When we think about how new medical innovations make their way to patients, the pathways feel familiar and (relatively) well defined. A new drug molecule moves from laboratory discovery, through phased clinical trials, to regulatory approval, and eventually into public procurement mechanisms that stock hospitals and pharmacies. Vaccines and diagnostics follow similarly structured stage-gates—rigorous evidence generation, regulatory oversight, pooled procurement, and policy inclusion. 

For digital health innovations, however, the story is very different. Whether it’s a referral app connecting rural clinics to hospitals, a tele-counseling chatbot for adolescents, or an emergency transport dispatch platform, innovators often find themselves in uncharted waters. There is no universally recognized pathway to navigate from promising pilot to public sector adoption at scale. The result is a frustrating cycle: countless promising tools launch as pilots, only to stall when it comes to public sector adoption. 

At Jhpiego, we’ve seen this problem repeat in our own work over the years. Now, in our role as lead operator of the HealthTech Hub Africa – along with partners Villgro Africa and HELINA – we’ve heard it echoed by countless startup founders. 

African health systems are under extraordinary pressure. Adolescents need confidential and trustworthy health information. Clinicians need tools to reduce administrative burden. Patients need faster referrals, reliable emergency transport, and continuity of care. Digital solutions can and do help. But unless they scale through the public system—still the major provider of care in most African markets—they remain a patchwork of isolated pilots, duplicating effort and leaving many communities behind. 

Governments, innovators, and funders all sense the potential, but governments hesitate to procure because the rules of the game are unclear. Innovators hesitate to invest in growth because they can’t see a pathway to long-term sustainability. Funders hesitate to back scale because they lack confidence in what the system will ultimately buy. Everyone is stuck. 

Contrast this with traditional medical innovation. For drugs, vaccines, and diagnostics, the journey is well defined: 

• Stage-gates: Discovery → Proof of concept → Clinical trials → Regulatory approval → Policy inclusion → Procurement → Post-market monitoring. 

• Oversight: National drug regulators, ethics boards, Ministries of Health, the World Health Organization (WHO), UNICEF, the Global Fund. 

• Funding instruments: Research and development grants, trial financing, pooled procurement mechanisms. 

• Monitoring and accountability: Pharmacovigilance, lot testing, ongoing safety surveillance. 

The clarity of this pathway allows innovators to plan, investors to support, and governments to adopt. No one would dream of rolling out a new vaccine nationally without these checks in place. 

Digital health innovations, which increasingly shape patient care and population health, deserve the same predictability. 

Drawing inspiration from these established pathways, we can imagine a nine-stage universal pathway for digital health solutions: 

1. Prototype & Concept – minimum viable product aligned with national health priorities, user needs, and local context. 
2. Early Field Validation – small-scale pilots demonstrating usability and feasibility. 
3. Evidence & Impact Data – outcomes, cost-effectiveness, and equity impacts. 
4. Regulatory & Compliance – oversight from health regulators, ICT authorities, and data protection commissions. 
5. Interoperability & Standards – readiness to integrate with national health information systems. 
6. Policy & Clinical Endorsement – alignment with digital health strategies, inclusion in clinical workflows. 
7. Business model & Procurement Readiness – target payers, revenue models, distribution channels, model contracts, service-level agreements, pricing, and licensing frameworks. 
8. Operational Capacity – demonstrated ability to provide support, training, and ongoing maintenance. 
9. Monitoring & Sustainability – dashboards, reporting mechanisms, and financial planning for long-term use. 

When we hold digital health against this framework, several challenges and gaps become clear: 

• Stakeholder alignment: Scaling digital health solutions requires buy-in from multiple different actors (patients, clinicians, health systems, insurers, employers, regulators), each with their own incentives and adoption criteria. 

• Regulation: Many countries have not yet defined whether digital health apps, AI-driven tools, or SMS-based interventions fall under health regulators, ICT authorities, or a hybrid. The pace of change outstrips regulators ability to keep up. Innovators face uncertainty around what sorts of evidence and analyses they need to provide, and ministries may delay decisions for fear of risk. 

• Procurement systems: Government procurement was designed for tangible goods—drugs, hospital beds, vehicles. Service contracts for a cloud-based chatbot don’t fit neatly into those templates. This leaves ministries improvising, often without legal comfort. 

• Budgeting: Few health budgets include line items for digital solutions. Even if a tool is approved, there is often no mechanism to pay for it sustainably. 

• Post-market monitoring: We have well-established systems for pharmacovigilance, but very few countries track algorithm drift, privacy breaches, or digital equity in uptake. 

• Integration and standards: While some countries have invested in national digital health architectures, many still lack robust interoperability frameworks, making it difficult to integrate new tools.  

These gaps explain why pilots flourish but scaling stalls. Unlike vaccines or diagnostics, digital solutions are often left in limbo, neither fully approved nor fully rejected. 

Closing these gaps does not require reinventing the wheel. Much of the infrastructure already exists in other domains of health innovation. A few targeted steps could radically accelerate digital health scaling: 

1. Publish digital health readiness roadmaps. Ministries of Health could set out expectations for evidence, interoperability, compliance, and procurement readiness—just as drug regulators publish trial requirements. 

1. Pilot regulatory and procurement sandboxes. Governments could create structured environments where digital solutions are trialed with clear terms, allowing risk-managed experimentation without bypassing procurement law. HealthTech Hub Africa is already creating a  Standards & Interoperability Lab for interoperability testing and certification of solutions.  

1. Adapt procurement and budgeting models. Ministries could adjust templates to handle software licenses, recurring service contracts, and operational expenditure for digital services. 

1. Invest in “bridge institutions.” Digital health units, independent evaluators, or standards-setting bodies can play the role of arbiters, much like ethics boards or pharmacopoeias in traditional health innovation. 

1. Strengthen post-market oversight. Build mechanisms for monitoring data security, usability, and equity, so governments can have confidence in solutions even after adoption. 

These are not radical reforms. They are practical steps—borrowed from pathways that already work for other innovations—that can bring predictability to digital health. 

As a practical first step, here’s a stage-gate checklist for innovators. Before approaching governments, ask: 

• Strategy and policy alignment: Have we aligned with relevant strategies, policies and stated government priorities? Is our value proposition for governments clear? 

• Evidence: Do we have credible data showing strong adoption, improved client and/or health system outcomes, and value for money? 

• Compliance: Have we mapped and ensured compliance with regulatory, ICT, and data protection requirements? 

• Integration & Interoperability: Can we integrate with existing service delivery workflows and health information systems? Are we compliant with national and international data standards? 

• Procurement readiness: Do we have pricing models, service-level agreements, and contracts that a ministry could sign? 

• Operational readiness: Can we deliver at scale—training, support, ongoing maintenance? Have we engaged the right local stakeholders and appointed dedicated liaisons to work with any government champions? 

• Sustainability: Do we have a plan for financing maintenance, upgrades, and monitoring? 

Innovators who can confidently answer these questions will find themselves far better positioned when engaging ministries and funders. 

If we build this clarity, Africa’s digital health innovators can finally move beyond fragmented pilots. Governments will gain confidence to procure solutions that meet clear criteria. Funders will know precisely where their catalytic support makes a difference. And most importantly—patients, health workers, and young people will gain sustained access to digital tools that improve care and save lives. 

We’ve solved this before, with drugs, vaccines, and diagnostics. It took decades to refine those pathways, but they now make possible the rapid introduction of lifesaving tools around the world. It’s time to do the same for digital health—building predictable, trusted stage-gates that allow innovation to scale safely and sustainably. 

Because in the end, innovation doesn’t save lives until it scales 

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Joanne Peter is Senior Advisor to the HealthTech Hub Africa, operated by Jhpiego. With thanks to Pulkit Aggrwal (Grand Challenges Canada) and Rob Beyer (Villgro Africa and Senior Advisor to HealthTech Hub Africa) for their useful contributions.