People with problems, by and large, know how to solve them. As hard as we try to improve the lives of the poor, nobody understands the nature of ill health, contaminated water, and economic stagnation better than those facing it every day. Their condition is not caused by a lack of creativity, or a failure to understand their predicament – they simply lack the money and support to make their solutions a reality. These solutions have the potential to simultaneously improve livelihoods and make people the fundamental drivers of their own development. To improve global health in the next 15 years, the United States needs to invest in the power of local innovation.

In Ilolangulu village, Tanzania, 70% of pregnancies are delivered at home instead of the clinic. This is a dangerous status quo – without a skilled health worker present, any complications will likely lead to the mother or newborn’s death. As a result, Tanzania’s maternal mortality rate is almost 100 times that of the United States. In my efforts to increase the number of women delivering in Tanzanian clinics, I quickly learned that those with whom I worked were better equipped to find solutions than I was. Mama Jesinala and Mary, health workers at Ilolangulu’s clinic, approached me suggesting that we offer free diapers and soap to women who come to their clinic to deliver. When I encouraged them to write down their ideas in a short proposal, their initial reaction was shock and uneasiness. Yet within weeks, these two women wrote the first proposal of their lives, refined it, and received four months worth of funding to test their idea – a grant of $615. In just a few weeks, deliveries at their clinic have increased, with women even coming from other villages to deliver. Knowing their community better than I ever could, Mama Jesinala and Mary have made an impact and inspired others to follow their lead.

I contend that this tiny example of innovation in a remote village in East Africa represents the most important thing the US can do to improve global health. The solution that these women found was highly specific to Ilolangulu – and that is why it was so successful. Though the global health community struggles to find broadly applicable solutions, I believe that we should embrace the heterogeneity of local context. Much of the developing world faces a similar set of challenges: water‐borne disease, malaria, HIV/AIDS, infant mortality. Yet the determinants of each vary widely depending on the historical, cultural and political context. To address these problems with the same “one size fits all” solution invites misunderstanding, ineffectiveness, and a lack of ownership over the solution by the community. Only by tapping into the knowledge and creativity of local residents will problems be meaningfully solved.

A world investing in local innovation would not make NGOs – who work tirelessly to address pressing global health problems – irrelevant. Instead, their role would shift from creating health programs to providing logistics and technical support to locally developed programs. Rather than providing a service to beneficiaries, NGOs would work in partnership with their target population, executing the ideas developed by community groups and providing counsel when needed. Additionally, these organizations would be charged with the monitoring and evaluation of community programs and sharing successes with other organizations. This would ensure that communities around the world learn from past experiences.

Though programs focused on local innovation might operate more slowly than the traditional development model, the funds are much more likely to directly benefit communities over the long term. In Ilolangulu, for example, all grant money was used to pay for soap and diapers for pregnant women. As such, the worst possible outcome of the study is that we bought $615 of soap and diapers for pregnant mothers. By definition, these programs have buy‐in from communities, virtually eliminating the tendency of health programs to fade away once outside program implementers leave. Perhaps most importantly, they accomplish what Amartya Sen has called a fundamental component of development – the expansion of opportunities and expression for the poor and marginalized.

In March 2010, a consortium of health NGOs will hold a competition for the residents of a Kenyan slum to improve water and sanitation in their community. This issue, definitively the number one priority of the community, is too often overlooked by global health practitioners. Despite their best intentions, the structure of aid allocation makes responsiveness to local conditions difficult, inconsistent, and rarely rewarded. We hope that this “Local Solutions” competition will help to address this problem, and inspire a culture of innovation in the process. By embracing the potential of local innovation, we can enable the poor to improve their own lives, and bring about a fundamental change in how we do global health.