(Illustration by iStock/Yikang Lan)
A hard truth is emerging in global health innovation: some solutions reach scale, but few last. Equipment goes dark. Dashboards fade. Paper charts return. And the status quo—marked by health care inequities and the digital divide—persists. The foreign aid contractions of 2025 forced a long overdue shift: government partnership is now front and center. Yet, after 15 years of ministries of health working with our organization, Nexleaf Analytics, we’ve learned that partnership—while necessary—is not sufficient. To achieve scale that lasts, innovators must move from managing government partnerships to catalyzing country ownership of solutions. And while highly intuitive natural language interfaces enabled by AI may be able to leapfrog useless paper charts and unusable dashboards, the core challenges to sustaining digital health remain the same.
Much has been written about the importance of government partnership in scaling digital tools. Experienced practitioners such as Rakesh Rajani and Tim Hanstad note that NGOs and philanthropies often overlook “the most effective pathway to scale solutions to our planet’s biggest challenges—partnering with government.” Others focus on solution affordability and government willingness to pay, often measured by whether an innovation earns a budget line in the national plan. As one Kenyan county official put it, successful innovation requires “cost effectiveness, ability to solve the problem, and the budget line needed to sustain the innovation.”
Yet a government’s willingness to pay does not guarantee that a system will survive leadership turnover, procurement delays, or shifting donor priorities. Too often, innovations fade once the initial partnership ends, because countries rarely sustain what they don’t truly own.
Partnership in practice can operate more like permission. A ministry may allow a solution to be deployed within its health system, but it’s not fully integrated into daily workflows. Ministries may work with dozens of “partners” at once, each running projects in parallel, creating operational noise rather than lasting change. Strong partnership is an enabler of ownership, but not sufficient.
Ownership means country agency. It means the country retains decision-making authority, control over data, the ability to adapt tools without external approval, allocations of budget and staff time, and processes and operations that rely on the solution to function effectively.
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How ‘Government Partnership’ Falls Short
When Nexleaf’s remote temperature monitoring (RTM) technology reached scale in multiple countries, we had reason to celebrate: active procurement, wide deployment, data integrated into national systems, and budget allocations for future purchases. Yet performance was uneven. Devices went offline, repairs stalled, and usage declined in some areas. Despite scale, adoption was fragile. We found the problem was not demand. Without integration into daily government operations, scale was superficial.
Partnerships often stall not because governments resist innovation, but because innovators optimize for deployment rather than routine use—and because implementers underestimate the operational burden governments must absorb. Leadership turnover, procurement delays, audit culture, and fiscal shocks are not edge cases; they are structural realities that must shape solution design. When digital systems fail publicly, the political cost is high, making risk aversion rational.
This helps explain why paper systems endure. They are locally repairable, predictable, and firmly under government control. Reliability, not sophistication, is the currency of bureaucratic trust. Until digital tools offer comparable predictability, paper remains the safer choice.
Progress begins when innovators stop blaming governments and start designing for sovereignty—systems that ministries can run, adapt, and fund on their own terms. Ownership emerged in Tanzania only when ministry teams saw themselves as responsible for day-to-day performance, not as participants in a partner-led rollout. That shift—from partnership to operational responsibility—marked the beginning of true ownership.
Building Toward Country Ownership in Tanzania
Nexleaf began deploying its remote temperature monitoring (RTM) solution for Tanzania’s vaccine cold chain in 2021. Early on, we observed a decisive shift: when Ministry of Health staff—not contractors—installed devices, connectivity and uptime improved dramatically. Staff who took ownership over its success from the beginning went the extra mile to get sensors online, even in remote areas. This marked a transition from partnership to government ownership.
Building on this momentum, the ministry co-launched transport monitoring for vaccine trucks and adapted logistics procedures based on the data. Regional and district teams began advocating for expansion, shaping system features, and embedding RTM into routine practice. Over time, the ministry revised standard operating procedures, integrated data review into regular meetings, and assumed responsibility for training, installation, and day-to-day operations.
At the start of the 2025–26 fiscal year, the ministry introduced several long-term operational reforms to sustain performance: every district established a dedicated cold chain maintenance fund, enabling repairs flagged by RTM data to be paid for and completed. The government was no longer just purchasing technology—it was changing how it operated in response to what the data revealed.
Several signals confirmed that ownership had taken root:
Operational leadership: Ministry teams lead training, installation, procurement, and troubleshooting, partnering with a local university’s IT department. A rollout once estimated at four months was completed in just six weeks—entirely by the ministry.Process and data integration: RTM data flows into the national data platform and routine review meetings. SOPs built around real-time alerts replaced static paper charts, and clear equipment performance targets are tracked nationally.Peer accountability systems: Regional communities of ministry personnel emerged organically, driving performance through WhatsApp groups and peer support.Resource commitment: Domestic budget lines fund cold chain logistics and maintenance needs highlighted by the RTM.Cultural shift: RTM is no longer seen as “the Nexleaf project,” but as an essential component of vaccine management.
Tanzania’s experience underscores a central lesson: ownership emerges when governments internalize responsibility for performance and reshape workflows around the system. Digital tools succeed not by replacing existing processes, but by strengthening the human-powered operational intelligence already within the system.
A General Pathway to Country Ownership
Country ownership doesn’t appear overnight; it emerges through a deliberate progression of shifts. Importantly, this pathway isn’t purely linear. Countries may advance on multiple fronts at once—or move backward due to leadership changes or fiscal shocks. Still, the pattern is clear: ownership gets stronger through gradual increases in integration, agency, and reliance.
What follows is a set of shifts necessary to elevate a government partnership to the level of country ownership (the order of the shifts is not intrinsically fixed or sequential):
Shift 1: Entry Through External Channels
Governments procure the solution through donor or UN mechanisms, getting access and granting legitimacy, but not actually retaining the ability to fully access and/or control the solution. Funding and operations are implementer-led, and sustainability depends on donor priorities. This is procurement, not ownership.
Shift 2: Early Domestic Resource Commitment
The first signal of ownership appears when countries allocate indirect resources—assigning staff roles, covering SIM cards, or mandating the tool’s use. These commitments may seem small, but they mark a psychological shift: the system is starting to become “theirs.” Integration, however, remains shallow.
Shift 3: Government Is the Doer
The ministry takes over day-to-day operations—training, installation, and troubleshooting—and embeds the solution in national systems. As with DHIS2—a widely used open-source digital platform used by governments to manage health and social sector data for decision-making—country-led configuration accelerates when tools are built to integrate with government platforms. Innovators must design for this from the start: interoperable APIs, ministry-ready training, and low-touch configuration. At this point, countries achieve basic operational independence, though not yet full ownership.
Shift 4: Inclusion in the National Budget
Once the solution is a line item in the national budget—partially funded by domestic resources—it brings political visibility and financial legitimacy but remains fragile. Budget lines can vanish with leadership changes or fiscal crises unless deeper integration follows.
Shift 5: Integration Into Daily Workflows
The turning point comes when the ministry embeds the innovation into daily operations. Data drives routine meetings, informs decisions, and replaces legacy (often paper) systems. The ministry begins reshaping workflows and processes to get the most from the tool. With this shift, the solution becomes indispensable; removing it would disrupt core functions.
Shift 6: Full Country Ownership
Finally, the government funds and procures the solution entirely through domestic channels. The ministry manages operations, renewals, and expansions without donor involvement. The implementer’s role narrows to maintaining infrastructure, not driving operations. This is true ownership. The solution endures leadership turnover, donor exits, and fiscal shocks. This shift can take years, depending on the complexity of the system and the political and economic context—but once achieved, it represents lasting transformation.
The Mindset Shift
For Nexleaf, this transformation didn’t follow a typical donor cycle. It took years of steady presence, trust built through reliability rather than visibility, and a mindset shift—from seeing ministries as beneficiaries to treating them as the primary customer. We had to focus less on which dashboard was used and more on ensuring the right people could use the data to act. Country ownership has to be designed into every layer of an innovation—from the data architecture to the user experience.
For our peer organizations, for multilaterals, and for donors, we urge you to consider the following takeaways that challenge the status quo of how social innovators, funders, and countries usually work together:
Operational ownership > technical ownership. Ownership isn’t about who holds the codebase or whether software is open source—it’s about control over workflows, data, budgets, and adaptation across leadership cycles.
Procurement does not equal ownership. A line item in a national budget doesn’t mean the system is owned. Without process changes, data integration, and routine reliance, it remains a project.Commercial sustainability and government ownership are compatible. In fact, the pathway specifically targets innovators “stuck at sustainability,” those with product-market fit who are widely deployed but not yet deeply owned, and thus at high risk of customer churn over time despite having viable, services-based business models.Nothing happens without trust. Trust is the invisible infrastructure behind technical success. The government’s willingness to lead installations and rewrite SOPs came only after we proved we were dependable partners over time.
Our aim is to elevate the conversation on ownership by offering a concrete model of what it looks like in practice. Country ownership is not the same as partnership or “hand-off.” Indeed, as TaRL Africa’s Ashley Morrell asks in her recent article on scaling education reforms, “How do organizations resist the temptation to design solutions in isolation and expect them to be effectively ‘handed over’ to governments toward the end?” We agree with the components she has rightly identified, and we also believe that a fundamental mindset shift from “government partnership” to “country ownership” is required.
Until we move from partnership to true ownership, we risk building elegant but fragile systems—undermined overnight by staff turnover, donor shifts, and policy reversals. Governments will always favor solutions they can control and sustain, even over those that are co-designed or sophisticated.
Ultimately, ownership is what makes innovation stick. It’s the difference between a successful pilot and a lasting system. We are all tired of watching critical healthcare technology and infrastructure fail because it’s viewed as a temporary project that will cease to exist once partnerships end. It’s time to shift to a country ownership paradigm.
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Read more stories by Nithya Ramanathan, Nelima Otipa & Hosea Kintu.