Scaling innovations in public health systems – Guide and toolkit

📜🔗LINK to the source

1. Analytical summary

Context, issues and target audiences

The document starts from the observation that the Sustainable Development Goals related to health are behind schedule, in a context of multiple crises (climate, pandemics, misinformation, tensions on human resources and funding) and a strong production of innovations (social, digital, technological) that too often remain limited to pilots. It primarily targets governments (ministries of health, national and subnational agencies, public institutions) as the "architects" of innovation, but also non-state partners (NGOs, private sector, universities) wishing to work in alignment with public objectives. The WHO defines health innovation as a deeply new or improved product, service, process, or organisation, and scaling as a deliberate effort to broaden and sustain the impact of innovations at the level of public systems. The guide acknowledges the diversity of contexts (countries, regions, levels of system maturity), emphasises persistent obstacles (unstable funding, procurement rules, interoperability, monitoring and evaluation capacities) and adopts a systemic vision: scaling up is a non-linear, political, iterative process that requires leadership, participation, and equity.

Operational contributions for stakeholders

The heart of the document is a framework articulating three scaling strategies (make it happen, help it happen, let it happen), seven key roles of government (from policy-maker to communicator) and three cross-cutting processes (exploring, adapting, learning) supported by a typology of ten families of tools. It details the expected competencies for each strategy (systems thinking, change management, consultation, adaptive management, strategic communication) and proposes a 'missions' reading for systemic challenges: defining long-term societal objectives, mobilising a portfolio of initiatives, crowding-in resources and organising measurement-learning. The operational chapters describe the roles of government in policy design, governance, regulation (including public procurement and HTA), capacity building of actors and financial engineering (grants, public purchasing, partnerships), illustrated by cases (JSY in India, Mamas del Río in Peru, M-mama in Tanzania, innovation office in Quebec, SingHealth). Annex A presents a structured toolbox (ecosystem mapping, foresight, user-centred design, innovative procurement, MEAL, agile management) with practical recommendations and links to recent external resources. The whole provides a coherent framework for moving from a logic of isolated projects to a strategy of systemic transformation, aligned with universal health coverage and human rights.

2. Key points of the document

1. Three scaling strategies (make/help/let it happen)

   The guide formalises three strategic 'archetypes': make it happen (directive approach, top-down, suited to stable contexts), help it happen (catalytic, co-constructed approach for complex contexts) and let it happen (activation approach for capable ecosystems, for emerging contexts). It highlights the importance of combining these strategies according to the maturity of innovation and the system, for example through an incubator pathway (let) – adaptation (help) – consolidation (make). (p.26–29)

2. Seven structuring roles for governments

   The document describes seven complementary roles: policy-maker, governance designer, innovation steward, regulator, capacity strengthener, funding enabler, communicator, showing how they combine and are distributed among ministries, agencies, and levels of governance. It emphasizes the importance of orchestrating these roles rather than treating them in isolation, and illustrates their implementation with examples (M-mama, Quebec innovation office, SingHealth). (p.43–53, 97–103)

3. The procedural triptych "explore – adapt – learn"

   The WHO proposes structuring scaling-up approaches around three processes: exploring (formalising public demand, identifying relevant innovations, producing initial evidence), adapting (contextualising innovation, adjusting organisational, regulatory, and financial models) and learning (MEAL, iterations, policy adjustments). These processes are explicitly presented as iterative and not sequential, with associated tools and activities (needs analyses, prototypes, regulatory sandboxes, monitoring and evaluation mechanisms). (p.59–66, 81–86)

4. Mission-oriented approach for systemic challenges

   The guide dedicates a section to "missions" as a lever to align innovations, policies and funding with concrete societal objectives (e.g. reduction of NCDs, EU cancer mission, Vision Zero Cancer in Sweden), with seven key characteristics (societal objective, social relevance, time horizon, intersectoral approach, portfolio, crowding-in, strategic learning). It proposes this approach for situations where scaling a single innovation is not enough, and where it is necessary to manage a portfolio of experiments and reforms over time. (p.36–41)

5. Structured toolkit and practical references

   Annex A presents a typology of ten families of tools (ecosystem mapping, foresight, human-centred design, pro-innovation procurement, scalability assessment, funding/partnerships, open innovation, regulatory sandboxing/policy labs, MEAL, agile management) by explicitly linking them to the three processes explore–adapt–learn. Each family is illustrated by concrete examples and links to practical guides (ExpandNet, MSI, BetaHealth, Nesta, etc.), making it a direct entry point for practitioners. (p.82–93)

3. Action tracks for local actors

1. Establish a "scaling filter" for any innovation supported by the community (p.21–29, 81–86)

   Establish, at the level of an ARS, a region or a metropolis, a systematic framework for scalability analysis for any funded innovative project (public, associative or mixed), mobilising the criteria highlighted by the WHO: alignment with public priorities, organisational feasibility, cost and sustainability, equity, possibilities for routinisation. This filter can rely on tools such as the "scaling assessment map" and the ExpandNet guides, adapting them to French realities (dialogue with CPAM, local authorities, operators).

2. Formalise structures for innovation governance at the regional level (p.43–49, 82–85)

   Create, within the ARS or regional health conferences, innovation and scaling committees involving state services, local authorities, health insurance, university hospitals, user and grassroots associations, to play the roles of governance designer and innovation steward. Rely on examples from the innovation office in Quebec or innovation hubs to clarify mandates, decision-making processes, funding circuits and community participation modalities.

3. Build a portfolio of "regional missions" (p.36–41, 97–101)

   For complex issues (for example: youth mental health, ageing at home, health-environment), formulate regional missions with time-bound objectives, indicators and a portfolio of innovations (associative projects, digital devices, service reorganisations). Use the triptych make/help/let it happen to distinguish what falls under a top-down decision (e.g. service reform) from what can be left to the initiative of local collectives, with methodological and financial support.

4. Equipping public procurement for innovation in prevention and community health (p.49–52, 91–93)

   Experimenting with results-oriented public procurement mechanisms (result-based procurement, innovation markets) to finance the scaling up of prevention programmes, health mediation, or community support, drawing on recommendations for pro-innovation purchasing. Testing small-scale incentive clauses (coverage, quality, equity indicators) and competitive dialogue approaches, involving associative operators and social enterprises.

5. Strengthening the capacities of local teams to "explore – adapt – learn" (p.30–35, 59–66, 81–86)

   Establishing targeted training for health executives, associative coordinators, and local elected officials on key skills: systems thinking, adaptive management, partnership facilitation, MEAL, data literacy. Using the listed tools (labs, MEAL, open innovation, agile management) to co-construct short cycles of trial–adjustment–scaling, with particular attention to the participation of users and communities.

From local to regional

A. Clarifying the 'why' of scaling up

In France, moving from local to regional first involves clarifying what truly justifies an increase in scale:

• a public health issue shared across several territories (for example: access to care, mental health of young people, prevention of chronic diseases) ;

• an innovation that has proven itself locally, with documented results (effectiveness, acceptability, equity) and a reproducible model ;

• coherence with national and regional strategies (National Health Strategy, regional health plans, One Health, etc.).

In this context, scaling up is less a 'local success that is generalised', than a political choice: integrating an innovation into a regional strategy and into ordinary instruments (funding, regulation, service provision).

B. Articulating local and regional levels: co-production rather than duplication

The WHO guide emphasises the three approaches make/help/let it happen. In France, this can be translated as:

• Make it happen : the region (via the ARS, the local authority, health insurance) decides to include the innovation in a regional plan, in contracts (CLS, CRTE, CPOM) or organisational schemes, with quantified objectives and dedicated resources.

• Help it happen : the regional level supports local actors (local authorities, associations, establishments) by structuring governance, methodological support, monitoring-evaluation tools and spaces for sharing experiences.

• Let it happen : the region plays a catalytic role, allowing territories the flexibility to adapt, co-construct and experiment, while providing a common framework (references, indicators, minimum conditions).

The transition from local to regional, in this logic, is not a "copy-paste" but a process of co-construction and harmonisation: we maintain local anchoring while linking it to a regional and national architecture.

C. Relying on existing devices and structures

In France, several devices already support the scaling up of territorial innovations:

• the territorial innovation laboratories and the modernisation approaches (led by the DITP, the ANCT, the local authorities), which explicitly aim to "support the scaling up of local successes";

• the ARS architecture / regional cells of Public Health France / local authorities, which allows for linking observation, prevention and organisation of care at the regional level;

• the national and regional programmes (national public health plans, national strategies like One Health, experimental programmes) that can serve as vectors to integrate local innovations into regional policies.

Saying "transition from local to regional" in France, therefore, means referring to inclusion in these devices, not just a voluntary "diffusion" by field actors.

D. Minimum conditions for successful scaling up

By taking up the logic of the WHO guide and the feedback from French experiences, we can affirm that the scaling up of a local innovation to the regional level relies at a minimum on:

• evidence and a narrative : data, testimonies, cost analysis, which help to convince decision-makers of the need to generalise ;

• clear governance : who does what between municipality, department, region, ARS, national operators, associations, users ;

• regulatory and contractual adjustments : integration into regional schemes, decrees, contracts and public procurement ;

• adequate funding : moving from one-off funding (calls for projects, innovation funds) to sustainable budget lines or service purchasing mechanisms ;

• a learning strategy : monitoring-evaluation systems, capitalisation and continuous adjustment to avoid imposing a rigid model on all territories.

4. Additional references 

🔍➕ For more information, see the articles referenced by "Health Practices": Summary of conceptual, methodological, and pedagogical work on the intensification of complex public health interventions: a framing review

Other: 

OECD (2023) – Scaling up social innovation in the public sector*

OECD report on scaling approaches and governance frameworks, useful for articulating the WHO guide with public innovation policies in Europe.

URL : https://www.oecd.org/en/publications/starting-scaling-and-sustaining-social-innovation_ec1dfb67-en.html

5. Frequently Asked Questions (FAQ)

1. Who is this guide primarily aimed at? (p.16–18)

   It primarily targets public officials: health ministries, national or regional agencies, local authorities, and public institutions involved in the governance of health systems. It also concerns non-state actors (NGOs, private sector, universities) who wish to align with public priorities and understand how to engage with governments to scale their innovations.

2. What is the difference between "innovation" and "intervention" in this document? (p.18–21)

   The guide considers innovation to be a product, service, process, or system that is genuinely new or significantly improved compared to previous practices, and effectively used. An intervention can be innovative or not; to be considered innovation, it must present a character of novelty and significant transformation.

3. What does scaling up ("innovation scaling") cover according to the WHO? (p.18–21)

   Scaling up is defined as a set of deliberate efforts to increase the impact of proven innovations in order to reach more people and sustainably support policies and programmes. It is distinct from the notions of diffusion or simple implementation, as it is intentional, linked to innovation, and oriented towards systemic integration.

4. How to choose between make it happen, help it happen, and let it happen? (p.26–29)

   The choice depends on the context: degree of stability, number and capacity of actors, level of available evidence, political constraints. The document recommends combining these strategies over time, for example by allowing solutions to emerge and spread (let), supporting their adaptation (help), and then consolidating through political decisions and structural funding (make).

5. What are the main obstacles identified to the scaling up of innovations? (p.16–19)

   The guide highlights financial obstacles (limited or unstable funding), regulatory (lengthy procedures, complexity of public procurement, intellectual property), and organisational (limited monitoring and evaluation capacities, constrained human resources, lack of interoperability). It also emphasises the difficulties of multi-level coordination and the tendency to multiply pilots without a systematisation strategy.

6. How does the document address the dimension of equity and vulnerable populations? (p.14–17, 31–32)

   Equity is presented as a central principle: innovations must be inclusive, affordable, demand-driven, and context-adapted, with explicit attention to marginalised and underserved populations. The guide encourages clarifying trade-offs and integrating equity indicators into the processes of exploration, adaptation, and learning.

7. What concrete tools are proposed for practitioners? (p.81–93)

   The guide proposes a typology of ten families of tools (ecosystem mapping, foresight, human-centred design, innovative procurement, scalability assessment, funding/partnerships, open innovation, sandboxes, MEAL, agile management), each described with objectives, practical advice and links to resources. These tools are positioned in relation to the three processes explore–adapt–learn and can be used by public structures, NGOs or partnerships.

6. Rewriting in Easy-to-Read Language 

Title

Scaling up public health innovations – Easy-to-read summary

Context and issues (Easy-to-Read Language)

• The world still has many health problems.

• There are many new ideas to improve health.

• Often, these ideas remain in small projects.

• This guide aims to help governments use these ideas everywhere.

• It is aimed at ministries, public services and partners.

What the guide offers (Easy-to-Read Language)

• It explains three ways to grow an innovation.

• It describes seven important roles for public authorities.

• It proposes three main steps: explore, adapt, learn.

• It provides concrete tools for each step.

• It shows real examples in several countries.

Three simple strategies (Easy-to-Read Language)

• Make it happen : the government decides and organises everything.

• Help it happen : the government helps actors work together.

• Let it happen : the government supports and allows actors to act.

Seven roles of the government (FALC)

• Make the rules : decide on priorities and policies.

• Organise governance : create committees and teams.

• Animate partnerships : connect actors and stay on course.

• Regulate : adapt laws, standards and public procurement.

• Strengthen capacities : train teams and structures.

• Finance : find and organise funding.

• Communicate : explain innovation and its benefits.

Three key processes (FALC)

• Explore : understand needs and identify good ideas.

• Adapt : adjust innovation to the local context.

• Learn : track results and correct the course.

Toolbox (FALC)

• The guide lists several simple tools.

• For example: map actors, test prototypes, track results.

• The tools can be used by public services and associations.

7. Cross-cutting analysis — values of health practices

• Literacy : the document remains technical but offers adaptable tools, with some definitions and examples, without being explicitly designed in simplified language for all audiences.

• Empowerment : several cases emphasise the mobilisation of CHWs, communities, and beneficiaries (e.g. Mamas del Río), integrated as actors in scaling up rather than mere beneficiaries.

• Participation : the strategies help it happen and let it happen rest on co-construction with stakeholders (communities, NGOs, private sector), through laboratories, consultations, and shared governance.

• Community health : the community dimension is strongly present, particularly for innovations in rural areas, programmes centred on CHWs, and participatory approaches.

• Ethics : the guide emphasises equity, transparency, accountability, and the need to avoid biases in the selection and scaling of innovations, while not developing a detailed ethical framework.

• Human rights : it explicitly aligns with universal health coverage and the SDGs, with attention to marginalised populations and sustainable access to innovations.

• Intersectorality : the mission-driven approach assumes the mobilisation of multiple sectors (health, finance, education, urban planning, etc.), with concrete examples (cancer missions, public health, and safety).

• Partnership : the document values public-private partnerships, NGOs, universities, and proposes tools for co-financing and co-management.

• Fight against discrimination : equity is an explicit criterion for scaling, with the idea of not reproducing access inequalities; the issue of specific discriminations (gender, orientation, social status) is nonetheless poorly detailed and remains implicit.

8. Assessment of the reliability of the resource

• Scientific relevance :

  The guide is based on a literature review, expert consultations, and previous work by the WHO and ExpandNet, with explicit references (Greenhalgh, missions, HTA, etc.). The methodology is described (annex C), the limitations acknowledged (cases not representative of all contexts), and the key concepts defined (innovation, scaling, governance, etc.).

• Operational relevance :

  The resource is clearly action-oriented, with a strategic framework linked to concrete tools, detailed case studies, and explicit recommendations for governments and partners. The level of detail is suitable for decision-makers and technical managers, less so for field facilitators without mediation, but the document provides a solid foundation for developing more contextualised national or regional guides.