Most medical devices are designed by western firms from efficient innovation systems with a focus on their home markets. A disproportionately high percentage of imported medical devices in low resource settings become non-functional. Despite interest from global health and innovation studies, little is known about firms in emerging markets appreciative of challenges in their home environments. Using empirical evidence from innovative manufacturing firms in South Africa, this study investigates frugal orientation and mechanisms to innovate under resource constraints, in a technology intensive sector typically under the purview of western firms. Systematic analysis of six devices by adapting a global health lens reveals that while some innovations specifically address health challenges of low resource, others are more affordable technological innovations with universal relevance and some frugal elements. Resource constrained innovation strategies involved building advanced internal manufacturing capabilities to overcome institutional voids while forging multiple knowledge collaborations to complement inhouse capabilities. This drives frugality around design, engineering and manufacturing processes. Innovation delivery strategies are complementary to these processes. The evidence suggests fundamentally new products were designed in collaborative bottom up processes. The role of the state and global non-profits in harnessing frugal innovations for public health was found to be critical.@en

The lack of appropriate and affordable medical devices to serve the needs of developing countries is a global health concern; a need felt even more acutely during the COVID-19 pandemic. In recent years, the growing medical device manufacturing sector in South Africa has drawn policy attention, with some studies highlighting its significant potential to contribute to South Africa’s National Development Plan 2030. The prompt deployment of funding and home-grown technologies by the South African government during the pandemic to address medical device and diagnostics shortage through local manufacturing reaffirms the country’s capabilities. This study explores firm-level innovation processes through a fresh lens. It adapts the heuristics of an ‘institutional triad’ to highlight the institutions, interactions, and tensions between the three stages of innovation – generation, production, and diffusion – which are influenced by different policy domains. Further, it explores the ways in which the harmonisation of policies can enable South Africa’s medical device manufacturing sector to reconcile the twin objectives of industrial growth and social development, including lowering its own healthcare cost. Empirical evidence from three case studies demonstrates that, despite facing many constraints and challenges to innovate, some small and medium enterprises (SMEs) engaged in medical device manufacturing in South Africa have high levels of innovation capabilities and have successfully brought various frugal innovations to market. Frugal innovations in this study are fundamentally new products – they are not adaptations or stripped-down versions of products initially developed for Western markets. The evidence suggests varying levels of involvement of the state in the three case studies presented. However, much more proactive support, particularly to innovative SMEs, would be needed to enable more inclusive technological change where both economic and social goals can simultaneously be achieved. @en

Within a context of accumulated technological capabilities in the Global South and the re-emergence of industrial policy, this article seeks to reintroduce production and development in frugal innovation discussions, in the traditions of its antecedents. While frugality is commonly associated with appropriate technology, this paper identifies the less recognised roots of frugality in the technological capabilities literature that studied manufacturing firms in developing countries. Moving away from the dominant business and management-based enquiry, this paper advances a development lens to frugal innovation by deconstructing frugality as innovation for and under resource constraints. While innovation for resource constraints offers a path for enhancing individual capabilities through availability and access to frugal products, innovation under constraints contributes to firm-level capability. We argue that active policy interventions are needed to enable both these processes. Failing this, frugal innovation would continue to reproduce the status quo, offering a limited challenge to mainstream technological hegemony. @en