Across Africa, there is no shortage of healthtech innovation. Governments are investing in digital health strategies and policies. Donors and ecosystem actors continue to fund innovation challenges, accelerators, and demonstration projects. Yet, despite years of pilots and growing enthusiasm around healthtech, public-sector scale remains largely unresolved.
I recently left a co-design workshop hosted by HealthTech Hub Africa in Nairobi that brought together government officials and innovators from across 8 African countries thinking less about healthtech innovation itself and more about health systems. One conclusion emerged clearly throughout the discussions: “The core challenge is not a shortage of innovation, but a weak connection between innovation and public-sector health systems.”
This distinction matters. Much of the current conversation around healthtech still assumes that if a solution proves technical value, that if it is well aligned with government priorities, scale should naturally follow. But the workshop discussions repeatedly showed that many innovations fail not because they are technically weak, nor because they are misaligned with government priorities but because they do not enter the system at the right time, through the right pathway, or with the required institutional, financial, and political alignment.
In other words, health innovation does not scale because it works. It scales because systems can absorb it.
“Bureaucracy” Versus “Checks and Balances”
Again and again, participants resounded that public-sector scale depends not only on the product quality, but also on timing, fitness, process, and trust.
The clearest example was procurement.
Innovators described government procurement systems as “bureaucratic, slow, and difficult to navigate.” Government officials described those same systems differently, citing “fairness, accountability, process control, and risk avoidance.” At one point, the divide was captured in two competing phrases: “bureaucracy and checks and balances.” Both sides were often describing the same reality.
What innovators experience as inefficiency is frequently, from within government, a distributed architecture of responsibility spread across technical teams, finance units, procurement offices, committees, and accounting structures. As the workshop noted, “the problem is not only technical or financial; it is also conceptual and linguistic.”
In the baraza session, the underlying tension between government systems and innovation practice became visible, not as conflict but as structured listening. Government officials and innovators sat in a shared circle each side required to sit through the other’s lived reality without interruption. As the session unfolded, what had previously remained abstract became tangible. The divide was no longer theoretical; it was experienced in real time through language, assumptions, and interpretation. What emerged was not immediate alignment, but a gradual softening of certainty, as each group encountered the internal logic of the other for the first time in full.
It was in this moment of mutual exposure that a kind of perspective inversion emerged, not agreement, but recognition. Innovators began to see procurement not simply as friction, but as a system designed around accountability. Government officials, in turn, could hear more clearly how those safeguards translate into delay, opacity, and frustration at the point of implementation.
The discussions also made clear that procurement systems were largely designed for goods and standard services rather than “digital, service-based, and adaptive technologies.” As one participant put it; “Healthtech is difficult to procure because it behaves differently from standard commodities.” Digital systems require updates, maintenance, hosting, retraining, interoperability management, cybersecurity protections, and ongoing technical support. Yet procurement systems often continue to evaluate healthtech as though it were a static commodity rather than a long-term service relationship.
The Pilot-to-Scale Gap
The pilot-to-scale gap is one of the clearest signs that the ecosystem is still confusing proof of value with readiness for adoption.
The participants agreed that even though a donor-funded pilot performs well, the technology demonstrates value, outcomes are positive, the innovation still fails to move into routine financing, procurement, and system adoption. Not necessarily because the pilot was a failure but because the pilot was never fully designed for scale.
In many cases, pilots are built around proving technical value but not around answering the realistic public-sector questions: who owns the system after the pilot ends, how it will be financed, which procurement pathway supports it, what department will manage it, and what implementation burden it creates.
One participant put it candidly: “We proved it works, but that did not solve who pays, who owns, or who maintains it.”
That is the real tension. Technical success is not the same as institutional readiness. A pilot can show that something works in a controlled environment, but that does not mean a public system can absorb it, sustain it, or govern it. If scale is the goal, then pilots must do more than demonstrate outcomes. They must create a possible transition path to financing, ownership, and continuity or what in this space we call sustainability.
Timing, Trust, and Readiness
Government officials identified timing as a structural determinant of scale. In their observation, by the time many innovators approach ministries, annual workplans and budgets have often already been finalised. Procurement begins long before a public call or tender appears. If innovation is not already reflected in planning and budgeting processes, there may be little room to accommodate it later, regardless of its relevance. This makes timing not just a practical issue but a strategic one.
Innovators often enter when they are ready to sell. Governments, however, need solutions to show up earlier during planning, budgeting, prioritization, and policy formation. By the time a tender appears, the most important decisions may already have been made.
Trust emerged just as strongly. What stood out was the way governments described trust not as emotional, but institutional. Public officials may hesitate to support new technologies not because they oppose innovation, but because they are accountable for consequences in ways companies often underestimate. Supporting an innovation that later fails may carry real professional risk.
Governments raised concerns around sustainability, sensitive data, and long-term system functions. Innovators, meanwhile, raised concerns around delayed payments, policy continuity, and changing decision-makers. In many ways, both sides were describing the same underlying problem: uncertainty inside fragmented systems.
Perhaps this is why the discussions repeatedly returned to the need for translation and brokerage, not simply matchmaking between governments and innovators, but translation between different ways of understanding risk, evidence, sustainability, accountability, and public value.
So then, what is the challenge?
I left co-design workshop with the view that the challenge is not simply whether a solution works, rather it is whether health systems are ready to absorb it.
That means designing for scale from the start, not treating the pilot as the finish line. It means aligning innovation with country budgeting cycles, procurement pathways, institutional ownership, and public accountability. And it means recognising that scale is not earned by technical promise alone, but by the system’s ability to carry, finance, and sustain what has been introduced.
Because health innovation does not scale because it works. It scales because systems can absorb it!
Elizabeth Mbugua
Government Affairs and Policy Lead, HealthTech Hub Africa
