Written by: Wilfred Njagi, Co-Founder and CEO, Villgro Africa; and Waringa Kamau, Partnerships & Stakeholder Engagement Lead, Villgro Africa
On average, governments in East Africa manage 70-90% of the health system. As a result, many health startups often find they must partner with the government in order to scale. However, while key for growth, collaborating with governments can be fraught with challenges. Villgro Africa’s experience in supporting health tech startups to scale through the public sector demonstrates that enterprise support organizations (ESOs) have a central role to play in reducing the friction that can mar the collaboration between governments and health innovators. This blog highlights four ways how, drawing on Villgro Africa’s work with Murang’a County government in Central Kenya. This work forms part of the Million Lives Collective’s Ecosystem Catalyst programme, through which Villgro Africa and E&K Consulting facilitate the MLC’s East Africa Regional Hub, with support from Grand Challenges Canada.
Across the health innovation ecosystem, enterprise support organizations identify promising innovations, support innovators to strengthen their businesses, generate evidence, and create opportunities for them to engage with governments.
All of these activities are important. However, our experience suggests they are most effective when anchored in a clear understanding of government demand. During our initial engagement with Murang’a County government, we began by simply listening to county officials. They spoke candidly about their needs: strengthened emergency referral systems, improved maternal and child health, enhanced blood supply and laboratory services, expanded access to primary healthcare, strengthened disease surveillance, support for community health promoters, and improved responses to gender-based violence. These were not abstract policy priorities. They were practical challenges shaping the County’s ability to deliver quality healthcare every day.
County health leaders were not asking where they could find more innovation. They were asking how they could strengthen referral systems, improve service delivery, reduce stock-outs, and expand access to care within the resources and systems available to them. Innovation was valuable, but only if it addressed those priorities and could realistically work within the health system.
Only after those priorities had been clearly articulated did the conversation turn to innovation and the innovators that were best positioned to respond.
Having taken the time to understand Murang’a county government’s health priorities, we realized that there was a need for an objective and transparent way to match the county with health innovators who had the necessary expertise and capacity to meet the county’s ambitions, and that were genuinely ready to operate within the realities of a public health system. With the MLC, we reviewed existing global scaling frameworks, drew on the growing body of literature on innovation scaling, and combined these insights with what innovators themselves had told us about navigating the public sector. Together, these informed the development of the Million Lives Collective’s Public Sector Scaling (PSS) Readiness Tool, a practical framework designed to assess not only the strength of an innovation, but its readiness for public sector adoption.
Using this approach, we mapped 40 public sector scale-ready innovations, sourced from the MLC portfolio and beyond, against Murang’a’s articulated priorities. Each was assessed before progressing through the matching process, allowing the County to move beyond identifying interesting technologies, and towards identifying solutions that were relevant, implementation-ready, and aligned with its health system priorities.
This process ultimately led to five ventures, Ambulex, Care360, LifeBank, Zipline, and Zuri Health, being shortlisted for deeper engagement. After each startup presented their innovations to the county, county officials and innovators moved into technical working sessions focused less on what the technology could do and more on what implementation would actually require. They explored issues such as integration with existing health information systems, patient data governance, financing and long-term sustainability, compatibility with existing workflows, and the evidence that would be needed before scaling further. In other words, the central consideration driving this process was not “Is this an impressive innovation?” but rather “Can this realistically become part of our health system?”
This demand-led approach bore fruit: in August 2026, two of the shortlisted ventures, Ambulex and Care360, signed Memoranda of Understanding with Murang’a County, moving from initial matching and technical discussions towards implementation. Ambulex will work with the County to pilot a digital emergency medical services and ambulance coordination solution, supported by a joint Technical Working Group overseeing implementation. Care360‘s partnership responds to a different set of county needs. Its 12-month pilot brings together mental health step-down and rehabilitation care, support for the establishment of a GBV safe house, and initiatives to strengthen the local health workforce, including caregiver training and the development of local wound-care training capacity. In the background, we provided strategic support and coaching to the entrepreneurs as they navigated the process with the county, while also supporting the costs and logistics associated with these partnership engagements.
Without this mediation and matchmaking effort, it would have been very difficult for the parties to attain a mutual understanding of each others’ needs and collaborate effectively.
Conducting needs assessment exercises to enable local and national governments articulate their priorities, then matching those priorities to a pipeline of incubated ventures that have the expertise and the capacity to work within government systems, is an essential contribution that ESOs like Villgro Africa can make to support public sector scaling.
Benacare, a home nursing care company, one of Villgro Africa’s portfolio companies, and a member of the MLC, observed an unaddressed spike in cases of renal failure and chronic kidney disease (CKD) among their home-based patients. With the support of a research voucher from Villgro Africa through a separate program, Benacare commissioned researchers at the Jomo Kenyatta University of Agriculture and Technology (JKUAT) to conduct a study on the options for the treatment and management of CKD in Murang’a County. The results of the study informed the creation of Benacare’s state-of-the-art mobile dialysis trucks that bring affordable dialysis treatment to communities in Murang’a.
This initiative, dubbed Renal Roads, anchored in Murang’a County government’s health systems, has eased the financial and logistical burden of accessing dialysis for thousands of patients, and ensured that more patients are able to stay on this life-saving treatment. Our experience serving the ecosystem has demonstrated time and again that research is not a detour from scaling, but rather an essential, though chronically underfunded, route to it. Locally-generated evidence can lower the perceived risk for government and makes the case for adoption on the public sector’s own terms.
Growing opportunities exist for healthtech innovators and entrepreneurs to scale through the public sector. While many of our portfolio partners and MLC members are working to address these issues, there remain a lot of gaps in health services that innovative ventures can address. As an ESO and an ecosystem facilitator, Villgro Africa continuously highlights these opportunities to our portfolio companies:
Other opportunities include:
The supportive role of ESOs and ecosystem facilitators does not absolve innovators from taking preemptive action to mitigate some of the challenges of working with government. The MLC’s PSS Readiness Checklist provides a good starting point for innovators to test their readiness to partner with government.
Beyond that, innovators need to work out how to best get a foot in the door and through what mechanism, for example a private-public partnership, an MoU, or a supplementary budget. The MLC has published a briefing note exploring some of the different modalities available for public sector partnerships which innovators might find helpful.
Innovators also need to anticipate and plan for lengthy contract negotiation processes because governments typically have rules and regulations concerning procurement. Where a pilot is envisaged, innovators should initiate conversations upfront about what will happen beyond the life of the pilot and seek clarity about which party will bear which costs. If this is not done, the risk is that costs will be passed on to the innovator or to patients who may not be able to pay, risking the long-term adoption of the solution. Where a working relationship with the government is established, innovators should ensure that they have a strong cashflow management strategy in place to survive the often-long periods as payments make their way through government processes.
Health innovators in Kenya, and in many other parts of Africa, cannot scale effectively without the public sector, and the public sector cannot solve many of its health service delivery shortcomings efficiently without the help of innovators. As Villgro Africa’s experience demonstrates, ESOs and ecosystem facilitators are uniquely placed to broker the relationships between the two, to make smooth some of the inherent areas of friction, and to make public sector scaling an achievable goal for more health entrepreneurs.
