From Innovation Push to Government Pull: What Kenya's Counties Are Teaching Us About Government-Led Scaling of Health Innovations

For a long time, efforts to scale health innovations have largely followed a supply-driven model (“push”). Innovators develop products, technologies, or approaches and then seek opportunities for governments to adopt them. While this model has produced important successes, it has also contributed to a proliferation of pilots that struggle to achieve sustainable scale within public systems.

The Public Sector Scaling (PSS) experience from Kenya's Lake Region Economic Bloc (LREB), comprising fourteen counties in Western Kenya, implemented in partnership with Insight Health Advisors (IHA), suggests a different starting point: scaling becomes more feasible when governments first define priority problems and then pull innovations into the system through structured demand articulation, assessment, scaling pathways, and institutionalisation.

A critical enabler of this shift has been the use of the Mountain Model, a framework developed by Results for Development (R4D) and Insight Health Advisors (IHA) to help governments systematically translate health system priorities into innovation demand. Equally important has been the role of Insight Health Advisors as a PSS ecosystem catalyst providing facilitation, coordination, and technical assistance to help governments operationalise this new approach to scaling.

Fig1.0: The Mountain Model

Scaling Lessons from the PSS Counties in Kenya

1. Scaling starts with demand, not solutions

   
   

In the Lake Region Economic Bloc (LREB) counties, the process began not with innovations but with challenges or demand articulation. County governments, with facilitation, coordination and technical support from Insight Health Advisors, identified priority bottlenecks affecting health outcomes including newborn mortality, maternal health challenges, emergency referral gaps, and workforce constraints in frontline facilities.

Only after these priorities had been articulated were innovations assessed against them. The result is a demand-driven process in which innovations compete on their ability to solve clearly defined public-sector problems.

2. Scaling is about changing systems

   
   

The development of repeatable government processes that can continuously identify priority challenges, assess solutions, mobilise resources, and institutionalise what works is the most valuable outcome of Public Sector Scaling (PSS).

One emerging lesson from the LREB is that successful innovations scale when counties deliberately create enabling conditions through financing, governance, procurement systems, and leadership. The critical unit of scale is not the innovation itself but the public-sector capability to identify, assess, adopt, finance, and institutionalise innovations repeatedly.

Across the LREB counties, increasing attention has been given to strengthening these institutional functions. The role of the ecosystem catalyst (Insight Health Advisors) is particularly important at this stage. Building new processes, coordinating stakeholders, developing investment cases, supporting procurement pathways, and embedding innovations into government systems often require sustained facilitation and technical assistance. These functions help transform scaling from a one-off project into an institutional capability.

3. Frontline workers matter

The LREB experience reinforces the importance of involving frontline health workers in scaling decisions. Health workers are often the first to recognise operational bottlenecks and the first to determine whether a new innovation is practical within real-world service delivery settings.

When innovations address challenges experienced by frontline providers such as workload pressures, monitoring difficulties, or referral coordination, they are more likely to gain acceptance and demonstrate value. The Mountain Model process created opportunities for health workers to contribute to priority setting and solution assessment, helping ensure that selected innovations responded to real operational needs.

4. Scaling requires ecosystem coordination

   
   

Many of the barriers to scaling such as financing, procurement, policy alignment, and workforce readiness cannot be solved by innovators acting alone. Through the Mountain Model process, counties, innovators, health managers, technical partners, and financing stakeholders came together around a common pathway for identifying priorities, assessing solutions, and planning for adoption.

A key lesson is that this coordination does not happen automatically. It requires actors that can convene stakeholders, broker relationships, facilitate dialogue, and maintain momentum across multiple institutions. In the LREB experience, Insight Health Advisors played this ecosystem catalyst role, helping align incentives, surface implementation challenges early, and support collective problem-solving among diverse stakeholders. The experience highlights that scaling is not simply a technical exercise but a collective endeavor requiring coordinated action across the broader innovation ecosystem.

5. Political ownership is critical for innovation scaling

Across the Lake Region Economic Bloc counties, innovations advanced more rapidly where political and administrative leaders actively championed the process. Counties demonstrated stronger progress when Chief Officers, County Directors of Health, and facility managers were directly involved in setting priorities, convening stakeholders, and driving adoption decisions. In contrast, progress was slower in contexts where leadership engagement was less consistent, highlighting the importance of sustained ownership throughout the scaling journey.

This experience reinforces a broader lesson from public sector scaling: scaling is not only a technical process of identifying effective innovations and generating evidence, it is also a political process. Decisions about resource allocation, procurement, workforce deployment, policy prioritisation, and institutional adoption ultimately rest with government leaders. Even the most promising innovation can struggle to move beyond pilot implementation if it lacks influential champions within the system.

At the same time, political leaders often require trusted technical partners who can help translate ambition into action. Ecosystem catalysts like Insight Health Advisors can support leaders with evidence generation, stakeholder coordination, implementation planning, and problem-solving, helping maintain momentum while ensuring that ownership remains firmly within government institutions.

Conclusion

The experience of Kenya's LREB counties suggests that when governments lead the process, articulate demand, and strengthen the institutions that support adoption, scaling becomes more sustainable. Frameworks such as the Mountain Model provide a practical mechanism for translating public-sector priorities into innovation demand, helping governments move from being recipients of innovation to active stewards of scaling.

At the same time, the experience highlights the importance of ecosystem catalysts like Insight Health Advisors that provide facilitation, coordination, technical assistance, and strategic accompaniment to help governments operationalise new approaches to scaling. Sustainable scale emerges not from innovations alone, nor from government ownership alone, but from effective partnerships that combine public-sector leadership with ecosystem support. The result is a shift from scaling individual innovations to building systems that are capable of scaling innovation itself.