No matter how much trade facilitation and tariff-reduction occurs, countries on the global periphery will always struggle to develop in a way that meets both human and ecological needs without active measures aimed at stimulating investment, boosting demand and accumulating capital sustainably. The structuralists and developmentalists were writing largely before the challenges of climate change and questions of sustainability were widely understood.
Intra-country inequality has also since worsened. In the age of the sustainable development goals, it is worth reconsidering their output within the broader framework of sustainability, and even reconsidering the ends of development in LDCs. Several recent works, such as Raworth have underlined the importance of integrating human wellbeing and ecological sustainability in order to remain both inside ecological boundaries and above the social minimum necessary for people to live fair, fulfilling and healthy lives.
Sustainable development goal 3, on health and wellbeing, implies that at times, economic expansion should be subordinated to human fulfillment. Sustainable development goals concern sustainability, responsible consumption, climate action and life above and below water. Growth, while important for poverty reduction, should not come at all costs. It is important to recognize that the support measures provided the international community are not a recipe for development, nor do they hold all the answers for LDCs.
They should be seen not as low-hanging fruit which alone can stimulate or support sustainable development, but as part of the overall development process to be complemented by active government policies. The sustainable development goals, however, and the earlier work of the structuralists and developmentalists may imply the need for a redesign of international support measures for existing LDCs and for those leaving the category.
Given a blank canvas, what sort of measures might be designed to address the real constraints, needs and opportunities facing LDCs? Is the conventional support for trade in LDCs — duty-free, quota-free market access — enough to ensure that those countries benefit from trade? Will integration into the world economy alone address the concerns of LDCs, or will other steps be necessary? Are the goals of sustainability and poverty-reduction in LDCs sufficiently well defined?
Without creating undue complexity, it may even be necessary to design different international support mechanisms for different country groups. Cornia and Sognamillo , for instance, suggest dividing LDCs into six clusters, each of which should pursue different policy measures.
These groups are countries at war, small and remote countries, mining, agriculture, manufacturing and services LDCs. Prospective and new graduates may even merit dedicated support measures aimed at propelling them through and beyond graduation. Ecological sustainability must take a more prominent role in support measures for LDCs, alongside inequality. Until now international support for LDCs has focused almost exclusively on economic growth.
Even climate financing has often been couched in terms of mitigating the impact of environmental changes on economic output. Yet the LDCs are often the countries facing the worst impact of climate change.
Plenty of emerging theory and evidence suggests that multiple goals in addition to aggregate economic welfare are desirable, compatible and feasible. This said, any framework which questions the limits of economic growth is particularly controversial in LDCs. For countries at the very lowest levels of aggregate income, economic growth is absolutely essential to reduce poverty. Benefits to individuals and organizations in developed countries. Rather, our research overwhelmingly detected unique ways of responding to health challenges that support the concept of reverse innovation.
Narrative summaries describing our main findings are provided below, arranged according to the six key components of a health system [ 11 ]. These accounts provide insights on how innovations e. Many developing countries have developed mechanisms to reduce cultural, social, financial, or gender-related barriers to service delivery [ 12 , 13 ].
For example, family and community-based interventions in developing countries have been indispensable to the management and treatment of diseases like schizophrenia, through de-stigmatizing practices like therapeutic optimism, extended support networks, and more holistic appraisals of the disorder [ 14 , 15 ].
Where direct interaction between men and women is discouraged e. An Iranian thalassaemia prevention programme demonstrates culture-sensitive ways of prevention in high-risk individuals by screening school children as part of their regular health check-ups [ 17 ]. Such strategies can be helpful in managing developed-country healthcare challenges in marginalized developed country populations.
Indeed, this was the experience for Project Connect, a U. Developing countries have also long addressed the use of alternative medicine through policy models where modern and traditional medicine are either integrated through medical education and practice, or practiced through parallel mechanisms within the national health system [ 20 ]. As Western governments grapple with medical pluralism, developing country models of integrated health can offer guidance on how to provide a care continuum that enhances social integration.
Developing countries can also offer learning opportunities to those seeking to maximise health service coverage, quality, and safety. For example, organisational innovation and management using discriminatory service provision, fixed price models, and efficient supply and delivery chains, has helped improve production efficiency in India [ 21 ].
In Ethiopia, quality of hospital care was improved through partnership-mentoring models, which provide new approaches for increasing management capacity and improving hospital management systems [ 22 ]. Project Connect, a program based in the University of Alabama is reducing patient no-show rates by taking a community and patient centred approach adapted from lessons in Zambia.
Blood tests were taken during the first visit. A social worker did an interview, trying to identify and address any issues that might prevent patients from coming back. Medical tourism has resulted in the rapid development of major teaching hospitals abroad.
The work of subsidiary organizations like Harvard Medical International and Johns Hopkins International demonstrates strategic, financial, research and marketing-related opportunities in emerging economies like India, China, Pakistan, Malaysia, Chile, Peru, and Mexico [ 24 ]. Several U. Commercial partnerships can provide a channel to inform key service delivery challenges, including the training and retention of workers, maintenance of quality outcomes, and access to health care.
Developing countries are promoting novel approaches to dealing with the global shortage of professionally trained healthcare personnel by scaling-up modified service delivery models and introducing specialized worker education and training. For example, several developing countries are effectively and efficiently training mid-level workers to perform emergency interventions [ 26 — 29 ].
In Mozambique and Bangladesh, this approach has generated novel applications of task shifting that has improved health access [ 30 , 31 ]. In Ghana, pre-hospital trauma training of lay workers, such as commercial drivers, has led to a significant reduction in road traffic deaths [ 32 ].
In Nepal, the facilitation of professional relationships between traditional healers and government health workers is improving health service delivery [ 33 ].
Without doubt, human resource planning and development vary between developed and developing countries. However, as the developed country health workforce diversifies in remote and rural areas, workforce planners may benefit from utilizing developing country models for worker substitution, mobilization, recruitment, and retention. Community health workers CHWs are often underutilized in developed countries and a key challenge remains in institutionalizing and mainstreaming community participation.
Training programs involving CHWs and volunteer networks in countries like India [ 34 ], Peru [ 35 ], Haiti [ 35 ], and Brazil [ 36 ] have shown tremendous success in improving health outcomes for the chronically ill and dying.
These health-care workers are trusted members of society and play an important role in linking formal health systems to rural communities. Lessons from developing country experiences can help expand the knowledge base on community workforce policy, training, and education, as well as help raise the profile of community-based interventions. Over lady health workers have been deployed to date, reaching out to over 90 Million Pakistanis in all districts of the country.
The Programme is widely regarded as one of the best community-based programmes in the world. Developing countries have a rich history of both small and large CHW programmes that can offer a source of learning for developed countries wishing to employ such programmes in both rural communities as well as inner-city neighbourhoods.
Finally, clinical and public health training in developing countries can serve as a critical component of skills development and maintenance for developed-country practitioners who are at risk of losing knowledge due to differing patterns of disease burden [ 38 ]. Partnership reports also describe developing country settings as optimal grounds to build training competencies in the areas of public health policy and administration [ 42 , 43 ].
Some developing country models of patient-centred care give a human face to pathology, priming healthcare workers for expressive relationship-centred care that improves doctor-patient relationships and satisfaction [ 44 ].
Finally, connected health models and hospital-to-hospital links such as teleradiology partnerships illustrate how the use of global staffing models can allow for shift flexibility, sub-speciality consultations, and reduced overhead costs [ 45 ]. Such links also allow opportunities for practitioner learning through continued professional development [ 46 ]. Health information technology IT and connected health programs are increasingly being leveraged to manage chronic illnesses, maintain health and wellness, improve adherence, engagement, and clinical outcomes in developed and developing countries alike.
The rapid expansion of mobile health or mhealth in developing countries has created innovation hubs in countries like Kenya [ 47 ], Uganda [ 47 , 48 ], South Africa [ 47 , 48 ], Rwanda, [ 48 ], and India [ 48 ] where mhealth campaigns show high levels of popularity among physicians, and are transforming rural healthcare through improved data collection, disease surveillance, post-discharge surveillance, health promotion, diagnostic support, disaster response, and remote patient monitoring [ 47 — 49 ].
A Ghana-based network called mPedigree is an excellent example of how local IT innovation can protect the lives of people across continents [ 49 ]. While developed countries are more likely than developing countries to have a national mhealth policy or strategy, developed country organizational culture remains either unaccustomed to, or hesitant of, the advantages of mhealth [ 50 ].
Developing country experiences can promote concerted advocacy efforts on the benefits of mhealth in developed countries, especially for remote patient monitoring, emergency health management, medical adherence, and health education for disadvantaged communities [ 50 ]. Counterfeit pharmaceuticals are being combated through health technology in Africa. The program is built on cloud-based technology, scalable infrastructure expandable to other regions. Such technologies and business models can be scaled up through international cooperation to more effectively battle the global trade in counterfeit medicines, as well as tackle other medication safety issues such as remote support for aging populations.
Despite constraints, developing countries produce efficient and effective substitute health products and treatments [ 3 , 51 — 54 ]. Resource frugality not only compels creativity but also provides the right settings to train employees to adapt, create, appreciate, and utilise health products [ 54 — 57 ]. Indeed, there are numerous cases of famous innovative health products being generated this way. For example, in Ecuador, a simple polymerase chain reaction-based assay was used to diagnose leishmaniasis [ 58 ].
In Bangladesh, homemade spacers became a cost-effective and quality-assured means to help manage asthma in children [ 59 ]. Oral rehydration therapy, a simple treatment developed in Bangladesh to treat diarrhoea using sugar and salt solutions, has now saved millions of lives across the world [ 60 ]. Perhaps equally renowned, Kangaroo Mother Care is another example of how simple interventions can be scientifically sound low-cost alternatives [ 61 ]. One U. This treatment, which involves manipulation and splinting, was found to be more simple and effective than surgery and is now popularly used in the USA and Europe [ 62 ].
Clearly not all developing country innovations can be adaptable to developed country scenarios. However, a shift of thinking through the reverse flow of knowledge can help bridge the large gap between developed and developing country health products to pave the way for future collaboration. In the s, hospitals in Bogota, Colombia, did not have enough incubators to treat premature and low-birth weight infants.
Rey and Martinez developed a conceptually simple and elegant intervention out of this scarcity, which relied on continuous skin-to-skin contact between mother and infant. Known as Kangaroo Mother Care KMC or skin-to-skin care , this intervention quickly became an ideal model for homecare for low-birth-weight infants.
Detailed recommendations for the application of KMC have been issued in both developing and developed countries. Enhanced practice of KMC including continuous skin-to-skin contact is necessary to reap the benefits of the intervention e. Indeed, this innovation provides high quality care in high-income settings based on an intervention generated for low-income health systems.
Countries have a number of financing strategies at their disposal to advance their health systems. That being said, some developing countries have employed innovative financing strategies with a careful choice of well-aligned policy instruments.
Similarly, in Colombia, tax-based insurance schemes target both the rich and poor, working hand-in-hand to provide the basic level of care by increasing coverage and service [ 11 ]. District health planning matched by targeted incremental budgetary increases have led to a substantial decline in infant mortality and improvement in adult health in Tanzania [ 65 ].
It is expected that many developed countries will need to raise additional funds to meet future health demands, particularly due to population aging and the rising costs of new medicines and technologies [ 68 ].
Assessing experiences from low- and middle-income countries is not meant to yield strong conclusions about any one particular financing scheme but can help draw lessons for policy-makers who seek ideas on resource diversification. Born as a social experiment in Bangladesh, the Grameen Bank today serves more than 7 million poor families with loans, savings, insurance and other services.
The bank is owned and operated by its clients and has been a model for microfinance institutions around the world. Health-related services have been packaged with these micro-finance initiatives across the world and can have direct positive impacts. Indeed, poverty alleviation is clearly linked with improving a key wider determinant of health.
While micro-finance is not a panacea for health financing, the principals used and the experiences both positive and negative can inform local approaches to health solidarity.
A growing number of developing country success stories illustrate the progress of global health: polio eradication is closer than ever [ 69 ]; low-cost cataract treatments are restoring sight in India [ 69 , 70 ]; simple salt fluoridation has led to significant prevention of dental caries in Jamaica [ 69 ]; regional initiatives are succeeding in curbing Chagas disease in South America [ 69 ]; oral rehydration therapy has helped reduce infant diarrhoeal deaths worldwide [ 69 ]; tuberculosis prevalence is dramatically decreasing in China [ 69 ]; and prevention of HIV and sexually transmitted infections in Thailand has led to significantly fewer new cases of HIV [ 69 , 71 ].
Interventions like these would not have been possible without political and community vision and leadership [ 71 — 73 ], resourcefulness, and optimism [ 74 ]. Qualitative health-related action research on the Philippines health reform confirms the importance of local solutions to lead the way [ 75 ]. Indeed, for many of these successes, domestic health stewardship allowed effective oversight, performance monitoring, coalition building, system design, and accountability.
Some leadership programs in developing countries are demonstrating links between transparency, governance, and health outcomes by improving health system capabilities. By weaving leadership development into all underlying talent management systems and processes, the State has been able to strengthen leadership and management of public sector employees. This has contributed to improved health system performances over time.
Given that effective leaders and managers lie at the foundation of good governance, identifying key ingredients of successful leadership programmes remains in the interest of developed and developing countries alike. Taking stock of collaborative initiatives to reflect on strengths and weaknesses of such programmes is necessary to seize future opportunities for cross-fertilization of ideas focused on change.
In the s, industrial countries and international agencies such as the World Bank and the International Monetary Fund stressed the need for continued economic growth in order to promote development in Third World countries. The prevailing sentiment was that such growth could be achieved only through "structural adjustment programs" SAPs. IMF and World Bank loans were disbursed only to those developing countries that implemented tough domestic policies whose main thrust was to reduce government expenditure and make the over-all economy more competitive.
These long-term, market-oriented reforms were based on a simple premise: better government was less government. By the late s, studies revealed that adjustment measures were not working; many countries receiving IMF or World Bank assistance had made little or no progress in improving their economic performance. What is more, many of the reforms - such as reducing the size of government, raising interest rates, lowering budget deficits by cutting subsidies, abolishing price controls and curbing wage increases - were resulting in wide-spread unemployment and causing particular hardship among poor people and vulnerable groups dependent on food subsidies and agricultural, educational and welfare services.
Women were especially hard hit. In other words, the people most in need of assistance were being left to fend for themselves, with inevitable results. Structural adjustment programs continue to be implemented, however.
Over the last two years, Canada, for example, has become more directly involved in their initial formulation, and there has been an increased linking of Canada's bilateral aid to SAPs. This policy shift has come under considerable attack from Canada's NGO, church and academic communities, as the social costs of structural adjustment continue to inflict serious damage on the poorer segments of the Third World's population.
The focus on structural adjustment and the need for economic stabilization and growth in the s and early s have left human development in the shadows. While few would deny that SAPs are necessary so that developing countries can build market-oriented economies and learn to balance their budgets, it is becoming increasingly clear that adjustment will not ensure sustainable economic growth if a country's population is illiterate or in poor health.
Most experts now agree that in order to make structural adjustment work while at the same time reducing the severity of some of its side-effects , more effort must be made to target the poorest through support for the social sector, specifically primary health care and basic education.
Within these areas, women, who comprise the majority of the world's poor, must be given special priority. Producing a healthy population is not only an end in itself, but also releases resources that can be used to achieve other development goals. By raising workers' productivity, for example, it yields sustainable economic benefits. Primary health care is for many countries the cheapest and quickest way to improve health standards.
However, most developing countries spend a large proportion of their health budgets on hospitals, while very high infant mortality rates continue. Moreover, when a country is undergoing a severe economic adjustment program, primary health care is often the first social service to be cut.
Along the same lines, education in not only a noble aim in itself and a true measure of quality of life but promotes economic growth and puts other development goals within reach. Primary education, in particular, yields high economic returns, often twice those of higher education.
Moreover, it is an excellent means of channelling resources towards the poor, since a far greater share of the benefits of primary education accrue to those less well off.
Unfortunately, primary education accounts for less than half the total expenditure on education in developing countries. It has been estimated that over million children worldwide receive no primary education, while a further million receive no education beyond the age of International aid constitutes a high proportion of many Third World countries' development budgets, and for this reason, it should be carefully directed.
Clearly, the industrial states can offer tremendous help to the poor in developing countries by directing their aid towards the social sectors, in particular primary health care and education.
Unfortunately, the record up to now has not been impressive. According to the North-South Institute, Canada's record in this area follows the international trend. Most donor countries prefer to pour money into capital intensive schemes that happen to require machinery and technical assistance from the same donor countries. Unemployment of trained personnel and a national civil service demoralised by low salary levels often exist side by side with large numbers of foreign, high-priced experts and consultants.
The Human Development Report argues that the time has come to change this trend. This would not only reduce the cost of assistance, it would also release millions of dollars that could be put to more productive purposes.
Donors could also enhance human development in the Third World by offering new conditions for cooperation - for example, by specifying that human development programs should be the last, not the first, to be reduced in an adjustment period or by making it clear that external assistance would be reduced if a country's military expenditure exceeded its social expenditure. Finally, aid channelled into the social sector might also serve as an incentive to reluctant finance ministers to devote a larger share of domestic resources to social spending, as Third World governments often need to be encouraged to set up food and health subsidies that transfer income and other economic opportunities to the very poor.
The erection of such safety nets would cost only a small fraction of GNP and would prevent more costly political and social disturbances later. No aid strategy aimed at human development in the Third World can neglect the environment, for there is ultimately a fundamental link between a healthy environment and a healthy society and economy. It is no coincidence that the vast majority of the world's poor live in the most ecologically vulnerable areas of Latin America, Asia and Africa.
In these societies, there is no choice between rapid economic growth and environmental protection. Indeed, growth is not an option but an absolute necessity. Many choices that degrade the environment are made not because of lack of concern for the future, but because of the imperative for immediate survival. As the Human Development Report explains, "it is not the quality of life that is at risk - it is life itself. The countries of the North and South define environmentally sustainable development in different ways.
The industrial states focus on such "global change issues" as the depletion of the ozone layer and global warming; the Third World, on the other hand, is more concerned with localized issues such as soil degradation and polluted water. Clean water and safe sanitation, along with adequate food, are the foundations of human development. But the demands of poverty often clash with the environment, and vice versa. The poor, for example, overuse their marginal lands for fuel wood and for subsistence and cash-crop production.
This endangers their physical environment, which in turn reinforces their poverty and threatens the health and the lives of their children. It is a vicious cycle.
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