Posted originally on Carla Blauvelt’s LinkedIn.
Amid seismic shifts in global public health financing and delivery, it is more important than ever that health innovations are designed, evaluated and implemented in ways that enable institutionalization – the sustained integration of effective solutions into routine public health systems. Institutionalization is not simply a technical or managerial exercise. It is foundational to health sovereignty, ensuring every nation meets the health needs of its people without ongoing reliance on external actors.
VillageReach’s experience putting government leadership at the center of innovation adoption provides practical insights into how governments can work together with the social and private sectors to achieve sustainable impact at scale. In this article, we share three tools that governments and their partners can use to manage innovation pipelines and accelerate institutionalization within public health systems.
Government Driving Innovation Adoption
Many governments are moving activities previously performed by partners onto government teams. In Malawi, for example, due to the massive and rapid funding cuts in early 2025, there was a need to accelerate the institutionalization of solutions.
In response, VillageReach worked with the Malawi Ministry of Health to accelerate the design and implementation of a Rapid Transition of Solutions to Government Management Checklist (Figure 1). The checklist helped the Ministry of Health teams assess readiness across key operational and system dimensions, with outputs directly informing a structured transition plan.
Partners Integrating Sustainability Into Their Working Approach
Institutionalization does not begin at scale-up; it must be embedded throughout program design and delivery. For several years, VillageReach has applied a systematic approach to sustainability in partnership with governments. We recently added a Country Sustainability Scorecard for greater cross-cutting visibility, which is used by country leadership to assess all programs within it’s portfolio (Figure 2).
The scorecard assesses programs based on:
- Alignment with Ministry of Health priorities for the current and upcoming planning periods
- Current stage of sustainability
- Likelihood of progressing to the next stage within the next year
Using the scorecard, VillageReach Country Leads jointly determine priorities with government counterparts. Programs showing strong momentum can be accelerated, while others may require redesign, additional efficiency measures or – when sustainability is unlikely – a planned and responsible closeout. This disciplined approach enables difficult but necessary decisions that ensure the best use of available resources.
Governments and Partners Working Together on Institutionalization
Health sovereignty does not mean governments must do everything themselves. Relying exclusively on government staff, equipment and tools can constrain scale and reduce effectiveness, particularly in resource-constrained environments. Instead, strong primary health care systems depend on strategic collaboration between government, private sector firms, and non-profit partners to develop and implement innovations that improve health system performance.
Effective institutionalization requires alignment with government priorities, integration into existing systems, and deliberate changes to policies, budgets, and organizational processes. To support alignment, VillageReach, together with Spring Impact, developed the Journey to Scale with Government tool (Figure 3). This tool helps governments and partners co-create clear pathways to scale innovations sustainably and at scale.
The VillageReach Sustainability Journey The VillageReach approach is to co-develop, co-scale, and transition innovations with government leaders from the outset. Codified in our Sustaining Innovation body of work (formerly called Transitioning Well), this approach, also intended to support others, recognizes that institutionalization is not about “handing over” responsibility but about walking the journey together from the outset.
Innovation Management as a Key Enabler of Health Sovereignty
Ultimately, governments, partners and innovators share the same goal: better health outcomes that last. In the countries where VillageReach works, sustainable impact depends on putting governments in the driver’s seat with the tools, governance and partnerships needed to sustain innovation.
Managing the institutionalization of innovation is therefore not optional; it is a core enabler of health sovereignty. When innovations are aligned with national priorities, integrated into systems and budgets, and supported through structured collaboration, countries are better positioned to deliver equitable, resilient health care for their population, regardless of fluctuations in external funding.
For more information on VillageReach’s Sustaining Innovation approach and tools, visit Driving Sustained Impact on villagereach.org or contact carla.blauvelt@villagereach.org.
This perspective builds on an earlier article underscoring the need for government-led sustainability strategies grounded in prioritization, diversified resource mobilization and efficiency. Read the post Why now is the time to put sustainability first.