In December 2021 we submitted a speculative and unsolicited proposal to the Botnar Foundation. The SDG3 (health and wellbeing) Global Council had been overseeing work, in the global south, on innovation in healthcare products and services. They had noted that very few innovations achieved scale. Many never expanded beyond a pilot phase. This was particularly evident in public sector led, primary healthcare, innovations involving digitisation and related to last mile services delivery. Our proposal suggested supporting a global SDG3 Working Group (WG) to address these issues. It was approved in March 2022. Our four-person team worked closely with global healthcare organisations and regional and local implementers in east Africa. Our in-country research, case work and validation checks took place between June 2022 and September 2023. The final report and case studies were delivered in November 2023. These were approved in December 2023 and the programme was finalised in March 2024.
The outputs from our work were aimed at health policymakers, government officials programme implementers and healthcare funders. They have provided insights on how to address the structural constraints to scaling innovation in African healthcare systems. They focused on last-mile delivery of services via telehealth and digitisation. Our findings and insights were based on results from four case studies undertaken in four countries in east Africa, plus a literature review and feedback from global healthcare experts. Our findings and insights covered two pillars influencing scale: eight systemic factors; and ten process factors. Our report reached two main conclusions: many projects are transactional and should aim to focus more on the resilience of the primary healthcare system from within; and current scaling practice divides the process into piloting and scaling. This factor constrains innovation scale. Many scaling strategies prove concept through a pilot with the emphasis on the innovation, not the process. Innovation development should be a single process. Our report concluded by drawing together the thoughts of informants and researchers on priorities. These comprised four ‘calls to action’: a greater emphasis on initiatives that strengthen the resilience of the primary healthcare system; the need for a catalyst for next generation scaling models and frameworks; the dissemination of emerging scaling practices in an African context; and the establishment of a central healthcare innovation repository.