Social innovation for the promotion of health equity

Role of social innovations in health in the prevention and control of infectious diseases: a scoping review

BACKGROUND

The implementation of social innovations for addressing societal challenges, particularly in health, leverages community participation and technology to optimally meet social needs compared to traditional approaches. A key feature of these innovations is their ability to utilize existing capacities for contributing to resolving infectious disease outbreaks, which has attracted significant attention from health organizations. Given the potential of these innovations, this study has investigated social innovations in the prevention and control of infectious diseases as one of the major global challenges in the form of a comprehensive literature review.

METHODS

This review study examined the relevant literature from January 1, 2010 to December 31, 2022. Based on inclusion and exclusion criteria, 50 documents were retained and fully examined. The documents were analyzed by applying a thematic analysis, and important content related to the application of social innovations for the prevention and control of pandemic infectious diseases was extracted using a data collection form.

RESULTS

Five major themes concerning social innovation in the prevention and control of epidemic diseases were discerned as follows: new products, novel processes and policies, empowerment, innovative practices and behaviors, and community engagement. New products include technological products for control and management of epidemics, preventive products, diagnostic and therapeutic products. Novel processes and policies are related to reorienting and reorganizing care methods, control and monitoring policies, participatory and creative strategies. Empowerment is focused on enhancing the capabilities of health workers, community leaders, and communities. Innovative practices and behaviors involve technology-based participation and support mechanisms. Community engagement is related to awareness, consultation, community mobilization, and participation in production and support.

CONCLUSIONS

During the outbreak of infectious diseases, governments are faced with many challenges, including health, economic and social challenges. To answer these challenges, tools should be used that have the ability to answer the problem from several aspects. Social innovation as an appropriate process in response to health crises has led to new forms of relationships and empowered the communities. And to promote public health, it provides the opportunity for all members of the society to participate in crisis resolution and optimal use of resources.

Challenges in Promoting Health Equity and Reducing Disparities in Access Across New and Established Technologies

Medical innovations and novel technologies stand to improve the return on high levels of health spending in developed countries, particularly in cardiovascular care. However, cardiac innovations also disrupt the landscape of accessing care, potentially creating disparities in who has access to novel and extant technologies. These disparities might disproportionately harm vulnerable groups, including those whose nonmedical conditions-including social determinants of health-inhibit timely access to diagnoses, referrals, and interventions. We first document the barriers to access novel and existing technologies in isolation, then proceed to document their interaction. Novel cardiac technologies might affect existing available services, and change the landscape of care for vulnerable patient groups who seek access to cardiology services. There is a clear need to identify and heed lessons learned from the dissemination of past innovations in the development, funding, and dissemination of future medical technologies to promote equitable access to cardiovascular care. We conclude by highlighting and synthesizing several policy implications from recent literature.

The ties that bind: innovation configurations in low- and middle-income healthcare delivery settings

PURPOSE

This study examines innovation configurations (i.e. sets of product/service, social and business model innovations) and configuration linkages (i.e. factors that help to combine innovations) across six organizations as contingent upon organizational structure.

DESIGN/METHODOLOGY/APPROACH

Using semi-structured interviews and available public information, qualitative data were collected and examined using content analysis to characterize innovation configurations and linkages in three local/private organizations and three foreign-led/public-private partnerships in Repiblik Ayiti (Haiti).

FINDINGS

Organizations tend to combine product/service, social, and business model innovations simultaneously in locally founded private organizations and sequentially in foreign-based public-private partnerships. Linkages for simultaneous combination include limited external support, determined autonomy and shifting from a "beneficiary mindset," and financial need identification. Sequential combination linkages include social need identification, community connections and flexibility.

RESEARCH LIMITATIONS/IMPLICATIONS

The generalizability of our findings for this qualitative study is subject to additional quantitative studies to empirically test the suggested factors and to examine other health care organizations and countries.

PRACTICAL IMPLICATIONS

Locally led private organizations in low- and middle-income settings may benefit from considering how their innovations are in service to one another as they may have limited resources. Foreign based public-private partnerships may benefit from pacing their efforts alongside a broader set of stakeholders and ecosystem partners.

ORIGINALITY/VALUE

This study is the first, to our knowledge, to examine how organizations combine sets of innovations, i.e. innovation configurations, in a healthcare setting and the first of any setting to examine innovation configuration linkages.

Social innovation in health training to engage researchers in resource-limited settings: process description and evaluation

Research on social innovations in health has increased in recent years. However, little training is geared toward enhancing social innovation research capacity. Most health training for low- and middle-income countries (LMICs) is developed by individuals in high-income countries, disregarding LMIC researchers' wisdom and insights and the communities' needs. Our team organized a multi-phase investigation involving a series of surveys and co-creation group discussions to assess individuals' training needs that directly informed a subsequent co-created training workshop series. We conducted a Hennessy-Hicks Training Needs Assessment among the Social Innovation in Health Initiative (SIHI) network and formed a co-creation group comprising SIHI fellows to design related training workshops. We ran a final evaluation survey and analyzed the workshop series' strengths, weaknesses and threats. Descriptive and thematic analysis were employed to analyze survey data and open-ended responses. The final evaluation survey captured data from 165 learners in 35 countries, including 26 LMICs. Most participants (67.3%, 111/165) rated the training workshop series as excellent, and 30.3% (50/165) rated it as good on a five-point scale. The need for writing research grants and manuscripts was rated the highest priority. Learners were interested in community-engaged research and diversity, equity and inclusion. This workshop illustrated how co-creation could be an effective tool for developing training materials tailored for LMIC researchers. We also offer a template for conducting a needs assessment and subsequent training workshops for LMICs. The ground-up, locally developed courses may be more effective than externally developed training programs intended for LMICs.

Public health and social entrepreneurs as activators of equitable health ecosystems

OBJECTIVES

To describe approaches that public health and social entrepreneurs take to address health equity, and identify strategies for equitable collaborations with these entrepreneurs.

METHODS

We leveraged data from semi-structured interviews, conducted August to October 2022, with 20 public health and social entrepreneurs who focus on drivers of health and health equity. Two researchers employed content analysis, guided by a prior framework.

RESULTS

To support health equity, public health and social entrepreneurs: center equity, critique biases, innovate for inclusion, engage translational expertise, catalyze capacity, and activate equitable systems. Equitable collaborations are supported by re-examining roles, de-conflicting organizational barriers, prioritizing representation, mitigating bias in generating evidence, and employing equitable capital.

CONCLUSIONS

Public health and social entrepreneurs can uplift equity across health service design and delivery. More equitable collaborations can advance this work.

Commercial determinants of health: future directions

This paper is about the future role of the commercial sector in global health and health equity. The discussion is not about the overthrow of capitalism nor a full-throated embrace of corporate partnerships. No single solution can eradicate the harms from the commercial determinants of health-the business models, practices, and products of market actors that damage health equity and human and planetary health and wellbeing. But evidence shows that progressive economic models, international frameworks, government regulation, compliance mechanisms for commercial entities, regenerative business types and models that incorporate health, social, and environmental goals, and strategic civil society mobilisation together offer possibilities of systemic, transformative change, reduce those harms arising from commercial forces, and foster human and planetary wellbeing. In our view, the most basic public health question is not whether the world has the resources or will to take such actions, but whether humanity can survive if society fails to make this effort.

How local stakeholders' social representations shape the future of ageing in place: Insights from 'health and care social innovations' in Wallonia (Belgium)

This research attempts to study the social representations underlying health and care social innovations (HCSI) implemented in Wallonia, Belgium to shift ageing policies and management towards the ageing in place paradigm. A panel of 34 experts was interviewed to understand their representations using a Delphi-based methodology. The data were processed using thematic content analysis. The core of social representations of health and care social innovations was related to five key dimensions: D1, responding to unmet or emerging health and care needs; D2, defining (new) targets and beneficiaries of HCSI; D3, disrupting care practices; D4, mobilising a network of key actors; and D5, encouraging political recognition of HCSI to favour its viability and sustainability. Local stakeholders' social representations tended to recognise only the goal-oriented dimensions in innovations and ignore process-oriented aspects. The blind spots for workers' participation and empowerment may jeopardise their working conditions, causing a cascade effect on the quality of services and the care relationship. This affected how health and care organisations responded to innovation and might also compromise the long-term sustainability of ageing in place practices in Wallonia.

Description of global innovative methods in developing the WHO Community Engagement Package

OBJECTIVES

Development of a Community Engagement Package composed of (1) database of community engagement (CE) experiences from different contexts, (2) CE learning package of lessons and tools presented as online modules, and (3) CE workshop package for identifying CE experiences to enrich the CE database and ensure regular update of learning resources. The package aims to guide practitioners to promote local action and enhance skills for CE.

SETTING AND PARTICIPANTS

The packages were co-created with diverse teams from WHO, Social Innovation in Health Initiative, UNICEF, community practitioners, and other partners providing synergistic contributions and bridging existing silos.

METHODS

The design process of the package was anchored on CE principles. Literature search was performed using standardised search terms through global and regional databases. Interviews with CE practitioners were also conducted.

RESULTS

A total of 356 cases were found to fit the inclusion criteria and proceeded to data extraction and thematic analysis. Themes were organised according to rationale, key points and insights, facilitators of CE and barriers to CE. Principles and standards of CE in various contexts served as a foundation for the CE learning package. The package comprises four modules organised by major themes such as mobilising communities, strengthening health systems, CE in health emergencies and CE as a driver for health equity.

CONCLUSION

After pilot implementation, tools and resources were made available for training and continuous collection of novel CE lessons and experiences from diverse socio-geographical contexts.

Searching for Sustainability in Health Systems: Toward a Multidisciplinary Evaluation of Mobile Health Innovations

Mobile health (mHealth) innovations are considered by governments as game changers toward more sustainable health systems. The existing literature focuses on the clinical aspects of mHealth but lacks an integrated framework on its sustainability. The foundational idea for this paper is to include disciplinary complementarities into a multi-dimensional vision to evaluate the non-clinical aspects of mHealth innovations. We performed a targeted literature review to find how the sustainability of mHealth innovations was appraised in each discipline. We found that each discipline considers a different outcome of interest and adopts different time horizons and perspectives for the evaluation. This article reflects on how the sustainability of mHealth innovation can be assessed at both the level of the device itself as well as the level of the health system. We identify some of the challenges ahead of researchers working on mobile health innovations in contributing to shaping a more sustainable health system.

The gender responsiveness of social entrepreneurship in health - A review of initiatives by Ashoka fellows

There are vocal calls to act on the gender-related barriers and inequities in global health. Still, there are gaps in implementing programmes that address and counter the relevant dynamics. As an approach that focuses on social problems and public service delivery gaps, social entrepreneurship has the potential to be a closer health sector partner to tackle and transform the influence of gender in health to achieve health systems goals better. Nevertheless, social entrepreneurs' engagement and impact on gender and health remain understudied. Using the Ashoka Fellows database as a sampling frame in November 2020 (n = 3352, health n = 129), we identified and reviewed the work of 21 organizations that implemented gender-responsive health-related programmes between 2000 and 2020. We applied the UNU-IIGH 6-I Analytic Framework to review the gender issues, interventions, included populations, investments, implementation, and impact in each organization. We found that a low proportion of fellows engage in gender-responsive health programming (<1%). Many organizations operate in low-and middle-income countries (16/21). The gender-responsive programmes include established health sector practices, to address gendered-cultural dynamics and deliver people-centred resources and services. Interestingly, most organizations self-identify as NGOs and rely on traditional grant funding. Fewer organizations (6/21) adopt market-based and income-generating solutions - a missed opportunity to actualise the potential of social entrepreneurship as an innovative health financing approach. There were few publicly available impact evaluations-a gap in practice established in social entrepreneurship. All organizations implemented programmes at community levels, with some cross-sectoral, structural, and policy-level initiatives. Most focused on sexual and reproductive health and gender-based violence for predominantly populations of women and girls. Closer partnerships between social entrepreneurs and gender experts in the health sector can provide reciprocally beneficial solutions for cross-sectorally and community designed innovations, health financing, evidence generation and impact tracking that improve the gender-responsiveness of health programmes, policies, and systems.

The health and well-being impacts of a work integration social enterprise from a systems perspective

Recent research has drawn upon the social determinants of health (SDH) framework to attempt to systematize the relationship between social enterprise and health. In this article, we adopt a realist evaluation approach to conceptualize social enterprises, and work integration social enterprises in particular, as 'complex interventions' that necessarily produce differential health outcomes for their beneficiaries, communities and staff. Drawing upon the findings from four social enterprises involving a range of methods including 93 semi-structured interviews with employees, managers and enterprise partners, together with participant observation, we demonstrate that these health outcomes are influenced by a limitless mix of complex and dynamic interactions between systems, settings, spaces, relationships and organizational and personal factors that cannot be distilled by questions of causality and attribution found in controlled trial designs. Given the increased policy focus on the potential of social enterprises to affect the SDH, this article seeks to respond to evidence gaps about the mechanisms and contexts through which social enterprises promote or constrain health outcomes, and thereby provide greater clarity about how research evidence can be used to support the social enterprise sector and policy development more broadly.

Why is repositioning public health innovation towards a social paradigm necessary? A reflection on the field of public health through the examples of Ebola and Covid-19

Health innovations are generally oriented on a techno-economic vision. In this perspective, technologies are seen as an end in themselves, and there is no arrangement between the technical and the social values of innovation. This vision prevails in sanitary crises, in which management is carried out based on the search for punctual, reactive, and technical solutions to remedy a specific problem without a systemic/holistic, sustainable, or proactive approach. This paper attempts to contribute to the literature on the epistemological orientation of innovations in the field of public health. Taking the Covid-19 and Ebola crises as examples, the primary objective is to show how innovation in health is oriented towards a techno-economic paradigm. Second, we propose a repositioning of public health innovation towards a social paradigm that will put more emphasis on the interaction between social and health dimensions in the perspective of social change. We will conclude by highlighting the roles that public health could play in allowing innovations to have more social value, especially during sanitary crises.

Social innovation for life expectancy extension utilizing a platform-centered system used in the Iwaki health promotion project: A protocol paper

Introduction:

We are trying to create a platform for social innovation to extend life span.

Methods:

Since 2005, health data (approximately 3000 items per person as of 2020) of approximately 1000 adults have been collected each year during the Iwaki Health Promotion Project. The industry, government, academia, and citizens have involvements in data collection, aiming to build a platform that encourages societal innovation and subsequently extends life expectancy in Aomori. The Iwaki Health Promotion Project has been supported financially by the Japanese government since it was selected as the Center of Innovation program in 2013.

Results:

Since the numbers of academia, industries, governments, and citizens involved in the Iwaki Health Promotion Project increased over the years, the big data produced during the project has become increasingly pluripotent and adaptable. It has been used to promote public health, which has also created a stronger partnership among companies and research organizations. Consequently, the amount of data collected from the project has gained attention and became more open to companies and researchers participating in the Iwaki Health Promotion Project, resulted in establishing a larger platform. It also led to the acquisition of external funding, publications of numerous research papers, creation of new health examinations, and the establishment of the Health Promotion Center (an institution for cultivating health volunteers).

Conclusion:

The Iwaki Health Promotion Project aims not only to produce a pluripotent big data but also to improve the average life expectancy of Aomori by creating a large platform in the society. Its positive impact in the future is infinite and will keep growing as long as it is maintained by the society.

The application of social innovation in healthcare: a scoping review

BACKGROUND

Social innovation has been applied increasingly to achieve social goals, including improved healthcare delivery, despite a lack of conceptual clarity and consensus on its definition. Beyond its tangible artefacts to address societal and structural needs, social innovation can best be understood as innovation in social relations, in power dynamics and in governance transformations, and may include institutional and systems transformations.

METHODS

A scoping review was conducted of empirical studies published in the past 10 years, to identify how social innovation in healthcare has been applied, the enablers and barriers affecting its operation, and gaps in the current literature. A number of disciplinary databases were searched between April and June 2020, including Academic Source Complete, CIHAHL, Business Source Complete Psych INFO, PubMed and Global Health. A 10-year publication time frame was selected and articles limited to English text. Studies for final inclusion was based on a pre-defined criteria.

RESULTS

Of the 27 studies included in this review, the majority adopted a case research methodology. Half of these were from authors outside the health sector working in high-income countries (HIC). Social innovation was seen to provide creative solutions to address barriers associated with access and cost of care in both low- and middle-income countries and HIC settings in a variety of disease focus areas. Compared to studies in other disciplines, health researchers applied social innovation mainly from an instrumental and technocratic standpoint to foster greater patient and beneficiary participation in health programmes. No empirical evidence was presented on whether this process leads to empowerment, and social innovation was not presented as transformative. The studies provided practical insights on how implementing social innovation in health systems and practice can be enhanced.

CONCLUSIONS

Based on theoretical literature, social innovation has the potential to mobilise institutional and systems change, yet research in health has not yet fully explored this dimension. Thus far, social innovation has been applied to extend population and financial coverage, principles inherent in universal health coverage and central to SDG 3.8. However, limitations exist in conceptualising social innovation and applying its theoretical and multidisciplinary underpinnings in health research.

Bridging the health inequality gap: an examination of South Africa's social innovation in health landscape

Background

Despite the end of apartheid in the early 1990s, South Africa remains racially and economically segregated. The country is beset by persistent social inequality, poverty, unemployment, a heavy burden of disease and the inequitable quality of healthcare service provision. The South African health system is currently engaged in the complex project of establishing universal health coverage that ensures the system’s ability to deliver comprehensive care that is accessible, affordable and acceptable to patients and families, while acknowledging the significant pressures to which the system is subject. Within this framework, the Bertha Centre for Social Innovation & Entrepreneurship works to pursue social impact towards social justice in Africa with a systems lens on social innovation within innovative finance, health, education and youth development. The aim of this study is to demonstrate the capacity for social innovation in health with respect for South Africa, and to highlight some current innovations that respond to issues of health equity such as accessibility, affordability, and acceptability.

Methods

Different data types were collected to gain a rich understanding of the current context of social innovation in health within South Africa, supported by mini-case studies and examples from across the African continent, including: primary interviews, literature reviews, and organisational documentation reviews. Key stakeholders were identified, to provide the authors with an understanding of the context in which the innovations have been developed and implemented as well as the enablers and constraints. Stakeholders includes senior level managers, frontline health workers, Ministry of Health officials, and beneficiaries. A descriptive analysis strategy was adopted.

Results

South Africa’s health care system may be viewed, to a large extent, as a reflection of the issues facing other Southern African countries with a similar disease burden, lack of systemic infrastructure and cohesiveness, and societal inequalities. The evolving health landscape in South Africa and the reforms being undertaken to prepare for a National Healthcare Insurance presents the opportunity to understand effective models of care provision as developed in other African contexts, and to translate these models as appropriate to the South African environment.

Conclusions

After examining the cases of heath innovation, it is clear that no one actor, no matter how innovative, can change the system alone. The interaction and collaboration between the government and non-state actors is critical for an integrated and effective delivery system for both health and social care.

Marketing in social innovations targeted at healthcare

The paper deals with the implementation of marketing in social innovations, types of marketing, and the effects they can bring in the sphere of social innovations. The principalaim of the paper is to explain the possibilities of marketing approach implementation in social innovations and point out some specific areas of marketing which can contribute to more efficient applicability of social innovations and reaching a desirable change with social added value. The authors focused on the sphere of health and the population attitudes to its protection, emphasizing breast carcinoma prevention. The research was implemented on a sample of Slovak women to identify the level of women’s awareness of this issue, whether they are familiar with the methods of protecting their health and whether they use them. This study involved the methods of cluster analysis and binary logistic regression. The research uncovered the facts that are truly alarming from the perspective of societal benefit and women’s health protection. The respondents’ insufficient awareness and low activity in the field of their health protection result in the low level of prevention in this area on the side of women and on the side of medical doctors – specialists, particularly gynecologists. Such a situation includes the women’s insufficient awareness of prevention, low motivation, insufficient accessibility and validity of the needed data and precision, and doctor specialists’ lack of awareness of the possibilities and tools available to improve this area. That is exactly the space allowing for the use of marketing in a whole spectrum of its tools and processes and specific solutions capable of delivering the desired societal change and influencing women’s behavior in the preferred direction. Besides, it is especially effective to implement social marketing and social marketing programs that would mediate necessary information to the receivers and stimulate their motivation towards the desired approach to their health protection. The use of neuromarketing would be beneficial. It would be reflected in the better accuracy of the survey and thus the higher quality of the answers obtained. Based on them, it is subsequently possible to create better-targeted campaigns and strategies of social marketing that would approach the target audience more effectively than in acquiring the information via traditional marketing research methods. The findings would benefit marketing agencies, medical doctors (gynecologists, mammologists), and non-profit organizations actively working in this field.

Value co-creation through social innovation in healthcare: a case of WE CARE Solar

Purpose

Maternal mortality is an acute problem for many countries around the world, particularly those at the bottom of the pyramid (BoP). Most remote locations in these underdeveloped nations, for instance, in Africa, have to cope with the problem of interrupted electricity supply making healthcare practitioners often experience a helpless compulsion to compromise in providing quality medical attention, especially during childbirth. Along with many public, private and nongovernment initiatives, WE CARE Solar (hereafter WCS) – a social innovation venture comes with an idea of developing portable solar suitcases to respond to this intransigent problem.

Design/methodology/approach

This paper introduces a social enterprise that established its operation in Africa and so far has served in more than 30 similarly impoverished economies. Data was collected, analyzed using documentary research method. The authors have also collected and correlated the statements from the founder of WCS to complement the authors’ findings. With this paper, the authors intend to establish the type of innovation tools that are needed to provide value with a social innovation initiative in the health sector in the least developed country perspective. To facilitate better social outcomes and to ensure greater good, innovation requires to be accompanied by stakeholders’ involvement.

Findings

The findings indicate that WE CARE Solar has a positive social contribution toward ensuring safe motherhood and childbirth in underdeveloped countries by providing access to reliable solar power sources. The six-step social innovation process can be adopted by other social ventures to propose innovative solutions to social needs. Analyzing WCS's service delivery from the perspective of the 4As framework and value co-creation model, it is suggested that sustainable social change can be established with value co-creation through community engagement with multiple stakeholders.

Research limitations/implications

This research was solely focused on one organization alone. Future research could look into the model to ascertain its acceptability in similar social innovation in healthcare initiatives.

Originality/value

This paper attempts to address a gap in social innovation in healthcare and its adaptability using the 4As framework with the value co-creation model. The authors propose this model from the data accumulated throughout the research, which could also serve to assist organizations looking for scalable and sustainable change.

Fostering social innovation and building adaptive capacity for dengue control in Cambodia: a case study

Background

The social-ecological systems theory, with its unique conception of resilience (social-ecological systems & resilience, SESR), provides an operational framework that currently best meets the need for integration and adaptive governance as encouraged by the Sustainable Development Goals. SESR accounts for the complex dynamics of social-ecological systems and operationalizes transdisciplinarity by focusing on community engagement, value co-creation, decentralized leadership and social innovation. Targeting Social Innovation (SI) in the context of implementation research for vector-borne diseases (VBD) control offers a low-cost strategy to contribute to lasting and contextualized community engagement in disease control and health development in low and middle income countries of the global south. In this article we describe the processes of community engagement and transdisciplinary collaboration underpinning community-based dengue management in rural primary schools and households in two districts in Cambodia.

Methods

Multiple student-led and community-based interventions have been implemented focusing on empowering education, communication for behavioral change and participatory epidemiology mapping in order to engage Cambodian communities in dengue control. We describe in particular the significance of the participatory processes that have contributed to the design of SI products that emerged following iterative consultations with community stakeholders to address the dengue problem.

Results

The SI products that emerged following our interaction with community members are 1) adult mosquito traps made locally from solid waste collections, 2) revised dengue curriculum with hands-on activities for transformative learning, 3) guppy distribution systems led by community members, 4) co-design of dengue prevention communication material by students and community members, 5) community mapping.

Conclusions

The initiative described in this article put in motion processes of community engagement towards creating ownership of dengue control interventions tools by community stakeholders, including school children. While the project is ongoing, the project’s interventions so far implemented have contributed to the emergence of culturally relevant SI products and provided initial clues regarding 1) the conditions allowing SI to emerge, 2) specific mechanisms by which it happens and 3) how external parties can facilitate SI emergence. Overall there seems to be a strong argument to be made in supporting SI as a desirable outcome of project implementation towards building adaptive capacity and resilience and to use the protocol supporting this project implementation as an operational guiding document for other VBD adaptive management in the region.

Social innovation for health: engaging communities to address infectious diseases

Universal health coverage emphasises the value of the community-based delivery of health services to ensure that underserved populations have access to care. In areas where infectious diseases are endemic, there are often few resources and limited capacity, and the introduction of effective and accessible strategies require innovation. In this special issue, the contributing authors emphasise the power of local responses to the circumstances that underpin diseases of poverty, and highlight the methodological and programme innovations necessary to support and sustain these responses. Through case studies, the authors illustrate how social innovations can address health inequities, and they identify the role of academics in the Social Innovation in Health Initiative to support this approach.

Documentary research on social innovation in health in Latin America

BACKGROUND

Identifying social innovation in health initiatives, promoting quality of life through them, and transforming current health conditions demand the knowledge, comprehension and appropriation of the theoretical and methodological developments of this concept. Academic developments in social innovation have mainly occurred in and been documented for English-speaking countries, although relevant experiences have been implemented in Latin America. In this article, we describe and analyze how social innovation in health is being approached and understood in this region.

MAIN TEXT

To identify the theoretical and methodological developments of social innovation in health between 2013 and 2018, a scoping review with a mixed approach was carried out. Eighty texts in English, Spanish and Portuguese were selected for a process of reflexive analysis of intra and intertextual reading. The approaches identified in the studied initiatives were complementary. The most applied approaches were innovation in health, technological innovation in health and social innovation, each with twelve publications, and social innovation in health and ecohealth with ten and seven publications respectively. The approaches showed a general interest in reaching the goals of the Sustainable Development Goals (SDGs), the Alma Ata Declaration and the Ottawa Letter.

CONCLUSIONS

The social innovation in health approach in Latin America adopts educational strategies, identifies risk factors, optimizes resources, promotes interculturality, participation, community empowerment, and enhances intersectorality and interdisciplinarity. As an approach, process, program or solution, social innovation in health is a conceptual category under construction. This research provides a baseline for other systematic reviews on the subject.

Using micro-geography to understand the realisation of wellbeing: A qualitative GIS study of three social enterprises

Social enterprises are promoted as a method of welfare reform, to transition people out of disadvantage by addressing poverty, unfulfilled capabilities and social exclusion. This study explores how three Work Integration Social Enterprises (WISEs) in Australia help to realise wellbeing for their employees by mapping their micro-geographical experience of wellbeing. By mapping the sites within a social enterprise where wellbeing is realised, we provide a practical, empirical and replicable methodology that is useful for gaining insights into where and how wellbeing realisation occurs. This situates wellbeing as an upstream place-based resource likely to influence downstream health outcomes.

The impact of social enterprise on food insecurity - An Australian case study

Like many high-income countries, in Australia there are a range of programmes in place, from social security to food banks, to help address food insecurity. So far, they have been unable to adequately alleviate and prevent this growing nutrition challenge. This paper presents an evaluation of a new type of intervention in the food security landscape, the social enterprise. The Community Grocer is a social enterprise that operates weekly fresh fruit and vegetable markets in Melbourne, Australia. The aim of the study was to examine the market's ability to increase access, use and availability of nutritious food in a socially acceptable way, for low socioeconomic status urban-dwelling individuals. The mixed-method evaluation included: comparative price audits (n = 27) at local (<1 km) stores; analysis of operational data from sample markets (n = 3); customer surveys (n = 91) and customer interviews (n = 12), collected in two phases (Autumn 2017, Summer 2018). The results found common (n = 10) fruit and vegetables cost, on average, approximately 40% less at the social enterprise, than local stores. Over twenty per cent of customers were food insecure and 80% of households were low income. Thirty-four different nationalities shopped at the market, and just over half (54%) shopped there weekly. More than 50 types of vegetables and fruit were available to purchase, varying for cultural preferences and seasonality, which supported variety and choice. Overall, this enterprise promotes food security in a localised area through low-cost, convenient, dignified and nutritious offerings.

Gender and health social enterprises in Africa: a research agenda

BACKGROUND

Health social enterprises in Africa working with community health workers (CHWs) are growing rapidly but understudied. In particular, gender equality issues related to their work has important public health and equity implications.

METHODS

Particularly suited for generating timely findings from reviews at the intersection of overlapping disciplines, we utilized the rapid evidence assessment (REA) methodology to identify key unanswered research questions at the intersection of the fields of gender equality, social enterprises and community health workers. The REA used a series of structured Google Scholar searches, expert interviews and bibliography reviews to identify 57 articles in the academic and grey literatures that met the study inclusion criteria. Articles were thematically coded to identify answers to "What are the most important research questions about the influence of gender on CHWs working with health social enterprises in Africa?"

RESULTS

The analysis identified six key unanswered research questions relating to 1) equitable systems and structures; 2) training; 3) leadership development and career enhancement; 4) payment and incentives; 5) partner, household and community support; and 6) performance.

CONCLUSION

This is the first study of its kind to identify the key unanswered research questions relevant to gender equality in health social enterprises in Africa using community health workers. As such, it sets out a research agenda for this newly emerging but rapidly developing area of research and practice with important public health implications.

Conceptualizing the health and well-being impacts of social enterprise: a UK-based study

Social enterprises-businesses that work for social benefit rather than for the maximization of financial returns to shareholders or owners-could potentially prove to be an innovative and sustainable way of tackling 'upstream' social determinants of health. However, empirical work focusing upon how, and to what extent, social enterprise-led activity may impact upon health and well-being is still relatively scarce. This study examines how social enterprises portray their impact, and how such impacts may be considered in health and well-being terms. Through analysing evaluative reports of the work of social enterprises in Scotland (n = 17) utilizing a 'process coding' method, we investigate both the self-reported impacts of the work of social enterprises and the mechanisms by which these are said to be derived. Revisiting previous conceptualizations in the extant literature, this work allows us to present an 'empirically-informed' conceptual model of the health and well-being impacts of social enterprise-led activity, and thus presents a significant advance on previous hypothetical, theoretically-based conceptualizations. It is considered that these findings further improve our overall knowledge of ways in which social enterprise and other parts of the third sector could be considered as potentially valuable 'non-obvious' public health actors.

Public and patient involvement in needs assessment and social innovation: a people-centred approach to care and research for congenital disorders of glycosylation

BACKGROUND

Public and patient involvement in the design of people-centred care and research is vital for communities whose needs are underserved, as are people with rare diseases. Innovations devised collectively by patients, caregivers, professionals and other members of the public can foster transformative change toward more responsive services and research. However, attempts to involve lay and professional stakeholders in devising community-framed strategies to address the unmet needs of rare diseases are lacking. In this study, we engaged with the community of Congenital Disorders of Glycosylation (CDG) to assess its needs and elicit social innovations to promote people-centred care and research.

METHODS

Drawing on a qualitative study, we conducted three think tanks in France with a total of 48 participants, including patients/family members (n = 18), health care professionals (n = 7), researchers (n = 7) and people combining several of these roles (n = 16). Participants came from 20 countries across five continents. They were selected from the registry of the Second World Conference on CDG through heterogeneity and simple random sampling. Inductive and deductive approaches were employed to conduct interpretational analysis using open, axial and selective coding, and the constant-comparison method to facilitate the emergence of categories and core themes.

RESULTS

The CDG community has unmet needs for information, quality health care, psychosocial support and representation in decision-making concerned with care and research. According to participants, these needs can be addressed through a range of social innovations, including peer-support communities, web-based information resources and a CDG expertise platform.

CONCLUSION

This is one of the few studies to engage lay and professional experts in needs assessment and innovation for CDG at a global level. Implementing the innovations proposed by the CDG community is likely to have ethical, legal and social implications associated with the potential donation of patients' clinical and biological material that need to be assessed and regulated with involvement from all stakeholders. To promote people-centred care for the CDG community, and increase its participation in the governance of care and research, it is necessary to create participatory spaces in which the views of people affected by CDG can be fully expressed.

Supporting research readiness in social enterprise health services

Health-based social enterprises are spun out of the NHS, yet continue to provide NHS-funded services. With the spin-out, however, formal processes for research governance were lost. Patients have a right to take part in research, regardless of where they access healthcare. This paper discusses the barriers to social enterprises undertaking applied health research and makes recommendations to address the need for equivalence of governance processes with NHS trusts.

Conceptualising the public health role of actors operating outside of formal health systems: The case of social enterprise

This paper focuses on the role of actors that operate outside formal health systems, but nevertheless have a vital, if often under-recognised, role in supporting public health. The specific example used is the 'social enterprise', an organisation that seeks, through trading, to maximise social returns, rather than the distribution of profits to shareholders or owners. In this paper we advance empirical and theoretical understanding of the causal pathways at work in social enterprises, by considering them as a particularly complex form of public health 'intervention'. Data were generated through qualitative, in depth, semi-structured interviews and a focus group discussion, with a purposive, maximum variation sample of social enterprise practitioners (n = 13) in an urban setting in the west of Scotland. A method of analysis inspired by critical realism - Causation Coding - enabled the identification of a range of explanatory mechanisms and potential pathways of causation between engagement in social enterprise-led activity and various outcomes, which have been grouped into physical health, mental health and social determinants. The findings then informed the construction of an empirically-informed conceptual model to act as a platform upon which to develop a future research agenda. The results of this work are considered to not only encourage a broader and more imaginative consideration of what actually constitutes a public health intervention, but also reinforces arguments that actors within the Third Sector have an important role to play in addressing contemporary and future public health challenges.