Drivers and Barriers of Innovation Dynamics in Healthcare Towards a framework for analyzing innovation in Tuberculosis control in India

Tuberculosis remains the biggest infectious killer in India and worldwide, and it has recently regained substantial international attention with its come-back in drug resistant forms. The environment, the disease and the societal response to it are changing and with it challenges and opportunities to control the disease. Innovation in a variety of areas such as improved diagnostic tests, drugs, delivery mechanisms, service processes, institutions and treatment regimes is needed in order to be able to respond to the changing public health challenge. This paper reviews theoretical approaches to innovation of direct relevance to the case and examines what theoretical framework is useful to look at the problem of innovation in public health in India. Such an analysis can reveal drivers and barriers of change within the context of the Indian health system in a comprehensive, problem-oriented way and is thus able to add to existing research done on TB. However, given that TB control is a public health challenge, concerned with problems of delivery and implementation, the concept of innovation has to go beyond technological innovation and the private sector. The case can therefore simultaneously contribute to innovation theory and improve our understanding of what change processes and innovation for concrete public health challenges in a country such as India mean. After a short description of recent changes in TB control based on fieldwork in India the paper proceeds with an examination of existing frameworks on healthcare innovation upon their usefulness for such a case. The paper concludes with a proposal for a theoretical framework and areas for further empirical fieldwork.