Pro-Poor Innovations to Promote Instrumental Freedoms: A Systematic Literature Review

Abstract

Through a systematic literature review, this article aims to evaluate the impacts of various concepts of pro-poor innovations (PPI) on the five instrumental freedoms in Amartya Sen’s Capability Approach. For this, 165 articles were analysed to summarize the main influences of the pro-poor innovation on each type of instrumental freedom: political freedoms, economic facilities, transparency guarantees, social opportunities, and protective security. In general, the results indicate a positive influence of the innovation concepts for distinct types of freedom, with emphasis on the expansion of social opportunities and economic facilities.

1. Introduction

The influence of innovation and technology for human development and progress has been debated for a long time, going back to Schumpeter’s pioneering contributions to the understanding of the factors that generate economic growth [1]. Since then, the notion of development and well-being has evolved by broadening its scope of analysis to include dimensions that go beyond the economic perspective [2]. The innovation literature has also advanced by defining a wide diversity of types of innovation that have a direct or indirect social impact, allowing low-income consumers to be included in previously inaccessible markets [3].

Concepts such as frugal innovation, inclusive innovation, grassroots innovation, social innovation, reverse innovation, and indigenous innovation come together to place the poorest at the focus of innovation, whether in consumption or production. This research adopted the term pro-poor innovations (PPI) as an overarching concept serving as an umbrella for a host of other concepts. It is important to emphasize that this definition does not depend on whether the innovation was generated or consumed in emerging or developed countries, in addition to including innovation for different purposes (commercial or social). When specific differences between concepts are identified and will be explained in the results of this study.

Regardless of whether they are for-profit or explicitly developed for inclusive purposes, the initiatives of PPI have the potential to contribute to sustainable development [4,5,6]. Products that come from frugal innovations, for example, seeking to minimize the use of resources and energy, have the potential to support environmental sustainability [7]. The concepts of innovation discussed here can promote economic development focused on the poorest social strata, fighting inequality, which is critical in the search for social sustainability [8]. The potential of PPIs to support Sustainable Development Goals (SDGs) is well-recognized in the literature [9]. For instance, several studies point to the innovations that make health services less expensive, ensure access to clean water, and support the efforts against hunger. Others have focused on frugal innovation [10,11], grassroots innovation [12,13], low-end Innovation [14], constraint-based Innovation [15], inclusive innovation [16], and reverse innovation [17]. Thus, enough research on PPI has been carried out to warrant a systematic review and organize the knowledge gathered so far, hoping to pave the way for future initiatives.

Most of these reviews focus specifically on the relationship between particular concepts of PPI and sustainable development [18,19,20,21]. This review, however, identifies, analyses, and organizes the literature on PPI with the view of the CA’s instrumental freedoms.

Alves and Mariano [22] and Lima et al. [23] previously adopted the CA’s instrumental freedoms as a theoretical lens to systematically examine the joint literature on climate justice and human development. The use of instrumental freedoms as an analytical tool in literature is instructive because it offers a normative framework that explains the development arising from the innovation process in a broad sense, including the transforming role of the human agency living in poverty.

The present research differs in terms of method, both in the way the articles were collected and the manner in which the sample was systematized and analyzed. The research incorporated a considerable number of terms related to the phenomenon of PPI to ensure greater coverage in selecting documents from the databases. In addition, within the theoretical framework of the CA, the systematization process enabled an unprecedented organization of the main advances in PPI literature that have an impact on human development research.

This article aims to answer the following research question: how does PPI relate to expanding the capabilities of people in poverty?

2. Conceptual Foundation

2.1. Pro-Poor Innovations and Derived Concepts

Various concepts have been coined to describe different models of innovation with the potential to improve the well-being and freedom of marginalized communities [24]. Although these concepts have many overlaps, they do have significant theoretical differences that will be addressed in this section.

A group of concepts with a strong commercial bias, and a potentially inclusive impact, can generally be understood in terms of externality. One of such group terms is frugal innovation; a concept focused on core functionalities, substantial cost reduction, and optimized performance and efficiency [7,25]. The cost reduction feature is linked to other terms such as low-cost innovation [26], cost-reducing innovation [27] and low-tech innovation [28]. Low-cost and cost-reducing innovation differ from frugal innovations by seeking to reduce costs even at the expense of quality. Low-tech innovations are based on low levels of R&D investment, not necessarily generating low-cost products and services. Differentiated products can be generated on simpler technological platforms, differentiating low-tech innovations from low-cost innovations. Although the platform target is the developing countries, these types of innovation can be adopted in the developed world in what is known as reverse innovation [17,29]. This type of innovation meets the requirements of decreasing consumer demand, known as voluntary simplicity [30].

Several concepts are named after the motivating element of the innovation, for instance, resource-constrained or constrained-based innovation [15]. This perspective understands that scarcity conditions stimulate the generation of solutions created by the community under constraints. Resource-constrained innovation differs from frugal innovation by focusing on the environment that originates the innovation instead of focusing on product and target audience characteristics. The Indian term jugaad is constantly used to represent this sense of a simple solution using limited resources to overcome severe restrictions [31]. Jugaad differs from other terms in that it is not a colloquial word, lacking theoretical formalization. Another term coined from the origin of innovation is the so-called grassroots innovation that designates community-led solutions aimed at sustainable development, taking advantage of the knowledge and skills of a local community [32]. The idea of developing local technologies also permeates the concept of indigenous innovation, linked to Chinese economic growth [33].

Another group of terms clarifies the inclusive and socially responsible objective of these types of innovation. Inclusive innovation generally designates initiatives focused on marginalized communities and impacts their livelihoods [24]. The most ambiguous concept in literature, often with multiple definitions, is that of social innovation. The common points among the various definitions are that social innovations include a change in social structure, relationships or systems and that change solves a relevant social problem or meets a human need or goal [34]. This definition is similar to that given by Christensen et al. [35] for a catalytic innovation, which involves new scalable and sustainable solutions for social change. Catalytic Patiño–Valencia et al. [36], in catalytic, differentiate social and inclusive innovation by the type of problem they aim to solve and the type of population assisted. These authors conclude that inclusive innovations are carried out in specific populations as a way to overcome the condition of exclusion. In contrast, social innovations address general problems of society, whether there is exclusion or not.

The term pro-poor innovation [37] is applied here and elsewhere as an overarching concept because it represents the characteristic common to the described concepts of generating benefits to the poorest either intentionally or through externalities. Although there are more innovation concepts in the literature similar to those presented, the definitions in this section are sufficient to analyse the results of this review. These definitions are summarized in

Table 1. Types of pro-poor innovation.

Classification	Concepts	Definition	Background/Origin	References
Commercial concepts	Frugal Innovation	Innovations with substantial cost reduction, optimized performance level, and concentration in main functionalities.	Concept with foundations in the theory Base of the Pyramid. Focus on specific features of the frugal product.	[25]
	Low-cost and Cost-reducing innovation	Innovations that reduce product costs aiming at more competitive prices or increase profit margins.	Cost-focused competitive strategies.	[26,27]
	Low-tech innovation	Innovations based on rudimentary and traditional technologies.	Non-R&D-intensive firms.	[28]
	Reverse innovation	Selling innovations developed in EMs, DMs.	Research on the General Electric case but based on the inverse flow of innovation diffusion.	[17]
Concepts named after their origin	Resource-constrained and Constrained-based innovation	Innovations conceived under conditions of scarcity.	Generating cause of innovation based on the type of environment.	[15]
	Jugaad innovation	Innovation related to the Indian concept of jugaad that indicates an impromptu and unconventional solution.	Specific cultural bases of India.	[31]
	Grassroots innovation	Community-led solutions aimed at sustainable development.	Local movements such as cooperatives and voluntary associations (grassroots movements).	[32]
	Indigenous innovation	Concept related to the Chinese government’s stimulus for the development of local technological innovations.	Innovation based on industrial policy theories and aspects of Chinese culture.	[33]
Explicitly social concepts	Inclusive innovation	Innovations focused on marginalized communities, impacting their livelihoods.	The concept of inclusion; products and services derived from this innovation make it possible to eliminate barriers that limit the participation of specific groups in society	[24]
	Social innovation	Innovations aiming to solve a relevant social problem or to meet a human need or goal.	The theoretical bases of this type of innovation are in development theories, focusing on the generation of well-being and improving the quality of life.	[34]
	Catalytic innovation	Novel solutions for social change that are scalable and sustainable.	Clayton Christensen’s disruptive-innovation model.	[35]

using a classification of definitions proposed by the authors.

2.2. Capability Approach and Instrumental Freedoms

The Capability Approach (CA) is a theory that focuses on the ability of individuals to achieve the kind of life they have a right to value, which distinguishes it from more traditional approaches such as utilitarianism [38]. A person’s ability to have a good life is defined as the set of valuable actions and potential states [39]. The CA was first articulated by the Indian economist and philosopher Amartya Sen in 1980 [40]. CA is of practical importance in formulating public policies, being the basis of the Human Development Reports and the Human Development Index [41]. A prime concept for understanding the CA is that of functioning. Functioning refers to aspects of a person’s state, that is, the variety of things a person can be or do in their life [42] and applies to more basic needs such as ‘being well nourished’ as well as to more complex ones, such as ‘being socially accepted’. On the other hand, a person’s capability reflects the alternative combinations of functioning that a person can achieve [43]. A person’s capabilities will depend on several factors that differentiate how a person converts resources into functioning. Their physiological conditions and physical and social environment limit their access to functioning [42].

In his work, Development as Freedom, Sen considers that individual freedoms are the basic elements of development [44], being, simultaneously, means and ends of its achievement. There is a two-way relationship in which public policies can expand capabilities, and these, in turn, can influence policies through their effective use [45]. That said, certain freedoms play an instrumental role in development, contributing directly and indirectly to people living the way they would like to live [46]. These freedoms represent critical means for capabilities, as they contribute to one’s ability to live more freely and thus directly enhance one’s capabilities. Sen categorizes five basic instrumental freedoms [45] shown in

Table 2. Instrumental Freedoms.

Instrumental Freedom	Definition
Political Freedom	Fair elections, ability to criticize the government, freedom of the press, potential to run for elective office and contribute to the political process.
Economic facilities	Access to financing, credit, and global markets.
Social opportunities	Education, healthcare, and social services, which enable citizens to become productive members of society.
Guaranteed transparency	Open and transparent negotiations in business, government, and any transactions between citizens.
Protective security	Social security net that prevents the population, when vulnerable and exposed to critical changes, from succumbing to extreme conditions such as poverty and hunger.

.

From the above, it follows that the Capability Approach provides a broader analysis of development, considering factors other than purely economic ones, such as income and wealth of the population, for example. This allows development policies to be evaluated more thoroughly.

3. Research Method

This systematic literature review will be guided by the assumptions proposed by Tranfield et al. [47] and replicated in other studies [22,47,48]. The research was structured into the following steps: (1) problem planning and formulation, (2) structuring a search strategy, (3) data collection, (4) sample quality assessment, (5) development of a categorization and analysis system that represents the dimensions of the object of study, (6) synthesis and analysis of the data, and (7) preparation of a research agenda. Step (1) has already been addressed in the introduction section of this article which describes the evidence that justifies the objectives of this review and the scope of the research.

The second step involved two tasks: selection of databases for bibliographic collection and selection of keywords and logical operators to be used. The Scopus and Web of Science databases were chosen to ensure comprehensive coverage of relevant bibliographic material in Innovation and Development. The choice of keywords began with a prior search for previous systematic reviews about PPI concepts and the CA to reduce the subjectivity of the selection. Of the set of keywords contained in these previous reviews, only those with broad meanings that would include too many articles irrelevant to the purpose of this research were excluded. The search terms ‘capability approach’ and ‘capabilities approach’ were used in place of the words ‘capability’ and ‘capabilities’ because they are too generic.

To strengthen the keyword selection process, additional screenings were performed using the ‘bibliometrix’ R package for bibliometric analysis [48]. For PPI, the 2000 most cited articles in Scopus were collected applying all the keywords identified in the four selected systematic reviews (see Table 2), using the ‘OR’ operator to relate them. In addition, it was collected the 2000 most cited articles in Scopus containing the words ‘human development’ or ‘social development’. The 50 most frequent keywords in each of the two searches were analysed, and new terms relevant to the topic under study were included among the words in the systematic review.

Table 3. Keywords related to pro-poor Innovations and Capability Approach.

	References	Keywords
Pro-poor innovations	Agarwal et al. [15]	Catalytic innovation, frugal engineering, frugal innovation, Gandhian innovation, grassroots innovation, indigenous innovation, Jugaad, resource-constrained innovation, reverse innovation, trickle-up innovation.
	Pisoni et al. [10]	Cost innovation, frugal innovation, good enough innovation, grassroots innovation, inclusive innovation, Jugaad, low-tech innovation, resource-constrained innovation, reverse innovation.
	Reinhardt et al. [14]	Constraint-based innovation, cost innovation, cost-reducing innovation, frugal innovation, frugal technology, Gandhian innovation, Gandhian technology, inclusive innovation, low-cost high-tech innovation, low-cost innovation, low-cost strategy, low-cost technology, low-end encroachment, low-end innovation, low-price innovation, low-price technology, low-tech innovation, low-tech technology, resource-constrained innovation, reverse innovation.
	Rosca et al. [20]	Frugal engineering, frugal innovation, frugal innovations, Jugaad.
Capability Approach	Alves and Mariano [22]	Freedom, human rights, vulnerabilities, vulnerability, well-being, capabilities approach, capability approach.
	Lund et al. [49]	Community networks, education, educational status, employment, health, expenditures, housing, income, poverty, social class, social conditions, social environment, social support, socioeconomic factors, unemployment, violence.
	Mariano et al. [50]	Human development, quality of life, social development, social indicators, social performance, welfare, well-being.
	McKinnon et al. [51]	Clean water, empower, food security, health, human capital, livelihood, nutrition, resilience, social capital, vulnerability, well-being, wellbeing, well-being.
	Vaziri et al. [52]	Autonomy, happiness, life evaluation, life satisfaction, mastery, negative feeling, positive feeling, psychological well-being, psychological well-being, subjective well-being, virtue.
	Bibliometrix search	Human development index, inequality, millennium development goals, social change.

lists the keywords pertaining to PPI and CA and the sources consulted, as well as the words included through the analysis using the bibliometric package.

The fields searched were titles, abstracts, and keywords. The search applied the Boolean operator ‘AND’ between the group of words about PPI and the group of CA terms to ensure that the articles included in the initial sample have at least one word from each group. The words of each specific group are connected with the ‘OR’ operator. Other filters were used only to include articles written in English and whose sources are scientific journals. The bibliometrix package was used to remove the articles contained in both databases, forming a raw sample to be analysed for its quality. Duplicate documents not deleted by the package due to slight variations in their base registration were rejected manually.

In Step (4), titles and abstracts were evaluated to eliminate articles that deviated from the main themes of this research.

Table 4. Main reasons for exclusion of articles from the sample.

Reasons for Exclusion	Details and Examples
Articles without access to an abstract.	Example: [53]
Coincidence of words appearing together in the abstract.	The word “cost” ending a sentence, and the word “innovation” begins the following sentence, although the article did not discuss cost innovation. Example: [54]
Economic modelling articles on innovation licensing and competition.	Cost reduction is one of the inputs, but it does not contribute to social aspects. Example: [55]
Articles with a single focus and contribution to environmental aspects.	Example: [56]
Documents selected in the search because of the use of keywords outside the expected context.	Indigenous innovation used for innovation produced by/for indigenous groups.
A few keywords yielded numerous articles that did not contain substantial discussions about social aspects	An example is the keyword “income”.
Editorials without major original contributions were excluded.	Example: [57]
Cases in which the selected words were used only for contextualization, while the article did not offer relevant findings for the purpose of this research;	Example: [58]

summarizes some recurring reasons for exclusion.

This step followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol [59], which gives the number of studies filtered at each step of the selection process (see Figure 1).

In step (5), when the articles were read in their entirety, additional articles were excluded based upon a more in-depth understanding of the scope of these studies, resulting in the composition of a final sample of 165 articles, which was effectively systematized.

Step (5) was based on the qualitative analysis of the content of the bibliographic material [60]. This content analysis began with developing a system of categorization and analysis that represents the dimensions of the object studied by means of previous reading of the collected material. The results were systematized in a table that crossed the types of innovation reviewed in Section 2.1 with instrumental freedoms.

4. Results

In this section, results obtained from the analysis of the collected literature are presented. Before addressing more specifically the content of these articles, however, it is worth mentioning that, (a) from the 165 selected documents, 127 (77% of the total) have been published since 2015; (b) the countries with the largest number of publications, by nationality of the corresponding author, were the USA (23.9%), the United Kingdom (16.3%), Canada (9.8%), Germany (8.7%), Finland (5.4%) and India (5.4%); (c) that only four journals presented five or more articles in the sample: Globalization and Health (9 articles), European Journal of Development Research (6), Innovation and Development (6) and Sustainability (5); (d) the most cited articles in the sample were: Christensen et al. [35] (259 citations), Immelt et al. [61] (226 citations) and George et al. [16] (218 citations), and (e) the authors with the most articles in the sample were Professors Mario Pansera from the University of Vigo (six articles) and Matthew Harris from Imperial College London (five articles).

Developed countries stand out in scientific production on the subject, except India., The cases discussed in the literature are concentrated in developing countries, despite the fact that studies are often led by researchers from Europe and the USA.

During the entire reading of the sample articles, the main findings were labelled in terms of conceptual innovation (frugal innovation, reverse innovation, grassroots innovation, etc.) and the instrumental freedom potentially affected by this type of innovation.

4.1. Economic Facilities

The findings indicate that PPI is important to ensure market access to the poorest as potential consumers and producers through the empowerment fostered by these innovations. In addition, there is potential for productivity gains derived from these innovations. However, there is no consensus about the impact of PPI on poverty reduction and inequality.

One of the common points in research into different concepts relating to PPI is the generation of entrepreneurial opportunities and the opening of consumer markets in the low-income population. Nari Kahle et al. [62] indicate that creating more inclusive markets by multinational corporations enhances economic development. Pansera and Sarkar [63] offer evidence suggesting that innovations generated by the low-income population not only satisfy previously ignored consumer needs but can also foster greater productivity, sustainability, and poverty reduction through more significant income generation. A considerable group of articles, particularly those involving the concept of grassroots innovation, describe the entrepreneurship generated by PPI as closely connected to environmental causes [64,65,66]. Research on inclusive innovation indicates that more accessible technologies can be used to train new entrepreneurs [67], addressing, in part, the problem of lack of entrepreneurial skills [68].

The literature on reverse innovation explains the competitiveness of frugal products and services in foreign markets, which offer cheaper solutions to meet people’s needs while consuming fewer resources [69]. Emerging countries would be pressured to produce innovations to solve their urgent social problems, leading to solutions that would rarely be conceived of in environments with different circumstances [70].

Job creation is a key challenge for pro-poor innovators [71]. There is evidence that PPI in the financial market with the democratization of means of payment and financial and banking inclusion have the potential to create jobs [72,73]. Dey et al. [74] present empirical evidence of grassroots innovations in India that have fostered job creation. Lowe and Wolf-Powers [75] warn that job creation may not be directed at underprivileged classes.

In addition to helping to create jobs, many articles indicated that the development of more accessible funding programs could create conditions for entrepreneurship at the grassroots level [76,77,78,79]. Noteworthy are the technologies that exploit mobile phone coverage in developing countries, such as M-PESA in Kenya [79,80,81]. Smartphone apps allow marginalized communities to access banking services and avoid costly intermediaries by sending money [67].

Some articles presented specific opportunities for women’s economic inclusion. As men and women living in poverty differ significantly in their needs and perspectives on everyday problems, gender equality is a crucial factor in efforts to design frugal products [82,83]. The framework proposed by Vossenberg [84] to evaluate the impact of frugal innovations on gender presents the inclusion of women in the market as one of its main aspects. Alamelu et al. [85] stress that women’s specific needs must be taken into account during product development.

Particularly in the case of grassroots and inclusive innovations, a significant amount of research focuses on exploring the impact of these innovations on the agricultural sector. Some articles deal with land management [86,87] and food security issues supported by innovations [88,89,90]. Furthermore, the literature suggests that a possible obstacle to the participation of rural local groups in the creation and use of new technologies beneficial to them is the level of qualification of people in rural areas [74,91]. Access to more affordable agricultural inputs seems to have a significant impact on economic inclusion [92]. Finally, Baur et al. [93] discuss ways to assess the impact on the development of agricultural innovations.

A considerable number of publications have cast doubt on the potential for poverty reduction and inclusion. Knorringa et al. [94] considered that it would be questionable whether frugal innovation alone would address gender, wealth, or power inequalities between western multinational and low-income consumers. More recent research has indicated that, despite their potential to generate jobs and business, mobile technologies can widen inequalities [72]. Thus, the literature suggests that technologies must be evaluated from the perspective of social justice and debated democratically to be effectively understood as empowering [95,96].

Concerning instrumental freedom, results in developing countries stand out, except research on the impact on poverty reduction (empowerment) and on the concern that job creation occurs only among the wealthiest people, which was demonstrated predominantly in developed countries.

Table 5. Main findings on the impacts of PPI on economic facilities.

Impacts	Predominant Development Level of the Countries Analyzed	Main Findings	Main Countries
Entrepreneurship at the low-income population	Developing	Relationship with environmental causes (grassroots innovation).	India, Bangladesh.
		Opening to international markets.	China
		Relevance of gender aspects.	India
	Developed	Income generation with potential for poverty reduction (empowerment).	Kenya, Finland, Italy, Germany, Belgium, UK, USA.
Employment creation	Developing	Empirical evidence of the potential of PPI to create jobs.	Zambia, India.
	Developed	Concern about the creation of employment for already favoured classes.	USA
Opening of inclusive markets	Developing	Interest of multinational companies in serving low-income people generate economic development.	India, Bangladesh.
		Own base supplying needs by innovative means.	China.
		Innovations targeting women’s specific needs.	India.
Innovations in financing	Developing	Use of applications that exploit mobile phone coverage for banking services.	Kenya.
		Greater access to credit creates conditions for greater entrepreneurial potential for the low-income population.	Kenya, India.

summarizes the main findings of this section.

4.2. Impacts on Social Opportunities

Social opportunities address a wide variety of capabilities that represent basic requirements for citizens, such as good health, basic education, female welfare, and childcare.

Health is the central theme in a substantial number of articles in the sample. Frugal innovations appear to be appropriate for health care organizations that operate under severe resource constraints and can universalize access to health [97]. Bhatti et al. [98] point out sixteen innovations, grouping them into six categories that demonstrate the wide range of options for applying frugal innovation to health care. Another survey of 50 health frugal innovations found that most of the innovations surveyed were generated in developed countries and first marketed in developing countries [99].

In articles dealing with the term frugal innovation, the analysis identified several reports of technical developments that ensure more affordable medical solutions. Baekelandt [100] describes a feasible hysterectomy procedure using reusable laparoscopic instruments and an inexpensive single-port device. Technologies for personalized care, such as cheaper physiological signal monitoring systems, can also reduce inequalities in healthcare [101]. Other diagnostic-related frugal solutions can be cited, such as solutions for detecting biological fluids [102] and those based on mobile technologies [80].

Developing countries face specific challenges in terms of surgical safety and quality. Valiathan [103] points out that the search for more affordable surgical technologies is not a recent phenomenon. O’Hara [104] and Prime et al. [105] describe a device designed to overcome the shortage of surgical drills in low-income countries. Another example of PPI’s potential for complex health procedures is their application in critical care areas such as maintenance of intensive care units, which often require expensive drugs and equipment [106]. In addition, articles on indigenous innovation with locally generated solutions for heart [107] and skull base [108] surgery were also found in developing countries.

Bianchi et al. [97] describe frugal innovations as part of a broader management strategy involving not only the adoption of technology but also the promotion of organizational change. An example of this integration is the development of a service that combines paper-based solutions with the use of mobile phones to provide digital data in clinical case management [6]. Bloem et al. [109] classify as a frugal innovation the development of a network of professionals and patients involved with Parkinson’s disease treatments that enable the dissemination of information about this disorder. The use of information technologies for health system management is also described in articles using concepts other than frugal innovation [80,110]. In addition, research has demonstrated the importance of a national, often state-led, health innovation system to create favourable conditions for development [97,111,112].

Several articles mention limitations in the outcomes of PPI on health because some innovations can be developed under misguided beliefs, such as the use of cola based soft drinks, which were recommended as an inexpensive and reliable source for hydrating patients with severe diarrhoea [113]. In line with this idea, Aranda–Jan et al. [114] state a clear need to establish a holistic view on medical device development. Another problem is the disagreement between offering and adopting innovation for health [113]. The authors cite as an example the heating of breast milk to reduce HIV transmission.

A prominent topic in articles on reverse innovation is their potential to create mutually beneficial cooperation networks between developed and developing countries. Firoz et al. [115] provide evidence that reverse innovation is a way in which nations can globally work together to address maternal health challenges. Another example is the Brazilian model of primary care based on community health agents, which was exported to the United Kingdom [116]. DePasse and Lee [117] describe a model for applying reverse innovation in health.

In order to identify common problems in low- and high-income countries, taking into account knowledge and resource constraints in developing countries, it is important to establish a mutual learning environment to promote the codevelopment of solutions, as evidenced by various studies [118,119,120,121,122,123,124]. Cultural differences can be considered drivers of this type of innovation for health. An example is the practice of yoga that has, due to its health benefits, successfully gained ground in countries such as the USA [125]. Large companies such as Phillips [69] and GE [61] can explore solutions created at their branches in developing countries, generating well-being and promoting health in these countries.

The proportion of health-related articles focusing on the concepts of inclusive and grassroots innovation was less significant compared with other freedoms discussed here. Among these, two studies describe the inclusive potential of nanotechnology applied to drug development [126,127]. Clifford and Zaman [128] and Farmer et al. [129] underscore the importance of policies aimed at strengthening local communities, enabling them to participate in the development process.

A considerable part (38%) of the innovations reviewed by Lehner and Gausemeier [77] focuses on addressing educational inequalities. The literature on PPI seems to be more concentrated on changes in higher education. So, the so-called ‘development universities’ (institutions whose primary academic objective is to foster development and social inclusion through knowledge) can be important centres for spreading PPI [130]. Furthermore, PPI can be supported by community colleges that are more affordable options than traditional long-term university courses, meeting more specialized demands [35].

The literature that relates frugal innovation to medical developments also stresses the importance of both medical and patient education for the development and adoption of innovations for health [6,109,131]. This perspective was also observed in research on inclusive innovation, highlighting the urgent need for remodelled higher education courses in health [128]. An example of educational innovation in healthcare is a proposal of a set of intercultural educational tools for menopausal women to improve communication between them and their caregivers [132].

Articles on grassroots innovations underscore the importance of new learning models better suited to the need for local groups to engage in building solutions [133,134]. White and Stirling [135] present cases of organized local communities for innovation in the United Kingdom, which, while focusing on food production, present the promotion of education explicitly as a secondary objective. As discussed in relation to access to banking services, the use of mobile platforms has also supported access to training, overcoming problems of access to traditional teaching models [134].

The sample also includes articles that describe innovations in access to water. One of the proposals found in the literature is the construction of very affordable iron-based water filters that have good adsorption capacity [136]. The need for periodic replacement of these filters is a common barrier to adopting this technology, but there are already proposals for devices that encourage the user to change them after the specified service life [137]. The results reported by Soto–Gómez et al. [138] suggest that cuttlefish ink is an inexpensive substitute suitable for exploiting the transport of contaminants into groundwater and could be used to develop affordable water filtration systems. Other solutions are based on solar distillation [139] and nanotechnology [140]. While acknowledging the potential of innovations in the water sector, Hyvärinen [141] describe potential barriers to their implementation. Innovations aimed at the poorest do not always go beyond good intentions, as evidenced by the case of a water and sewerage utility in a large city in East Africa [142].

Once more, there was a prevalence of research in developing countries on social opportunities. Among developed countries, the relevance of information technology and community colleges, in addition to new learning methods, can be highlighted.

Table 6. Main findings concerning the impacts of PPI on social opportunities.

Impacts	Predominant Development Level of the Countries Analyzed	Main Findings	Main Countries
Access to health	Developing	New procedures and devices of varying levels of complexity.	China.
		Developing countries have unique conditions that inspire new solutions.	India, Uganda, Syria, Papua New Guinea, UK.
		Significant number of reports on reverse innovation for health.	Mozambique, India, Pakistan, Nigeria, UK, Brazil, Uganda, South Sudan, Liberia.
		Integration between technology and organizational change to improve health system efficiency.	Uruguay, Kenya, Netherlands.
		Some negative impacts (innovations based on misguided beliefs, lack of a systemic view during implementations).	African countries.
	Developed	Relevance of technology-supported information management.	USA.
Access to education	Developing	Providing cost-effective quality education.	India, China, South Africa.
		Higher priority given to higher education in the literature.	Uruguay, USA.
		Improvement in medical education and empowerment of people for personal healthcare.	Kenya, Netherlands, South Africa, Gabon, Egypt, India, Canada.
		Using mobile and internet technologies to democratize education.	Ukraine.
	Developed	Relevance of community colleges.	USA.
		Need for new learning models for empowering local communities.	Spanish, Ukraine.
Access to water	Developing	Research has been identified with reports of technical solutions for frugal water filtration procedures.	Cameroon, Spain, India, South Africa.
		Potential barriers to the implementation of frugal technologies for the water sector are found in the literature.	Tanzania, Kenya.

summarizes the main contributions about the relation between social opportunities and PPI.

4.3. Political Freedoms

Social opportunities address a wide variety of capabilities that represent basic requirements for citizens, such as good health, basic education, female welfare, and childcare.

Democratic aspects such as the empowering role of decentralization of authority are little discussed in traditional innovation models such as the triple helix [143]. In this regard, it is possible to indicate how PPI can broaden political participation, the right to free expression and strengthen democracies.

Overall, studies point to greater political engagement and strengthening the democratization process through PPI. Poorer people find in their own social condition a strong barrier to political participation. By increasing empowerment at the low-income population, PPIs can remove this barrier, contributing to the state-building process [62]. The term with the most documents presenting contributions to political freedom and low-income people engagement was grassroots innovation, perhaps because of its historical exposure to activist movements [144,145]. Paneque–Gálvez [87] states that marginalized groups such as indigenous peoples, through their access to previously financially prohibitive technical skills, may gain a greater mastery over their territories and greater capability to participate in political discussions about their management. While today’s grassroots innovations seem less explicitly political than their predecessor forms, they can still represent a form of political participation [146,147].

By eliminating geographical barriers and giving voice to marginalized groups, innovations such as participatory videos [148] and internet-based applications for participatory mapping [149] provide inexpensive opportunities for citizens to participate in the democratic process. Specifically, regarding the terms inclusive innovation and jugaad, inexpensive solutions in mobile-based telecommunications have been identified [64,150,151]. Of particular note is the case described by Karjalainen and Heinonen [64] of a mobile application developed in response to postelection violence in Kenya in 2008. This application enables mobilization to share crisis information.

Political freedoms were the ones that presented the most balanced proportion between researches in developed and developing countries.

Table 7. Main findings on the impacts of PPI on political freedoms.

Impacts	Predominant Development Level of the Countries Analyzed	Main Findings	Main Countries
Impacts on political engagement	Developing	Through low-income people empowerment, PPI would provide opportunities for political participation.	Indian continent.
		Contribution to strengthening democracy and supporting the state-building process.	Indian continent.
	Developed	Highlighted research on grassroots innovation that originates in activist movements.	Spain, UK.
	Developing	Special relevance of mobile technologies for political participation.	Kenya, India.
Advances in communication	Developed	Free expression and spread of ideas supported by new information technologies and social networks. Examples: Participatory Videos and Mapping Technologies;	Spain, USA.

summarizes the impacts of PPI on the political freedoms collated in this review.

4.4. Transparency Guarantees

Widespread access to information, especially on government affairs, not only broadens economic freedom but also ensures greater clarity about the terms of the social contract between the public administration and citizens.

Despite the paucity of articles dealing directly with aspects of corruption that could be impacted by PPI, some articles have discussed ethical aspects of these new forms of innovation. One term that stands out in this theme is the Indian term jugaad. This term is constantly linked to corrupt traditional Indian practices having a primarily negative cultural connotation. The sample authors criticize the use of the word to designate an innovation for reinforcing systemic risks in India [152] and legitimizing corrupt practices [153]. The articles have no central focus on the innovation aspects of these practices. Thus, some innovations known as Jugaad in India may have positive purposes and social impacts.

Two articles discuss the ethical aspects of inclusive innovations [143,154]. For these authors, the discourse connected with this kind of innovation has always been shaped by widely implied value assumptions, and discourse about inclusive innovation reflects unease about some of the most common values. Thus, from an ethical point of view, innovations aimed at inclusion need to be in line with the values and principles of those most in need.

Innovators often have to deal with faulty institutions, corruption, unclear property rights, inadequate infrastructure and cultural barriers [155]. In discussing possible advantages of infrastructure-related frugality, Asakawa et al. [156] argue that overcoming is time-consuming and that this type of strategy requires long-term support. In particular, from the legal standpoint, Yadav [73] describes the project to unify citizens’ registries in India, an innovation with the potential to create a more trusting environment and speed up legal proceedings.

Research on transparency in developing countries is concentrated in India due to the emphasis on jugaad innovation. Evidence from Norway on the importance of considering values when analyzing ethical aspects was also highlighted.

Table 8. Main findings on the impacts of PPI on transparency guarantees.

Impacts	Predominant Development Level of the Countries Analyzed	Main Findings	Main Countries
Corruption	Developing	Jugaad stands out for its negative cultural connotations.	India.
	Developed	Low-income people values should be considered when analyzing ethical impacts of PPI.	Norway
	No specific countries	Paucity of articles dealing directly with corruption.	-
		Lack of support to decisively confirm the corruption impacts of Jugaad innovations;	-
Institutional voids	Developing	PPI can be adopted to overcome weak institutions.	India
	No specific countries	Solutions to overcome the lack of infrastructure (hard and soft) and legal uncertainty stand out.	-

summarizes the impact of PPI on transparency guarantees.

4.5. Protective Security

The contributions found in the literature on PPI for protective security can be divided into two fronts: protection in the event of financial crises and protection in emergencies caused by natural disasters and climate change.

As for the insertion of PPIs in markets undergoing an economic recession, the crisis scenario seems to influence the decision process regarding the adoption of innovations since low-income consumers are more vulnerable [157]. This innovation class can be crucial for the survival of companies in developing countries during crises, enabling growth, which underscores the importance of emerging markets in the global economy [69]. Schillo and Robinson [158] point out that during economic crises, innovations may produce negative results, such as increased income inequality, even if these innovations lead to economic growth. Thus, the authors suggest that to identify innovation as inclusive, economic, environmental, and social outcomes should be evaluated.

Poor communities are the ones that suffer most from environmental unsustainability, and it is the poor people that suffer the most from calamities caused by climate change and environmental degradation, such as floods, droughts, fires and famines [159]. In this regard, a concept that relates PPI with environmental problems is the idea of green leap innovation, whereby businesses of the low-income population are involved in the sale of clean and regenerative technologies [155,159]. Nevertheless, despite the potential of PPI to protect against environmental problems, there is evidence in the literature that this type of innovation can also engender environmental concerns such as deforestation and pollution [160].

Relevant research on protective security has focused only on developing countries, most likely because of their characteristic of greater social vulnerability.

Table 9. Main findings on the impacts of PPI on protective security.

Impacts	Predominant Development Level of the Countries Analyzed	Main Findings	Main Countries
Financial crisis	Developing	Decision to adopt products from PPI is influenced during crises due to increased vulnerability of the low-income population.	Brazil.
		During crises, companies can serve emerging markets to ensure their survival.	China.
	No specific countries	Need for holistic analysis of the impact of innovation during crises.	-
Environmental problems	Developing	Poor people suffer most from calamities caused by climate change and environmental degradation.	Bangladesh.
		There are indications in the literature of possible environmental concerns resulting from PPI.	Kenya, Tanzania.

summarizes the key protective security impacts of PPI discussed in this section.

Figure 2 summarizes the findings of the systematic literature review.

5. Conclusions

This article is the first to systematically review the literature on the various concepts relating to pro-poor innovations and the Capability Approach. Thus, this systematic review explains how an innovation type can impact each type of instrumental freedom, allowing for a more systemic analysis. As many of the empirical results of studies presented in the review come from case studies, the resulting impacts should not be generalized, and further studies are required to confirm them. The findings of this literature survey indicate that, in general, the various concepts of pro-poor innovations (frugal innovation, grassroots innovation, including innovation, among others) do not differ significantly in terms of their relationship to CA’s instrumental freedoms. This may show that the slight conceptual differences between the terms are not sufficiently significant to address social aspects.

Especially concerning pro-poor innovations, this review clarifies that even innovations with a commercial purpose can potentially present positive social externalities. For example, the focus on eliminating secondary features in frugal innovations allows poorer people to access a broader range of opportunities. Companies that develop products that serve people in a state of vulnerability must consider capacity effects during product development.

In addition to strengthening the theoretical bases of the social aspects of these emergent innovation concepts, this review fills an important gap in the CA literature by applying it in the context of innovation. The results demonstrate the utility of using this development theory for a more complete assessment of the relationship between innovation and its impact on society, considering not only economic aspects.

Research on PPI so far indicates positive contributions to the expansion of freedoms. The freedoms with more direct relationships with PPI were economic freedoms and social opportunities due to the common characteristic of this type of innovation to generate more affordable products and services for the low-income population. Regarding social opportunities, the analysis highlights the numerous studies that focus on the expanding reach of health services for the low-income population, mainly involving the concept of reverse innovation. It is important to point out that although more positive impacts of PPI have been identified, this review indicated potential negative effects in cases where there is not a sufficiently systemic analysis in the design and implementation of innovation.

Future empirical research may further evaluate the relationships established in this research, especially by evaluating possible trade-offs between the instrumental freedoms presented here. The inverse relationship in which the level of capabilities can influence the generation of PPI may be the subject of future research that could also use other concepts from CA to assess the type of innovation discussed here. For example, the concept of conversion factors could be applied to better understand how resources coming from PPI would effectively become capacities for the poor. The volume of research on certain instrumental freedoms (political freedom, transparency guarantees and protective security) was found to be smaller than that on other freedoms, requiring further investigation.

This article offers practical contributions for public managers wishing to foster PPI by pinpointing the social conditions that have stimulated, or prevented, the generation of this type of innovation and by indicating possible benefits for human development, thereby supporting the decision making process. Practitioners can select the innovation mechanisms that have shown the most results for specific social goals. For example, for health managers, the results point to an emphasis on reverse innovation practices. Furthermore, science and technology public policymakers can use instrumental freedoms as a more complete framework for evaluating the social impacts of their decisions.