“A living lab within a lab”: approaches and challenges for scaling digital public health in resource-constrained settings

Frontiers in Public Health · 5 authors, 3 centres

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TL;DR

This qualitative study describes the use of a 'living lab' model embedded within a medical college field site in India to co-develop and attempt to scale digital public health tools. The central result is that successful scaling requires aligning the lab's governance with multi-level state health systems and sustained institutional, not just project-based, support.

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This article presents an empirical analysis of a 'living lab within a lab' model for developing and scaling digital health innovations in primary healthcare facilities in India. The authors describe a process of co-production involving technical teams, health workers, and researchers to build digital solutions for public health challenges. A key finding from the INTPART project case is that scaling failed when the lab's governance was not integrated into the formal state reporting framework and relied on finite funding and a single champion. In contrast, an institutional agreement with a medical college in another state enabled scaling to 22 facilities, though continuity was hampered by personnel transfers. The study concludes that scaling is a socio-cultural-institutional process, not just technical replication, requiring multi-level governance support, co-production, and agile techno-institutional partnerships like that with HISP India.

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other

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public health

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AI pipeline

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ORIGINAL PAPER

PMC10441214

“A living lab within a lab”: approaches and challenges for scaling digital public health in resource-constrained settings

Frontiers in Public Health

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ABSTRACT

A living lab is an emerging concept, particularly in Europe, as a vehicle to develop digital innovations through a process of co-produced design and development, which takes place, physically and socially, in real-life use contexts. However, there is limited research relating to guiding our understanding of the process by which such labs are established, and digital innovations are co-created and scaled to other settings requiring similar solutions. Furthermore, beyond Europe, the concept of a living lab has not found widespread application in low- and middle-income countries (LMICs), particularly in their public health contexts. Public health systems offer the unique scaling challenge of “all or nothing”, implying that data are required from the whole population rather than isolated pilot settings. The living lab approach promises the rich potential to strengthen public systems but comes with twin interconnected challenges. First, for building appropriate digital solutions to address local public health challenges, and second, in scaling them to other public health facilities. This article investigates these twin challenges through ongoing empirical work in India and identifies three key domains of analysis, which are as follows: the first concerns the process of establishing an enabling structure of a “living lab within a lab”; the second concerns leveraging the capabilities offered by free and open-source digital technologies; and the third concerns the driving impetus to scaling through agile and co-constructed technical support.

CITATION EXPORT

Arunima S. Mukherjee, Sundeep Sahay, Rajesh Kumar et al.. “A living lab within a lab”: approaches and challenges for scaling digital public health in resource-constrained settings. Frontiers in Public Health. (2023). https://doi.org/10.3389/fpubh.2023.1187069

AUTHORS

5 · 3 CENTRES

Arunima S. Mukherjee, Sundeep Sahay, Rajesh Kumar, Rashi Banta, Neha Joshi

1Department of Informatics, University of Oslo, Oslo, Norway
2HISP India, New Delhi, India
3Health Equity Action Learnings Foundation, Chandigarh, India