20 things we learned this year — that could be signals of what comes next

Predicting the future may be best left to seers and magicians, but what we can do is apply what we know now to the year ahead as they change the way we will work. We’re pleased to share our future gazing with you in the hope that there might be something simple in here that can help anyone in our sector.

When we launched COVIDaction, we asked the question: How can we build a technology and innovation pipeline to help the response to the pandemic? This was back in March (can you believe it was only March?). We started our work with a search for frugal innovation around ventilators and from this emerged three themes — Local Production & Local Solutions — to address the need for shorter supply chains and innovation at ground roots, Data — to explore the the best data tools to inform decision making, and Resilient Health Systems — to explore the role of technology and innovation in supporting countries to build resilient health systems as they respond to the COVID-19 crisis.

In December we launched a new theme — The Oxygen CoLab — to map oxygen supplies, spot bottlenecks and explore the creation of oxygen concentrators to ease the supply in low and middle income countries.

As you can imagine, work has been fast and curious. We have made connections, seen patterns emerge and worked in flexible ways to continue questioning and searching for answers. Here are the signals we’ve picked up this year that help us imagine the future.

Local Production & Solutions

1.Flexibility is the key to resilient production. Processes that calcify a venture or system’s ability to shift its behaviour in response to new problems or opportunities reduce its ability to survive in a dynamic environment. Flexibility can be achieved in two ways though — internally, with production capacity that is adaptable, or through collaborative manufacturing with other producers.

2. COVID-19 could be the driving force to address humanity’s bigger challenges. The pandemic has been catastrophic, but it pales in comparison to the climate crisis and global inequality. Humanity’s response is bringing us chances to make big strides towards greener manufacturing and democratised marketplaces. We need to keep our eyes on the prize though.

3. Localised value chains can be more resilient, more environmentally friendly, and serve consumers better. They are not at the whim of untrustworthy global supply chains and profit can build local capacity and additional services rather than go straight back to the top of a pyramid. Building locally means the ability to listen and adapt to what resident consumers actually want, rather than decide for them.

4. Waste is the worst thing humans have ever invented. We need to strike it from our memories. Innovators have woken up to the value in the resources left over from other production processes and found ways to incorporate them into other products. Systems to identify and nurture this resource use are always beneficial.

5. Local context and knowledge is crucial. Before you can try to solve local problems you need to forget what you know before you ‘arrive’. Many of the innovations we have found are being enforced and championed by a single person. Once we engage with these social entrepreneurs, we find that they have an intimate and detailed knowledge of local contexts, cultures and issues. It is this ‘on the ground’ connection and passion that drives the changing force and is part of the reason we have shown interest in their value.

Resilient Health Systems

6. Innovators learn by doing. It sounds simple, but these are the people who go out there and just see if it works. In our sector, people like to write and read papers — they prefer to take it slow. Innovators are folks who have the mindset that they will give it a shot and adapt as they go. Our RHS grantees are piloting telemedicine, mHealth, and data innovations and tweaking nimbly as they scale to ensure that their work is successful.

7. Health systems are complex…and so are their users. Mixed health systems solutions only work if the community trusts the system. That means they need to meet users where they are. When integrated into health systems, technologies that are focused on end users — innovations such as Wheels for Life and Pensa — can help to reach underserved communities and build confidence in the wider health system. Others, such as the Vaccine Confidence Project, help system stakeholders use data to identify issues with confidence and trust, and take action to improve.

8. Necessity remains the mother of invention. COVID-19 has been an action-forcing mechanism for health systems strengthening. While the pandemic has revealed significant challenges with essential service delivery during a crisis, innovators can help systems to adapt. A great example of this is the ability to shift the locus of care from facilities to homes and communities through telehealth innovations such as Digital Hospital (formerly TONIC) and mDoc. Adaptation is a hallmark of resilience: changes today will outlive the virus, and help us to better respond to the next shock.

9. Learning requires trust. Innovation teams and their coaches work best when mutual trust enables a learning environment where it is safe to fail. In response to our resilient health systems challenge, we’ve spotted different organisations coming together to form new consortia with even stronger applications. Our nine grantees know of each other already and so there is a foundation of credibility and trust on which they can build a peer learning network.

10. Teamwork is hard, but necessary. Our consortium partners are so different, but we need each team’s super powers to achieve the ambitious goals we set. RHS engaged a minimum of 300 expert hours (and likely much longer) into the first two evaluation rounds with 36 health and innovation expert reviewers and 11 FCDO regional expert reviewers committed to the task. It really does take a village!

Data

11. Data use is crucial. It means meeting people where they are and embedding data tools into existing workflows and processes. Working with GPSDD, the Data Challenge team is bringing data tools to decision makers working on a response to COVID-19. This includes overlap with other data tools and platforms funded by FCDO, like the GRID3 data hubs in countries like Nigeria and Sierra Leone.

12. Communicating complex tools takes time. Gaining buy-in for the use of new technology takes time. It’s why we prioritised mature offerings with an existing user base and built-in capacity. Even with these advantages, getting users to adopt new tools is hard. As an example, one of our grantees, OpenFN, has been working with a Ministry of Health to address a data interoperability problem for the past 6 months.

13. Data tools can pivot, fast. Our grantees have bolted on new COVID-19 data tools to existing platforms and gone to scale, fast! BAO Systems, for example, debuted a COVID-19 Surveillance Package in countries around the world, and has been evaluated as a leading digital solution for COVID-19 response by Johns Hopkins University, the CDC, and Digital Square.

14. Responsible data is crucial for digital tool use. In emergency contexts it’s often tempting to play fast and loose with responsible data considerations, things like privacy and security can take a back seat to response in the moment. That’s why COVIDaction is investing in programmes which help actors quickly address these concerns (to make it easier to do the right thing) and in grassroots initiatives that are pushing for improved data use.

15. Show don’t tell. Good data visualisation is key to uptake and use of digital tools. Data by itself doesn’t drive change, it needs to be structured and presented in a way that can drive data use (see point 1, above!). Grantees like Surgo Ventures (Foundation) have delivered tools that do just this, providing a platform for end users to better understand and apply data tools for their specific context.

The Oxygen CoLab

16. Systemic problems call for systemic solutions. To change the perspective across every node in a system is like aligning the stars in favour of a new constellation. It all kicks off when you find the stars that move most readily in the new direction. The Oxygen CoLab set out to solve a big market challenge and the CoLab participants most motivated to solve this challenge fuel everything we do.

17. To involve one agent of change is to go fast, but to go far we must go together. COVIDaction quickly recognised that we’d get nowhere worthwhile alone, working with partners makes it possible to cover every piece of a complex puzzle.

18. Innovation seems non-linear and yet incremental, it needs new ideas, which are often sparked by making useful connections. Designing the working practices to support oxygen concentrator innovation follows a similar path. Being a new initiative every collaborative interaction helps inform what we do in an incremental, non-linear way.

19. Starting a CoLab means motivating others to join us. Being clear, simple, and curious first, makes the work we’re planning accessible. Being clever comes last. Joining in should be easy and enjoyable, we don’t want others to think too hard, they probably have enough on their plates already.

20. Some problems seem like different pieces of a puzzle, to solve them you need a networked learning approach. The Oxygen CoLab seeks to stay in tune with one another’s work to spark useful connections amongst an active innovation space.

That’s a wrap! We hope that you have enjoyed our learnings and signals of possible futures, they will evolve and guide us through the future and maybe they can do the same for you.

We’ll keep on learning as our work continues and sharing the work that we do with amazing innovators in low and middle income countries around the world.

Thank you for following our journey this year and we wish you a great start to 2021! 🥳

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