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