The COVID-19 pandemic has highlighted the need for new health technologies, treatments, and service delivery models, and many innovations in health-care delivery are being developed to meet local needs in low- and middle-income countries. In Kenya, for example, CheckUps Medical Centre has partnered with motorcycle riders in Nairobi to deliver pharmaceuticals and telemedicine services to patients in their homes, while medical center network Penda Health has integrated a COVID-19 decision support tool into its electronic medical records (EMR) system. These kinds of innovations will be crucial in the days and years to come.
However, the global economic crisis brought on by the pandemic also threatens the ecosystem of funders, incubator and accelerator programs, manufacturing and distribution partners, and public and private health systems that help ensure that health-care innovation can thrive and meet emerging and long-standing health needs. In May 2020, Aspen Network of Development Entrepreneurs (ANDE) members reported that 40 percent of the small and growing businesses (SGBs) they support in East Africa were at risk of failing within the next six months (a June addendum suggests that those numbers have grown as recessions have deepened). Accelerators and incubators are also at risk: in May, 83 percent of capacity development organizations (CDOs) in the ANDE network reported moderate, high, or existential risk of shutting down operations.
At the Duke Global Health Innovation Center and the Social Entrepreneurship Accelerator at Duke program (SEAD), we’re studying both how accelerators and incubators supporting health innovation in East Africa have been affected by the crisis and how they’ve responded. From interviewing leaders of nine such organizations, we’ve found that the pandemic has both precipitated changes in innovator needs and prompted accelerators to reassess how to support growth. But despite looming risks in the changing landscape, accelerator leaders are optimistic about the future.
Pivoting to COVID-19
In many cases, accelerators in East Africa have pivoted from their usual programs to contributing directly to pandemic response. CAMtech Uganda used its innovation lab to mass-produce hand sanitizer in the early days of the pandemic, for example, and Villgro Kenya (now Villgro Africa) called for innovators developing COVID-19-specific solutions and sped up their due diligence process for quick onboarding. “I don't think we are slowing down anytime soon,” Villgro Africa CEO Wilfred Njagi said; “We are just stepping on the pedal even harder.”
Accelerators have also helped innovators pivot offerings to meet emerging needs in care delivery and production of physical goods. As Wairimu Muthaka from Amref Health Africa’s Innovate for Life program told us, “Conversations with the business coaches and even the health experts are about how you can tweak your innovation to now also deal with the COVID crisis.” Tai Tanzania, an innovator participating in the Duke-UNICEF Innovation Accelerator that develops interactive videos on sexual and reproductive health has been working with the Tanzania Ministry of Health to develop videos providing information on COVID-19. SaCoDé, a Duke-UNICEF innovator that produces menstrual hygiene supplies, partnered with the national government and private US-based foundations to produce masks and hospital gowns to support COVID-19 response in Burundi.
Shifting to Virtual Engagement
With the pandemic restricting face-to-face engagement and travel, accelerators have replaced in-person workshops, site visits, and coaching with virtual communication tools such as Zoom, Trello, and Slack. To make up for not having site visits, for example, The Duke-UNICEF Innovation Accelerator team has also added “office hours,” which gives innovators and mentors more time to speak about challenges not covered in the curriculum.
While accelerators that were already using virtual mentorship or webinars were able to ramp up familiar tools quickly, programs that relied heavily on in-person engagement have faced a more challenging task. Transitioning to online engagement added an extra layer of chaos to what was already a difficult time, as innovators and accelerators navigated new challenges around reliability of internet connection, culture, or (especially for those now with children at home) timing. Some activities could not be switched at all. Accelerators that normally offered access to a lab, makerspace, or coworking space, were not able to do so while travel and gathering restrictions remained in place.
Scouting has also been more challenging, especially for accelerators looking to source innovators from outside of their direct networks. Amref Health Africa’s Innovate for Life, for example, planned to travel to target countries to meet innovators in person, but with travel restrictions in place, the Amref team is considering whether to follow the original plan or to narrow sourcing to innovators in Kenya, where they have stronger network ties. Interviewees noted that collaboration between accelerator programs could help address this challenge: for example, an accelerator in Kenya could partner with an accelerator in Uganda to conduct site visits and scouting in their respective countries.
Accelerator leaders noted that virtual engagement did also yield some benefits, as when stakeholders engage with each other when travel would otherwise have been a barrier. A new reliance on virtual communication may also help accelerate Africa’s digital transformation and foster openness to virtual engagement. One interviewee told us that although there had been significant challenges in switching to virtual programming, virtual engagement was working so well that some entrepreneurs asked if they would have to go back to in-person.
Funding in the Time of COVID-19
Accelerator leaders we interviewed found that existing funding partnerships have mostly continued. Some accelerators have received additional funding to help innovators develop new solutions to address COVID-19, while others have received nonfinancial support, such as technical assistance to move to virtual models or flexibility on deliverable timelines. However, the broader funding landscape remains uncertain, as does the future of the global economy. Three accelerator leaders mentioned that although their programs still had funding at the time of the interview, they were unsure if their contracts would be renewed.
Moreover, establishing new partnerships has grown more challenging: virtual communication may exacerbate the challenge of engaging new funders, and as funders tighten their budgets in anticipation of lower revenues, they may be less likely to contribute to an accelerator partnership that is seen as a “nice-to-have” rather than a “need-to-have.” One interviewee told us that some donors have not been able to pay on their pledges and described difficulty in finding new donors. These experiences echo the findings from the above-mentioned ANDE survey, which showed that funders have been providing additional support to organizations within their current portfolio, but that few have provided support to new organizations.
For some health accelerators, organizational sustainability will be in jeopardy if funding contracts are not renewed or if donations do not pick up. Others will continue to deliver services, but with smaller cohorts, fewer mentors, and less funding for development and testing of innovations, lessening impact.
Recommendations for Moving Forward
Based on our experience and insights from these interviews, we offer recommendations for how innovators, accelerators, funders, and other partners can learn from the lessons of this pandemic to become more resilient and future-proof the ecosystem against similar crises.
1. Practice and prepare for flexibility, without losing sight of the vision. Accelerators should ensure that they have the right people on staff to help innovators with crisis management, scenario planning, and pivoting when needed, as well as adjust programming to support innovators in crisis and remain flexible with expectations. Sarah Jefferson, from the Making More Health accelerator, suggests building in modules on crisis management and having a “rainy day fund” to support innovators during a crisis. Funders can support innovator and accelerator adaptability by offering unrestricted funding and being flexible with deliverable deadlines during a crisis.
2. Formalize collaborations to share local market insights, scouting, and networks, and to create a unified voice advocating for innovation funding. While travel is restricted, accelerators could partner with programs in other countries, leveraging “on the ground” connections to help with sourcing, due diligence, and site visits. One leader hoped to “collaborate a bit more in understanding financing options, … [create] greater linkages with impact investors and philanthropists to understand their ability to identify and support emerging innovations.”
3. Drive digitization aggressively, seizing opportunities to accelerate digital health and business solutions. Accelerators have had to rethink program delivery and develop effective remote support. They are now seeing how this can expand their reach and impact. During the pandemic, virtual communication has become the norm for nearly all operations. Building on this shift to further accelerate digital solutions in both health-care delivery and business functions can reduce access barriers and create more flexible routes to growth.
4. Build stronger links to national and local scaling partners to drive innovations toward specific challenges and support scale. Governments and funders must build up the East African innovation ecosystem for the field to be truly resilient to crisis. Public and private sectors should focus on investing locally in science, technology, research, and innovation. Governments, in particular, should encourage sustainable growth of innovations and coordinate solution pipelines to meet public health priorities. “The response for us,” says one participant, “has to come from a strong ecosystem that will … provide the enabling environment for [innovators] to thrive.”
Optimism for the Future
Despite the question marks on the landscape, interviewees expressed long-term optimism for the health acceleration field in East Africa. They expect to see more focus on health innovation from governments and funders, as the COVID-19 pandemic has exposed weaknesses in health systems in the region. They also hope that innovation will be more highly valued as a field now that innovators have demonstrated flexibility and rapid response in the face of an unforeseen crisis.
Indeed, this shift has already begun, as demonstrated by the innovators in the Duke-UNICEF Innovation Accelerator that have partnered with governments to distribute their products and services. Accelerator leaders hope that East African governments will continue to recognize the importance of health innovation in responding to a global health crisis and increase their support to the field accordingly, which could help accelerators strengthen their partnerships and relevance within the market.
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The authors thank the accelerator leaders who took time to share their experience and perspectives: Data Santorino, CAMTech Uganda; Johnni Kjelsgaard, GrowthAfrica; Matt Nash and Taylor Conger, Duke-UNICEF Innovation Accelerator; Merck/M Ventures; Neville Igasira, Hive Colab; Sarah Jefferson, Making More Health (a partnership between Ashoka and Boehringer Ingelheim); Wairimu Muthaka, Amref Health Africa’s Innovate for Life; and Wilfred Njagi, CEO Villgro Africa. This work was supported by USAID through the Higher Education Solutions Network.
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