funding. Uncoordinated preparedness for RMNCAH innovation scale-up in resource-limited settings has led to suboptimal implementation in the past and should be avoided in the future to ensure the equitable uptake of new technologies. Therefore, a decision of the global health leadership to establish a dedicated financing mechanism to optimise and accelerate adoption of innovation would have important implications for RMNCAH in resource-limited settings. Such a decision would allow for the prioritisation of innovations that address the most urgent unmet needs for women, children, and adolescents. For example, digital health innovations could improve data accuracy and clinical care in remote communities, increasing the likelihood that a child would be correctly diagnosed and treated.4Keitel K D'Acremont V Electronic clinical decision algorithms for the integrated primary care management of febrile children in low-resource settings: review of existing tools.Clin Microbiol Infect. 2018; 24: 845-855Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar Policy makers' decisions to adopt and implement innovations would be informed by an expected level of evidence. A dedicated approach would contribute to the rationalisation and harmonisation of prequalification, regulatory processes, clinical guidelines, and training programmes and would provide opportunities to generate demand at a country level, as seen in the fields of vaccines and HIV, tuberculosis, and malaria. The development of long-term procurement financing channels would also help countries to adopt innovations at scale and would simultaneously allow the private sector to forecast development, production, and distribution costs against guaranteed volumes. A dedicated approach for RMNCAH innovation could streamline the path to adoption of emerging and promising technologies. For example, the Odon device for assisted vaginal birth provides an example of an innovation undergoing clinical testing at a stage when potential for impact is being progressively recognised.5Draycott T Crofts J Hotton E Mottet N Assisted vaginal delivery: the Odon device.www.mcascientificevents.eu/birth/odon-device/Date: Oct 1, 2020Date accessed: November 13, 2020Google Scholar The device is designed to be safe for mothers and babies and to reduce the skill level and equipment required to perform assisted vaginal deliveries during a prolonged or complicated second stage of labour.6Draycott TJ Di Renzo GC The role of operative vaginal birth in the 21st century and a way forward.BJOG. 2017; 124: 5-6Crossref PubMed Scopus (10) Google Scholar Interim results of ongoing clinical trials in the UK and France indicate promising levels of safety and efficacy.5Draycott T Crofts J Hotton E Mottet N Assisted vaginal delivery: the Odon device.www.mcascientificevents.eu/birth/odon-device/Date: Oct 1, 2020Date accessed: November 13, 2020Google Scholar If substantiated at the completion of these trials, these findings warrant further testing for determination of impact in resource-limited settings, where there is even greater need for the device than in high-income countries. Such testing could also inform plans for future in-country implementation. The logical progression of testing in different resource settings could be accelerated and optimised if dedicated financial and technical resources were readily available. There are options to build such a dedicated system, expanding on existing institutions like Unitaid and the Global Financing Facility. For example, in March, 2019, the Global Financing Facility initiated a call for proposals on scale-up innovations to save the lives of women and neonates.7Global Financing FacilityGlobal Financing Facility and partners launch a call for proposals to scale up innovations to save women and newborns' lives.https://www.globalfinancingfacility.org/global-financing-facility-partners-launch-call-proposals-scale-innovations-save-women-childrenDate: March 18, 2019Date accessed: November 16, 2020Google Scholar Such efforts should be expanded to realise a dedicated financing mechanism. The response of the global community to the COVID-19 challenge has shown that this mechanism is possible when supported by political will. MM is employed by Becton Dickinson and Company, which has licensed particular rights to the Odon device. All other authors declare no competing interests.