Mentoring, Training and Support to Global Health Innovators: A Scoping Review

Global health innovators must navigate substantial complexities to successfully develop, implement and sustain global health innovations with impact through application of an Integrated Innovation™ approach. We sought to examine the nature of the literature and evidence around mentoring, training and support of global health innovators. We conducted a scoping review searching eight databases with terms capturing different kinds of innovation and support. Assessment of relevance and mapping was completed by two reviewers, with interpretation by the review team. Twenty-eight relevant papers provided perspectives on fostering global health innovators and innovation. Fifteen included empirical data on supports to global health innovators involving a wide range of innovators. Eight included documentation of outcomes but without designs to determine effectiveness. The diverse mentoring, training and support activities included: business incubators, support organizations and centres for entrepreneurship, technology transfer and intellectual property management, internship programs for business skill development, initiatives to bridge industry and researchers, and platforms for South-led innovation for global health. We propose the cultivation of a pipeline of global health innovators to increase the number of appropriate, sustainable innovations with impact in global health. Further empirical work on how to effectively support global health innovators is needed.


Introduction
Global public health is being impacted by ongoing innovation in a myriad of ways that may or may not promote health equity (Cozzens & Kaplinsky, 2009), depending on the nature of the innovation's development and its scale-up (McGahan, 2012). Health innovations such as new vaccines, diagnostic devices, product development partnerships and preventive and therapeutic interventions are being rolled out in low-and middle-income countries (LMICs), stimulating growth in their economies (Gardner, Acharya, & Yach, 2007;Yamey, 2012;Morel et al., 2005 ). Innovation for global health can mean "…to [take] up novel ideas, inventions or processes and [apply] them to achieve improved health and greater health equity" (Matlin, 2008, p. 13). Global health innovation can be facilitated through various approaches such as venture funding for biotechnology, public-private partnerships, and novel models of health service delivery. However, these mechanisms are most often focused on various segments within an innovation cycle -either discovery (involving basic research), development (clinical development), or delivery (ensuring end users receive products) (Matlin, 2008). Other approaches to global health innovation include the work of the Bill and Melinda Gates Foundation, which is focused on developing and propelling technological innovation to tackle global health challenges.
However, technological, business, and social sectors are highly influenced by the complexities of international relationships, national innovation systems, and the general national environment. Each can affect the discovery, development, effective implementation and equitable adoption of innovations which impact health (Matlin, 2008;McCannon et al., 2007). This illustrates the significance of an Integrated Innovation TM (scientific/technological, business, social innovation) approach to global health that aims to support the entire process of innovation from beginning to end, in light of these factors. Recently, there has been a major push to conceive of health innovation as a multi-sectoral process, reflected through institutional funding and training (e.g. University of Toronto Institute of Global Health Equity and Innovation, National Institutes of Health Framework Programs for Global Health Innovation) (University of Toronto, 2013;National Institutes of Health Fogarty International Centre, 2012), and nonprofit organizations (e.g. PATH) (PATH, 2013) and higher level policy discussions within European organizations (Battams et al., 2011). Young innovators in both high income countries (HICs) and low and middle income countries (LMICs), who aim to achieve equitable health outcomes through innovation, must receive the proper mentorship, training and support so that they are better able to navigate complexities and mitigate gaps in skills, knowledge or resources during the innovation process. A vast literature speaks to the need for and provides specific examples of mentorship, training and support for innovators in different health sectors -clinicians in academic medicine, public health, academic entrepreneurs, etc. (Manabe et al., 2009;Mahayosnand & Stigler, 1999;Jackson et al., 2003). Challenges faced by innovators are often focused on scientists failing to cross the innovation-to-commercialization gap (the "Valley of Death") due to their lack of understanding of commercialization, entrepreneurship, product development, market value and general business concepts (Markham, 2002).
In the field of global health, young innovators are likely to face similar challenges, compounded by the complexities of innovation processes in different national innovation and public health systems. The Global Forum for Health Research aims to support strengthening of LMIC research and innovation systems for health, focusing on social, scientific/technological and business innovation research to impact on global health. The Canadian Coalition for Global Health Research (CCGHR), a network of global health researchers, organizations, and students, has expertise in mentorship, leadership and capacity development in global health research more generally. Grand Challenges Canada TM (GCC), funded by the government of Canada, is a non-profit organization that supports global health innovators in LMICs as well as Canada. However, we were unable to identify any sources that systematically examined requirements for and gaps in mentorship, training and support for global health innovators across the three Integrated Innovation TM sectors.
Hence, we conducted this scoping review to systematically scan the evidence for mentorship, training and support of innovators who would take an Integrated Innovation TM to global health innovation. We used GCC's organizational process and innovation funding cycle for global health innovators as a case example to which we could apply our review findings.

Methods
We chose a scoping review approach given our desire: (1) to map the extent, range and nature of research activity; (2) to help determine whether a full systematic review would be valuable and feasible; (3) to summarize and disseminate findings for an audience of innovators, mentors and funders; and (4) to identify research gaps in the current literature (Arksey & O'Malley, 2005 Vol. 5, No. 5; As shown in Table 1, the 34 Stars in Global Health projects had been under way between 9-12 months. The grantees were relatively young in their careers as eligibility to participate in the first two rounds was restricted to those within ten years of attainment of their latest degree and most were from science/technological, academic backgrounds. Few mentors or mentees had business related experience, though a number had social innovation experience in partnerships (see http://www.grandchallenges.ca for further details).
The review team included experience in commercialization of science-based health innovations in LMICs, strategy and operations analysis, and coordination of the Stars in Global Health program, all from GCC, along with global health research capacity development in LMICs. An MPH student specializing in health promotion and global health led discussions of the grantee context and GCC needs to formulate three questions for exploration in this scoping review: 1) What is the nature of evidence around mentorship, training and support for innovators in global health?
2) How is the Integrated Innovation TM approach in global health being reflected in the mentorship, training and support for innovators? And 3) What type of initiatives in mentorship, training and support for innovators are applicable to the GCC Stars in Global Health program and implementable in its structure and context?

Identifying Relevant Papers
Preliminary literature searches helped formulate a search strategy that encompassed the main concepts, appropriate terms and the most relevant databases.
As seen in Table 2, keywords within each topic category were combined with OR. Across topic categories, terms were combined with AND. The search strategy was piloted and refined during consultations with an information specialist, tested in various databases to ensure that relevant results were appearing. Eight electronic databases, chosen for their multidisciplinary focus and relevance to the research questions, were systematically searched for their earliest available year to June 2012 (see Supplementary File Table 1

Integrated Innovation
Scientific/ technological innovation Biopharm* AND innova* AND health Biomed* AND innova* AND health Biotech* AND innova* AND health Research and development AND innova* AND health Information communication technolog* AND innova* AND health Medical innova* Point of care AND innova* AND health Technolog* AND innova* AND health Medic* AND innova* AND health Scienc* AND innova* AND health

Business innovation
Entrepreneur* AND innova* AND health Business AND innova* AND health Commercializ* AND innova* AND health Technology transfer AND innova* AND health

Social innovation
Diffusion of innovation AND health Ethic* AND innova* AND health Health care AND innova* Health system AND innova* Health delivery AND innova* Economic* AND innova* AND health Politic* AND innova* AND health Legal* AND innova* AND health Social* AND innova* AND health Cultur* AND innova* AND health Policy AND innova* AND health Determinants of health AND innova* Human resource* AND innova* AND health Leader* AND innova* AND health www.ccsenet.org/gjhs Global Journal of Health Science Vol. 5, No. 5; 2013

Topic Categories Keywords
Social change AND innova* AND health Equity AND innova* AND health Govern* AND innova* AND health Implement* science AND health Translation* science AND health "Scaling up" AND health "Scale up" AND health "Scaling-up" AND health "Scale-up" AND health

Paper Selection
Retrieved English titles and abstracts were independently reviewed by one team member for initial relevance related to innovation, health, and mentorship/support/ training. A five percent random sub-sample was reviewed by a second team member. Raw inter-rater agreement on relevance was 77%. Formal inclusion and exclusion criteria were devised at this stage, and these two researchers independently reviewed each title and abstract for relevance, with resolution of disagreements by consensus. Major reasons for exclusion were: (1) no focus on health; (2) no focus on innovation; (3) no mention of type, potential, or need for support/training/mentorship of innovators. Included papers that were accessible by University of Toronto libraries were reviewed in full. Reference lists from papers included for full review were searched, and relevant papers to the research questions were also retrieved. Mendeley software was used for data management.

Mapping the Data
The following information was extracted from each paper: author(s), year, title, publication source, country, paper type, type of stakeholder(s), link to Integrated Innovation TM approach, and type of support/training/mentorship, either needs described or/and specific activities. The review leads held meetings to discuss extracted data and to synthesize our findings, following an inductive approach.

Results
The final search strategy generated 1535 titles and abstracts. Following initial title and abstract reviews and hand-searching of reference lists, 28 papers were judged relevant in this scoping review (full details in supplementary file).

What is the Nature of Evidence around Mentorship, Training and Support for Innovators in Global Health?
Most papers were published recently, with half (n=14) published in 2010. Eighteen (64%) were based in LMICs and the remainder in the USA and Canada (n=10). Most discussed all three of scientific/technology, business and, social innovation (n=23), with the rest (n=5) not including social innovation in a substantive manner. Four only discussed needs, ten focused on activities, half covered both. Nine provided perspectives (commentaries, editorials, etc.), four described programs of different kinds and 15 (56%) took some kind of empiric approach.
Eight of the latter papers included information on outcomes, including a promising framework for evaluation (Allen et al., 2010). Some reported students trained (Oden et al., 2010), university-industry collaborations initiated www.ccsenet.org/gjhs Global Journal of Health Science Vol. 5, No. 5; 2013 , companies developed (Chakma et al., 2010), and locally relevant technologies translated . One (Oden et al., 2010) reported a specific training outcome: 95% alumni commented that the program changed/modified their career plans to focus on global health medicine, research, and/or policy. Unfortunately, none provided sufficient evaluation data in comparative designs to determine the effectiveness of support, training, or mentorship activities in global health innovation.

How is an Integrated Innovation TM Approach in Global Health Being Reflected in the Mentorship, Training and Support for Innovators?
Drawing primarily on the empirical studies which included activities oriented by all three types of innovation (n=15) we found a wide variety of relevant activities, half with multiple stakeholders, reflecting innovation system perspectives. As outlined in Table 3, the specific activities in LMICs to support, train and mentor innovators for health innovation aimed to fill identified needs included: business incubators, support organizations and centres for entrepreneurship, technology transfer and intellectual property management, internship programs for business skill development, government funding, and initiatives to bridge industry and researchers, and platforms for South-led innovation for global health. There was a heavy emphasis on supporting, training and mentorship of innovators in the science-business knowledge and resource gap. The focus was primarily on commercialization for product-based health innovation with little explicit mention of training to understand the social contexts in which innovations are to be implemented.

Discussion
Given the newness of the global health innovation field, our mapping found papers on perspectives, new programs, and a range of activities to support global health innovators but limited empirical work to inform training, mentoring and support practice. Literature on mentorship in global health clinical research (Shah et al., 2011) and academic medicine (Nelson et al., 2012) are focused on helping trainees achieve research productivity, career development or appropriate conduct in global settings. These important objectives of mentorship need to be complemented for global health innovators by helping trainees understand the cycle of innovation and the social contexts in which innovations will be discovered, developed, scaled up, deployed, and sustained.

System Level
Papers identified in this scoping review did indicate a number of mechanisms by which support, training and mentorship of global health innovators may be facilitated with the involvement of micro to macro level stakeholders. In LMICs, the identified mentorship, training, and support structures were highly focused on capacity building within the innovation system itself so that innovation might be better facilitated. A good example of a program (unfortunately without evaluation data) is the African Network for Drugs and Diagnostics (Mboya-Okeyo, Ridley, & Nwaka, 2009). It enables African-led research and innovation for discovery, development and delivery to treat diseases affecting Africa (science/technology), with a focus on translation of innovations (social) and also aims to attract commercial investments and collaborations between South-South and North-South partners (business).

Institution Level
Responding to Hotez and colleagues' (2005) call for public health institutions to train students in appropriate technology, and to ensure core competencies are reflective of technical and "real world" skills for product development and use, is Northwestern University's tripartite collaborative model (Palamountain et al., 2010) Vol. 5, No. 5; of concept studies. Milestones in reporting for mentorship activities could be elicited. A repository of experts, particularly with business and social innovation acumen (as these areas of expertise seem to be lacking the most) and who have experience in global health contexts, could be built for grantees to contact if needed. Knowledge brokers could act as "middlemen" to guide and mentor grantees on bridging the challenges in taking an innovation to a specific commercial market, as well as to help with building core skills (e.g. writing a business plan). Innovations that merit Phase II funding could be showcased as part of an innovation marketplace for potential partners and investors, which would help grantees gain skills in presenting, making elevator pitches, networking, etc.
In Phase II, supplementary sources addressing implementation science, translational science, product development partnerships (Rabin et al., 2008;Yamey, 2011) could be added to the online proposal development resource, which would supplement the entrepreneurship skillsets being built to help fill in knowledge and practice gaps around evaluation, scaling up, and implementation. Communities of practice, which have been utilized widely in business and health sectors (Li et al., 2009), could be facilitated amongst these innovators to share tacit knowledge and learning. The partnerships and networks built through interactions amongst the innovators, potential partners and investors, as well as the knowledge and skills gained through the training, mentorship and support activities could enable capacity development of innovators as they move to achieve impacts on coverage and equity.

Limitations
As only papers written in English were included, other sources that may have been relevant may have been missed. In addition, due to financial resources and time, only papers that were available through the University of Toronto libraries were included. Nevertheless, the scoping review was sufficient to indicate the state of evidence available.

Conclusions
Our scoping review has identified the nature of literature on global health innovators and their organizations, funders, and educators relevant to training, mentorship and support of innovation in global health. It applied our findings to one programme aiming for Integrated Innovation TM in GCC's Stars in Global Health. More rigorous research and evaluation is needed to determine better processes for programmes to train, mentor and support innovators in global health and their effectiveness in impacting on global health equity.