Frugal Engineering – The Tide That Lifts All Boats

Frugal Engineering is usually discussed in the context of low-resource settings; a way to increase access to safe and affordable healthcare services in environments and economies that traditionally have not been able to access or utilise the latest medical technology developments. It is often seen as providing affordable and appropriate solutions for low-income countries; of improving sustainability and supporting local economies by increasing manufacture and provision of suitable technology nearer to its ultimate deployment; of providing low-tech solutions more resilient to harsher or less refined environments. All of this is true, but to limit our view of Frugal Engineering to this would be a mistake. It risks promulgating the notion that Frugal Engineering results in technology that the wealthy countries consider to be lower quality, second rate: good enough for low-resource settings but not acceptable in high-income countries. Allowing this view to persist encourages the world view that the best technology is developed for the wealthy, developed countries, while second-class, frugal technology is developed for everyone else, therefore increasing the Global North-South divide, rather than reducing it. Not only is such a view ethically wrong, but it is also foolish; it risks consigning Frugal Engineering to a second-tier discipline just for low-resource settings, whereas in truth it can, and should, be a discipline essential across all healthcare settings. Today, even the wealthiest countries face the challenge of healthcare demands outpacing capacity. If we did not know it before the COVID-19 pandemic, we certainly do now, as healthcare systems across the higher income nations were brought to the point of collapse during the pandemic. Solutions straight out of the Frugal Engineering copybook were deployed to rescue the situation. Our challenge then, is this: to celebrate the achievements of Frugal Engineering, yes. But much more than this; to build on these successes to elevate Frugal Engineering to be a core part of all Medical Technology development. By doing so, the power, the influence and importantly the resources deployed on the High-Tech solutions currently restricted to wealthy and relatively healthy populations will be better distributed to meet the needs of all and, crucially, the benefits of Frugal Engineering will improve healthcare globally, "leaving no one behind": it is the tide that lifts all boats.