In 2019, a mobile health platform was reaching millions of expecting and new mothers through South Africa’s national public health system, allowing them to access relevant health information, timely support, and receive text reminders to help them manage their pregnancy.
The South African Department of Health was funding the platform directly and planned to integrate the program into a permanent governance home. But a year later, the senior government official who had championed the partnership resigned. Along with the disruption of the COVID-19 pandemic in 2020, the platform’s momentum in scaling with government vanished. Years of relationship-building dissolved, forcing the team to rebuild relationships with an entirely new set of stakeholders. While the platform continued to grow, the pathway to institutional sustainability had fallen all the way back to the starting line.
This example isn’t unique. Across GCC’s portfolio, the same pattern appears: even the best and most promising innovations can still struggle to scale when the systems around them aren’t ready to adopt them. What are some of the challenges? In some cases, government partners weren’t engaged early enough. In others, the idea wasn’t sufficiently aligned with government priorities, or there wasn’t a clear pathway for government to fund, procure, or integrate it into an existing program.
As part of my Master’s Capstone project at the University of Toronto’s Munk School of Global Affairs and Public Policy, I am looking for patterns in this scaling challenge to help GCC address barriers to scaling. Alongside GCC’s new Policy, Learning and Reporting team, I reviewed 17 global health innovations spanning maternal and child health, mental health, digital health, and sanitation across 12 countries in Africa, Asia and South America, tracing each one’s relationship with government from first contact through to formal adoption.
Three insights emerged from examining our investments this way, and each has a direct implication for how GCC prioritizes support.
Insight one: The hardest stage isn’t the first one
Most of the innovations I looked at already engaged with government partners, but moving from government awareness of an innovation to an active partnership in building it is the hardest threshold to clear.
When government is still treated as something to be convinced, rather than something to build alongside, it’s a lot harder to move from awareness to partnership. The innovations that moved beyond this threshold tended to involve government in the work itself.
The innovators who succeeded built their models around existing government strategies and worked with public-sector partners to shape how the innovation would be delivered, rather than developing the model independently and then seeking government approval. Early engagement mattered most when it created shared ownership of a solution.
Insight two: Timing is part of the strategy
There are particular opportunities for governments to act. For example, a local government sets a new priority, revises a guideline or reallocates a budget. The GCC-funded innovations that leveraged these moments well weren’t guessing about when the opportunity would appear. They were prepared. They had already built relationships with relevant decision-makers, generated evidence that responded to government needs, and understood where their innovation could fit within the existing system.
When an opportunity emerged, the innovator was already positioned to respond with the right relationships, evidence, and a clear path for government action. This reframes what readiness support looks like: it’s less about moving fast once an opportunity appears and more about doing the groundwork early enough so that you are ready when it does.
Insight three: government as an early-stage partner, not an endpoint
Reaching government adoption is never just the result of a single factor. Every case that reached this stage had three conditions in place at once:
- an engaged government champion,
- a clear and realistic action being asked of government
- and a real, already-existing route to scale: whether it was a procurement process, a budget line, or a place in an existing government program.
Importantly, these conditions reinforced one another. A strong government relationship helped innovators understand what decision-makers needed. At the same time, a realistic pathway to adoption made it possible to turn that support into action. The innovators who engaged government as a design partner from an early stage, rather than as a target to eventually win over, moved towards government adoption faster.
These three patterns are a useful starting point. The next step is to look more closely at the underlying data and understand not just whether an innovation has stalled on its path to scale, but why, and how to get it moving again. For funders, that distinction matters: understanding where the gap lies can help identify the relationships, evidence, or pathways needed to move an innovation forward. In this way, portfolios can become more than collections of projects; they can become tools for learning, adaptation, and more sustainable impact.