By: Johnmark Ochieng
South Africa's health innovation ecosystem is not short of ideas. It
is not short of talent. In many cases, it is not even short of early-stage
funding. And yet, most innovations never reach the people who need them.
That is the contradiction worth sitting with. At the very moment the
National Health Insurance is set to drive unprecedented demand for locally
developed, scalable health solutions, the ecosystem is structurally unprepared
to supply them. Not because the ingredients are missing, but because there is
no shared system connecting them: no coordinated pipeline from idea to
adoption, and no funding designed for the stages where innovations most
reliably stall.
Around 76% of medical devices used in South Africa are imported.
University innovations take seven to eight years on average to reach the
market. These are not inefficiencies at the margins. They are signals of a
system that consistently loses innovations somewhere between early promise and
real-world adoption.
The problem is not that good work isn't happening. It is that good
work is happening in isolation, without a coherent pathway from idea to impact,
and without funding designed for the stages where things most reliably fall
apart.
And this breakdown is not neutral. The same transition points where
innovations stall, proof of concept, clinical validation, procurement
readiness, are also where Black innovators, women, and township-based
enterprises face the steepest barriers to capital, networks, and market access.
What gets described as a "valley of death" is not experienced
equally. For many, it is not a valley. It is a wall.
The real issue is not supply, it is system design
Most conversations about health innovation begin with supply-side
questions. How many innovators are there? How much funding is available? How
many programmes exist?
These are the wrong questions.
The deeper issue is structural. How does the ecosystem decide which
innovations move forward? How are they supported across stages? Is there a
clear, shared pathway from idea to adoption? Right now, the answer to that last
question is no.
Innovators navigate a maze with no shared entry point and no visible
route forward. Funding clusters heavily at the start of the journey. The middle,
where proof of concept becomes commercial viability, where a prototype needs to
survive regulatory scrutiny and procurement navigation, is thin,
underdeveloped, and largely undesigned. None of that work fits inside a
12-month cohort or a seed grant cycle.
The result is predictable. Capable innovations stall at exactly the
point they need the most support. Funding is duplicated at the early stage
while the critical middle goes unserved. The ecosystem generates fragmented
pipelines instead of scalable solutions.
The system is not failing to generate ideas. It is failing to carry
them across the line.
What needs to change
This does not require more programmes. It requires a different kind of
system.
The first shift is from parallel pipelines to a shared, visible one. Most
actors in the ecosystem support innovation through their own programmes, with
limited visibility of what others are doing. Strong project-level collaboration
exists, but system-level coordination does not. What is missing is a recognised
pathway, one that signals clearly to innovators, funders, regulators, and
health systems how strong solutions are expected to move from early development
to scale. Without it, coordination stays accidental.
The second shift is from time-bound cohorts to staged, milestone-based
progression. Health innovation is not a 12-month sprint. It is a multi-year
process that demands different support at different stages. Early-stage funding
is reasonably well served. The transition from prototype to procurement is not.
Closing this gap requires deliberate design: blended finance instruments,
milestone-based disbursements, recoverable grants, and co-investment structures
that bring public, philanthropic, and private capital together around a shared
progression logic. Capital alone is not enough. Regulatory and market-access
support must be embedded alongside it.
The third shift is from invisible to legible. One of the most
underestimated constraints in the ecosystem is the absence of shared
visibility. Funders do not know what others are funding. Support organisations
do not know what already exists. Health system buyers do not know what is
available. Regulators are brought in too late to be useful. A shared pipeline,
anchored by clear progression criteria and a recognised annual rhythm, turns a
fragmented set of efforts into a coordinated system. It becomes a reference
point, not just a programme.
Equity runs through all three shifts. It cannot be retrofitted through
targets or added as a reporting requirement at the end. It must be a design
constraint from the start, built into how the pipeline is accessed, how capital
is structured, and how progression is measured. This means moving from open
access to guided access, embedding support precisely where exclusion happens,
and making equity visible at the system level, not just the project level.
Building the missing middle
The first practical step is for ecosystem actors to get a clear
picture of what is already happening. Who is supporting what? Where are the
gaps? Where is the same work being done twice? Platforms like SHIP already
exist to help with this. The starting point is using them, not building
something new alongside them.
The next step is creating a
dedicated fund for the middle of the journey, the stage where most innovations
run out of road. This is not simply about putting more money in. It is about
putting the right kind of money in, at the right time, with the right
conditions attached. Innovations at this stage need funding that
can stretch beyond traditional timelines. They
need support that moves with them through regulatory approvals, clinical
testing, and the process of getting in front of the health system buyers who
can adopt their solution. Capital without that support does not solve the
problem.
This approach has already been
demonstrated. Within a coordinated support ecosystem, including platforms like
MeDDIC for visibility and institutions such as SAMRC and TIA for development
funding, VIVAstie, a locally designed needleless valve, secured a five-year
supply contract with the Western Cape Department of Health.
The evidence already exists
This is not a theoretical proposition. Where coordination and
lifecycle-aligned funding have been put in place, they have worked.
SHIP showed what a coordinated, multi-institutional pipeline can do.
By connecting early-stage research to downstream application, and by providing
catalytic funding for clinical validation, it enabled innovations like the
Ellavi uterine balloon tamponade to unlock further international financing and
reach wide-scale deployment. It also seeded what came after, Grand Challenges
South Africa, multiple UKRI partnerships, and a template for what a structured
pipeline can produce.
MeDDIC has demonstrated that shared infrastructure within the medical
device ecosystem can reduce duplication and improve visibility. Combined with
broader institutional support, it contributed to conditions under which a
locally designed needleless valve reached a five-year procurement contract, an
outcome requiring sustained, multi-institutional support at the stage where
most programmes disengage.
The lesson is not that the ecosystem needs to start from scratch. It
needs to scale what already works, with broader participation, stronger
coordination, and a shared commitment to the stages that have been consistently
underinvested.
The system is not broken, it is incomplete
South Africa's health innovation ecosystem has the talent, the ideas,
and enough early-stage activity to build something significant. What it lacks
is the architecture to carry that potential through to impact.
The funding blind spot is real, and it is fixable. The fragmentation
is structural, and it is solvable. But neither will change through incremental
adjustments or isolated interventions.
Progress depends on whether the institutions with the most influence
in this ecosystem are willing to move beyond parallel effort and design
something shared, a pipeline with clear stages, aligned capital, and the
deliberate intent to carry the best innovations all the way across the line.
Ideas aren’t the problem, building systems that turn them into
solutions is.
