Technological innovations can transform the lives of those who are able to take advantage of them. But many children, particularly in developing countries, remain excluded from their benefits. Reorienting innovation towards inclusion begins with recognizing unconventional pathways to innovation.

Since the late eighteenth century, several waves of technological revolutions have been changing the world. Their impact on children has been uneven. While innovations like vaccines and antibiotics have saved and improved many children’s lives, other aspects of technological revolutions have ravaged child populations. Consider, for example, the appalling conditions in which child labourers worked, lived and died during England’s Industrial Revolution. Or, in the automobile age, how advances in transport have meant that children can get to urgent care more quickly – even as vehicle emissions have degraded air quality, causing many more children to require urgent respiratory care.

The geographical distribution of technology’s double-edged gifts has also been uneven. While substantial populations have benefited from the full range of technological innovations – from paediatric vaccines to ambulances to the latest biotechnologies – many children, especially in the so-called developing world, remain outside their reach. Why is this so? One argument gaining support is that such technologies emerged from the contexts to which they are best suited – most often industrialized countries – making it difficult to export them to places that do not share the same resource base or institutional framework.

There are several possible pathways through which innovation can address problems that arise in developing countries. Some of these are more visible than others. Mainstream innovations, developed in advanced industrialized countries and then applied in developing countries via technology transfer, command the most resources and attention; these stem from dominant global industries and are most readily integrated into existing policy frameworks. But these approaches often fail to address exclusion. Many countries struggle to fit them into their local contexts, as these innovations often require considerable resources and specific combinations of institutions to bring them to life.

“Scarcity-induced innovations should not be equated with ‘appropriate technologies’ or products of ‘frugal engineering’, ‘reverse engineering’ or other such frameworks.”

For developing countries, greater potential for inclusive innovation can be found in unconventional or ‘scarcity-induced’ pathways to innovation. Scarcity-induced innovations should not be equated with ‘appropriate technologies’ or products of ‘frugal engineering’, ‘reverse engineering’ or other such frameworks. They are developed within significant financial, material or institutional constraints. They include ‘high-tech’ innovations like the Hib vaccine developed in Cuba as well as ‘low-tech’ products like the Jaipur foot developed in India. They can be combined with mainstream innovations, or not. What ‘scarcity-induced’ innovations have in common is their innovative use of scarce resources and their adaptation to local contexts. They have immense potential to improve children’s lives.

The Hib vaccine

The synthetic conjugate vaccine against Haemophilus influenzae type B (Hib) is one example of a scarcity-induced innovation that has had a dramatic impact on children’s lives. The ‘mainstream’ Hib vaccine, developed in the United States, relied on a core compound from the fermentation of the pathogenic bacteria. Its high cost put it beyond the reach of the Cuban public health system. Given the scarcity of available resources, producing an alternative hinged on a new framing of the science and engineering challenges, as well as a recommitment to public health outcomes in Cuba. After 14 years of intense effort, Cuban researchers collaborated with researchers from Canada and made a breakthrough, creating a synthetic process for carbohydrate antigens that could circumvent the expensive, imported option.

This innovation represented neither conservative science nor ‘low-tech’ engineering. But science alone was insufficient for its success. The process of creating a more affordable Hib vaccine sparked a scientific and public health revolution. Rather than an attempt to refine and lower the cost of the imported technology, this was a full-scale effort – involving not only research but also public support and financing for scale-up and manufacture – to find a homegrown alternative. The endeavour encouraged health scientists to embrace the humane nature of their research, and deliberately sidelined the issue of profit and the role of large companies to instead concentrate on public health research institutes and a network of clinics and outreach vehicles directly connected to families and children. Following the introduction of the synthetic vaccine, mortality and morbidity from paediatric meningitis fell in developing countries.

The Jaipur foot

Much has been written about the Jaipur foot, a prosthetic for the lower extremities, but this example is especially germane to a discussion of innovations that serve children and their developmental needs. Created in response to a range of scarcities – a dearth of financial and institutional resources, the absence of support from national policy, inadequate physical infrastructure – the Jaipur foot is the world’s least expensive prosthetic, costing US$45, compared to as much as US$12,000 for a similar product made in the United States, and also one of the most versatile. It is made from readily available materials and can be produced and repaired by local artisans. It allows for barefoot walking, running and climbing over uneven surfaces, as well as cross-legged sitting. It is thus well suited to cities and villages in developing countries, where people with disabilities often must contend with hard terrain. It is culturally versatile, adaptable to a range of local institutions and customs.

The Jaipur foot combines the innovative use of materials tailored to everyday life in developing countries with a philosophy that puts patients at the centre. Bhagwan Mahaveer Viklang Sahayata Samiti, the organization that produces the prosthetic, maintains an open-door policy – day or night – for walk-ins, admitting patients first before dealing with the registration paperwork and avoiding the need for repeat visits wherever possible. They keep management costs extremely low so that all funds go towards patients, most of whom are poor.

Where disability-friendly physical infrastructure is scarce, the Jaipur foot makes mobility possible. Its scarcity-induced characteristics – its mix-and-match approach to technology and design – have made it a highly attractive product and service around the globe. Indeed, it can be said to have incited a revolution in prosthetics, having benefited more than 1.3 million children and adults since 1975 – those born with disabilities and those who acquired them, including survivors of war, mine detonations and road traffic accidents.

Innovative toilets

In a different domain altogether, scarcity-induced innovations have the potential to address the problem of providing adequate sanitation facilities in places where, for various reasons, the standardized flush toilet may be inappropriate. Environmentally sound and community-friendly toilets can go far in safeguarding not only children’s health, but also their physical safety and dignity – particularly in the case of girls who risk sexual assault and other hazards when, lacking easy access to toilets, they must wander away from their homes or schools for privacy.

A number of innovative solutions have emerged, shaped by contexts where financial resources are scarce, physical infrastructure falls short, and the institutions needed to support the administration and maintenance of community toilets are missing. New bioremediation techniques and environmentally friendly pit latrines, for example, can work well in such contexts, as they can be mixed and matched into wider system grids where necessary, but can also work off-grid. To make these innovations sustainable, good design and technical feasibility are not enough – they also require reliable sources of funding programmes that encourage their adoption, and new institutional arrangements.

Unconventional innovations, equitable solutions

Scarcity-induced innovations do not fit the standard technology transfer model, in which technologies created in industrialized economies are sent out in search of problems to solve elsewhere in the world. One way to view the difference is to see mainstream innovations as a dominant story of supply that includes only a limited consideration of demand. If we think of demand as an iceberg, mainstream innovations – even as they usurp most of the attention in policy and practice – respond only to what is visible ‘above water’. Innovations that emerge from other pathways – notably, scarcity-induced innovations – can perhaps better respond to the remaining ‘submerged’ demand.

To enable scarcity-induced innovations to have an impact that corresponds to their potential, plans and policy measures are needed that ‘lift’ the excluded majority into sight. Often, in addition to financial investment, such innovations need certain types of skills or institutional channels to diffuse. Scarcity-induced innovations should not be crowded out or isolated; they need to be embedded along with, and dynamically connected to, innovations and capabilities represented by the other pathways to innovation. They present one important set of options available to governments, non-profits, private firms and public-private partnerships.

Unconventional innovations, exquisitely adapted to local needs and designed to work within constraints of many kinds – scarcity of resources, infrastructure, institutions – may be most likely to produce equitable and sustainable solutions to problems facing children in developing countries. We must have enough imagination to encompass – and galvanize – new and unconventional pathways to innovation. Otherwise, we risk excluding most of the world’s children from the benefits of technological progress.