Rethinking Health Innovation Funding in Africa for Maximum Impact
By guest contributor Obidimma Ezezika
Imagine if there was no concerted effort to eradicate smallpox after discovering the vaccine more than 200 years ago. Our world would be different today. Based on historical data of 50 million cases of smallpox reported annually in the early 1950s, the World Health Organization’s historical mortality rate of 30% for the common form of the disease, and given an infection rate of 2%, there would currently be approximately 48 million deaths and 160 million people infected annually. In addition, the persistent outbreaks would have placed significant pressure on healthcare systems, inflicted substantial economic hardships, and resulted in widespread anxiety and disturbance to social order. This hypothetical scenario underscores a critical truth: strategically allocating resources to scaling up effective health innovations can significantly alter the course of global health outcomes.
The current state of global health innovation funding
Current funding for global health innovations highly favours discoveries over widespread implementation. This imbalance is particularly evident in maternal and newborn health innovation funding, which is essential in the African continent, where 69% of all maternal deaths occur and which has the highest maternal mortality ratio globally.
This funding trend can be observed in initiatives and programs that fund innovations for global health. For example, between 2010 and 2021, the Development Innovation Ventures, an initiative of the United States Agency for International Development, awarded 252 grants to support innovation in 47 countries, including a few African countries. However, out of the 252 investments, 47% was awarded to the piloting phase, 44% to the testing and position-to-scale phases, and only 4% to the transitioning-to-scale phase. The number of grants awarded in the transitioning-to-scale phase was much lower than in the piloting phase and the testing and position-to-scale phase. This trend of prioritizing discoveries over scaling up is not unusual for funders and initiatives in the global health innovation funding space.
Why shift global health investments towards scale-up
There are several reasons why a paradigm shift is needed now more than ever toward scaling up evidence-based innovations in global health (Figure 1). First, we have reached a critical time point in the innovation trajectory. The last 100 years have seen an unprecedented discovery of evidence-based health innovations, which have provided crucial breakthroughs in transforming global health and medicine, such as measles, polio, and HPV vaccines, antiretroviral therapy for HIV/AIDS, Statins, Oral Rehydration Salts (ORS), and much more. Using our effort and capacity to scale up these innovations makes pragmatic sense, but despite their impact, not everyone who needs them gets them because insufficient effort and funding are not devoted to their implementation and uptake.
Second, with the preponderance of these innovations and their impact, there is enormous potential to save and improve lives right now; it is common sense to extend their effects. For example, if all evidence-based innovations were used, we could reduce lung cancer and cervical cancer by at least 90%, according to the Cancer Moonshoot’s Blue Ribbon Panel. There are notable cases of what can happen when innovations are scaled up. For example, the Expanded Programme on Immunization (EPI) has significantly reduced the incidence of vaccine-preventable diseases, currently preventing 2-3 million deaths annually. However, scaling up vaccination efforts to achieve universal coverage could avoid an additional 1.5 million deaths yearly. Similarly, Antiretroviral Therapy (ART) for HIV/AIDS has transformed the disease from a death sentence into a manageable condition. As of 2022, 29.8 million people were accessing ART, up from 7.7 million in 2010. Scaling up ART to reach everyone in need could prevent 28 million new infections and 21 million deaths between 2015 and 2030.
Third, focusing on scaling up proven innovations is more cost-effective, especially in resource-constrained settings in Africa. For instance, distributing insecticide-treated nets (ITNs) for malaria prevention costs about $2.20 per net and can reduce malaria incidence by 50%. Similarly, oral rehydration salts, a low-cost treatment for dehydration from diarrhea, could reduce cases by 90%, yet only four out of 10 children in sub-Saharan Africa received them in 2022 due to multiple barriers. Expanding access to these simple innovations could save hundreds of thousands of lives annually.
Figure 1. Rationales for scaling up evidence-based innovations in global health
Fourth, the recent social movements and increased awareness of health disparities have highlighted the need to address inequities in healthcare access. For example, by prioritizing the expansion of vaccination programs, funders can ensure that all children, regardless of their socioeconomic status, have access to life-saving vaccines. This approach can help bridge health disparities and promote a more equitable distribution of health resources. Ensuring wider access to essential medicines, such as antimalarials and antibiotics, can reduce the health disparities between high-income and low-income populations and improve health outcomes in underserved areas.
Scaling up evidence-based innovations creates a strong foundation of infrastructure, knowledge, and support systems, enabling efficient future scaling of new discoveries. This approach fosters continuous innovation and increases the likelihood of successful adoption and sustainability. Moreover, it sets a precedent for future innovations, encouraging their reliable and effective implementation. For example, eradicating smallpox has been crucial in advancing the goal of global polio eradication –incorporating global coordination, robust surveillance, mass vaccination, community engagement, adaptability, political commitment, rapid response, and innovative tools, despite multiple barriers.
Scaling up proven health innovations offers immediate, broad benefits, and global health funders should prioritize their expansion to maximize impact, cost-effectiveness, and equity. While many funders emphasize this in their strategies, more practical action is needed. For example, if existing health interventions in maternal and child health reached 90% coverage in sub-Saharan Africa, 4 million deaths could be prevented annually. By prioritizing the scale-up of effective innovations, we can address urgent health needs, optimize resource allocation, and significantly enhance health outcomes in the region.
About the author:
Dr. Obidimma Ezezika is the director and principal investigator of the Global Health and Innovation Lab at Western University in Canada, an implementation science research and education initiative on the systematic uptake of evidence-based interventions into routine practice in global health. He is the inaugural recipient of the Global Educator Award from the University of Toronto, and the recipient of several international awards, including the D2L Innovation Award in Teaching and Learning and the Next Einstein Award. He is the founder of the African Centre for Innovation & Leadership Development. He has a PhD in Microbiology from the University of Georgia and a master’s degree in environmental management from Yale University.
Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.
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