Who Pays for Innovation That Saves Mothers and Newborns? 

What happens when life-saving innovations stall—not because they don’t work, but because no one wants to pay?  

That was the uncomfortable question at the heart of our recent Real Talk series, where three experts tackled a topic we often whisper about in hallways but rarely say out loud: Who should pay for maternal and newborn health (MNH) innovations?  

The conversation brought together Aparna Kamath of Grand Challenges Canada, Rubayat Khan from Endless Network, and Jean-Philbert Nsengimana, Chief Digital Advisor at Africa CDC and former Minister of Youth and ICT in Rwanda. Each offered a candid perspective on why proven solutions fail to reach the people who need them most, and what it will take to change that.  

Where Good Ideas Go to Die  

We know the story: an innovation is piloted, it works, it even shows impact. And then… nothing.  
Jean-Philbert put it bluntly: “The graveyard of pilots is still full.”  

Failure isn’t inherently bad—every healthy innovation ecosystem needs experiments that don’t pan out. But when successful pilots fail to scale, that’s when alarm bells should ring. According to PATH’s Beyond Pilotitis report, 87% of digital health pilots in LMICs never make it beyond the pilot stage. That’s not just inefficiency—it’s a missed opportunity to save lives.  

Why Do Successful Pilots Stall?  

The reasons are complex, but several themes stood out during the discussion:

Fiscal Constraints 

Despite the 2001 Abuja Declaration pledge to allocate 15% of national budgets to health, most low- and middle-income countries spend less than 1% of GDP. After covering hospitals and workforce costs, there’s little left for innovation. With foreign aid retreating, the fiscal space for new solutions is shrinking even further.  

Decision Paralysis 

Innovation moves faster than government decision-making. Aparna noted that by the time ministries gather evidence and navigate approvals, the technology may have evolved or political priorities may have shifted. This lag creates uncertainty and slows adoption.  

Unrealistic Timelines 

Donors often expect governments to adopt successful pilots within 12 to 18 months. In reality, procurement cycles can take three to five years or more. This mismatch creates what Aparna called the “valley of death,” where funders step back just as governments are gearing up.  

Procurement Bottlenecks 

Public procurement systems were never designed for fast-moving digital health solutions. They were built for roads and buildings—projects that can be planned years in advance. As Jean-Philbert explained, anything not in the procurement plan simply doesn’t get purchased, no matter how transformative it might be. By the time an innovation proves its worth, the budget cycle has closed, leaving little room for agility.  

Trust Gaps 

Even when funding exists, trust between governments and innovators often falls short. Rubayat pointed out that many pilots launch without early conversations with ministries, creating disconnects about priorities and expectations. Governments question whether private-sector solutions truly solve their problems, while innovators struggle to navigate opaque regulatory landscapes. Without trust, and clear pathways for collaboration, successful pilots risk becoming isolated experiments rather than integrated solutions.  

Need vs. Demand 

Innovators often design for need without asking whether there is demand, meaning someone with both the willingness and ability to pay. Jean-Philbert captured it perfectly: “There could be a gap in the market, but is there a market in the gap?” If no one is willing to pay, the innovation stalls.  

The Role of Government and Its Limits  

Governments are critical players, especially in LMIC health systems. But their role isn’t always to be the ultimate payer-at-scale. Jean-Philbert reminded us that when there is no market in the gap (particularly for some of our most vulnerable mothers and newborns), that’s a market failure, and governments need to step in. But if there is a market, we can pursue market-linked business models without defaulting to government as the only solution.  

This means innovators and funders must think beyond handover-to-government as the inevitable endgame. Partnerships, blended financing, and private-sector models can—and should—play a role.  

The ‘Plumbing’ Problem  

Rubayat raised another uncomfortable truth: donors love funding shiny innovations, but not the ‘plumbing’—the policies, systems, and ecosystem enablers that make those innovations succeed. Without investment in public digital infrastructure, regulatory frameworks, and procurement reform, even the best tools remain stuck between pilot and permanence.  

Africa CDC’s Digital Health Marketplace is one bright spot, curating proven solutions and presenting them to governments to reduce decision paralysis. But these enabling investments are still an exception, not the norm.  

Bright Spots and Emerging Solutions  

There are reasons for optimism. Zipline’s drone delivery model scaled because of a three-way partnership: venture capital, philanthropy, and government buy-in. Maziwa’s breast pump rental model shows how business-model innovation can unlock access for low-income workers. And innovation sandboxes and ‘challenge-based’ procurement (now being pioneered in Rwanda, Senegal, Tunisia) offer governments a way to experiment without being hamstrung by rigid rules.  

Coordination efforts are also gaining traction. Africa CDC recently convened donors to align investments and reduce duplication, a critical step toward fixing what Rubayat called a “coordination failure” in the ecosystem.  

It feels so wrong to keep watching maternal deaths when the right solutions exist.

What Does This Mean for MNH?  

For Jean-Philbert, the answer was urgency: “It feels so wrong to keep watching maternal deaths when the right solutions exist.”  

For Aparna, it was about focus: we don’t need shinier tech. We need innovation in how we scale what already works.  

And Rubayat reminded us of the bigger picture: we’ve focused so much on sick care that we forgot the goal of healthcare is to keep people healthy. Building resilient primary care systems and empowering communities must be part of the solution.  

The Bottom Line  

If we want to save lives, we need to innovate not just in technology, but in financing, partnerships, and policy. That means:  

• Donors must contribute to the plumbing, not just the shiny objects.  

• Governments must address market failures. 

• Innovators must design for integration from day one.  

• Scaling requires time and systems.  

The conversation doesn’t end here. Join us at IMNHC 2026 in Nairobi, where innovation financing will be front and center. Because the question isn’t whether MNH innovations work. It’s whether we’re willing to pay for what works.