High-value innovations in otolaryngology born from a tertiary hospital in Rwanda: opportunities for bi-directional learning

The objective of this paper is to discuss bidirectional innovation sharing between high-income countries (HICs) and low-income countries and middle-income countries (LMICs) in otolaryngology surgery. The authors aim to highlight several high-value, context-appropriate innovations in otolaryngology care that have been developed in a tertiary hospital in Rwanda and discuss their safety and efficacy compared to the standard of care. Five surgeons (three Rwandan surgeons, two United States surgeons with longitudinal experience in Rwanda) provided their recommendations for high-value innovations currently being employed in their experience at a tertiary hospital in Rwanda. Otolaryngologists provided feedback on the utility, safety, and efficacy of ten ‘innovations’ that aim to optimize resource utilization and improve access to otolaryngology care. The authors emphasize the need for tailored, context-appropriate solutions in surgical care and the importance of research and evaluation to ensure the safety and efficacy of LMIC innovations. The authors also highlight the potential for HICs to learn from LMICs in terms of high-value and environmentally sustainable surgical practices. Further research is needed to guide national health systems in prioritizing their infrastructure, equipment, and training needs for scaling up otolaryngology services. Our review highlights the importance of bidirectional learning in surgical innovation and the potential for high-value innovations to improve surgical care in LMICs.