Factors influencing frugal innovations in south africa’s public health system within the national health insurance framework
1
1. National Health Laboratory Service, Sandringham, South Africa
2
2. MBS College of Business, King Abdullah Economic City, Saudi Arabia
3
3. Said Business School, University of Oxford, Oxford, United Kingdom
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4. Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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5. Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A1762
ABSTRACT
INTRODUCTION:
Achieving Universal Health Coverage (UHC) in low-and middle-income countries (LMICs) require innovations that are affordable, accessible and context-appropriate (1-3). In South Africa, the adoption of National Health Insurance (NHI) (4), increases the need to understand how frugal product, process and business model innovations are motivated, enabled and their impact within the public health system. Existing frugal innovation frameworks such as the antecedents, mediators, consequences framework (5), have not been examined within government-led UHC reforms to understand their adequacy to public sector operational realities. The study investigates antecedents, mediators, consequences (A-M-C) of South Africa’s public health sector’s frugal innovations and extend the A-M-C framework in health systems strengthening as part of NHI reforms.
METHODS:
This exploratory qualitative study drew on 30 key informant interviews (KIIs) with district managers and National Health Laboratory Service (NHLS) business managers across four provinces. Thematic analysis applied inductive and deductive coding. Hossain’s A-M-C framework (5), guided deductive coding, and additional constructs were inductively identified, specific for the public sector
RESULTS:
Public sector frugal innovations were primarily motivated by social drive (inclusion, equity) and operational drive (health system’s motivation to preserve reliable service delivery under chronic resource shortages). Mediators were separated into explicit facilitators (leadership support, partnerships, community engagement, training, performance monitoring) and constraints (resource, institutional and scale-up). The public sector produced operational consequences such as improved workflows, decongested facilities, shortened turnaround times, fewer laboratory test rejections and improved allocation of resources. Economic, social and environmental consequences emerged as gains arising from operational improvements.
CONCLUSIONS:
The study confirms the relevance of the A-M-C framework (5) and extends it with three additional constructs tailored to the public sector context: operational drive, explicit facilitators and operational consequences. The findings contribute to frugal innovation theory and provide insights on how to institutionalise frugal innovation as part of NHI implementation.
Achieving Universal Health Coverage (UHC) in low-and middle-income countries (LMICs) require innovations that are affordable, accessible and context-appropriate (1-3). In South Africa, the adoption of National Health Insurance (NHI) (4), increases the need to understand how frugal product, process and business model innovations are motivated, enabled and their impact within the public health system. Existing frugal innovation frameworks such as the antecedents, mediators, consequences framework (5), have not been examined within government-led UHC reforms to understand their adequacy to public sector operational realities. The study investigates antecedents, mediators, consequences (A-M-C) of South Africa’s public health sector’s frugal innovations and extend the A-M-C framework in health systems strengthening as part of NHI reforms.
METHODS:
This exploratory qualitative study drew on 30 key informant interviews (KIIs) with district managers and National Health Laboratory Service (NHLS) business managers across four provinces. Thematic analysis applied inductive and deductive coding. Hossain’s A-M-C framework (5), guided deductive coding, and additional constructs were inductively identified, specific for the public sector
RESULTS:
Public sector frugal innovations were primarily motivated by social drive (inclusion, equity) and operational drive (health system’s motivation to preserve reliable service delivery under chronic resource shortages). Mediators were separated into explicit facilitators (leadership support, partnerships, community engagement, training, performance monitoring) and constraints (resource, institutional and scale-up). The public sector produced operational consequences such as improved workflows, decongested facilities, shortened turnaround times, fewer laboratory test rejections and improved allocation of resources. Economic, social and environmental consequences emerged as gains arising from operational improvements.
CONCLUSIONS:
The study confirms the relevance of the A-M-C framework (5) and extends it with three additional constructs tailored to the public sector context: operational drive, explicit facilitators and operational consequences. The findings contribute to frugal innovation theory and provide insights on how to institutionalise frugal innovation as part of NHI implementation.
| eISSN: | 2654-1459 |
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