Innovation and Change Management



In the context of COVID-19, it has become apparent that health services need to be flexible and speedy to meet the rapidly changing needs of the population. Immunization and healthcare services in LMIC face several challenges to find new ways to achieve more efficient health systems and services. In recent years, donors and partners have been keen to support rapid innovations, yet there was no clear strategy on how innovations should be scaled up to maximize benefits of successful innovations.

Innovation scale-up is a challenge


GaneshAID has witnessed unfortunate situations where donors investing in novelties but then dropping support required for the long-lasting innovation adoption, sustainability and deployment to a larger number of users. Therefore, GaneshAID aims to support all stakeholders and partners in developing early innovation strategic planning to envision the innovations beyond experimental phase. It is strongly recommended that from the design phase, health system/service innovations are planned with successful scale-up in mind.

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Health innovation implies in-country change management


With each major and minor change, resistance is bound to appear. Even though the innovation brings desirable changes for the health and immunization systems, they are time-consuming to implement and require substantial resources. Additionally, the health system has a high level of inertia and a low level of perceived motivation for change. Changes in way of thinking or working that health innovations bring about should be supported and approved by Governments.

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Model Of Organizational Development adapted from Middlemist and Hitt (1988)

Advocacy for innovations scale-up strategies


Because of our strong engagement to transform health and immunization services in LMIC, we cultivate innovation as a strategic medium. We encourage all organizations to support innovative thinking and processes to save more lives around the world. We raise our voices for the essential needs for multisectoral supports to transform small-scale innovation into large-scale solutions and sincerely hope that they will be heard by the international community and donors.


Please join our network of innovators for health and immunization systems and services in LMIC!

Successful Scaling up: Call to action


Based on our experiences in Africa and Asia as well as the orientations of the ExpandNet model, GaneshAID recommends the following actions:

  • Co-design with Ministry of Health and implement the pilot project with the objective of expansion.
  • Build multiple partnerships and long-term funding – these requirements are often overlooked by donors, national stakeholders, and development partners.
  • From the beginning, collaborate with stakeholders to clearly define innovation, have a concrete vision of successful scaling, and identify specific indicators as well as benchmarks.
  • Find the right balance between innovation institutionalization and expansion.
  • Focus on monitoring, evaluation and learning during the expansion and necessary continuous adaptations.
  • Before and throughout the scaling process, identify necessary adjustments and mid-term corrections in new sites, maintain momentum and accountability as well as strengthen strategic planning skills among stakeholders.
  • When adaptation is needed, replicate the key features of the successful pilot project when scaling up (i.e. research-based planning, a systems approach, partnership with appropriate organizations, a diversity of stakeholders and providers, and communication with decision-makers).
  • At the operational level, define indicators for access to the new solution and its integration into health programs in the context of the health and immunization delivery system.
  • Involve multiple partners in research to document the progress of the innovation scale up.
  • Produce up-to-date and relevant data for stakeholders with diverse needs.

GaneshAID’s Innovation Scale-up Framework


GaneshAID envisions innovation scale-up process as a mechanism to increase the number of users/beneficiaries in local conditions, to study the innovations’ results and impacts in terms of increased performance health workers (knowledge and skills), thus consequently leading to the improved health service delivery. GaneshAID’s technical support focuses on organizational development that addresses necessary health service transformation – e.g. reorganizing immunization activities with skilled vaccinators to cope with the Covid-19 pandemic. We support countries in formulating appropriate strategy to introduce planned change needed to scale up tested innovations. This is critical to assist the health systems with managing the turbulent environment so to save more lives.


Any scale-up scenario implies a scale up strategy that covers six key components:

Scale-up strategy – 6 key components for VacciForm (Benin)
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Benin case study: Innovation scale-up for maintaining routine immunization


In Benin, one of our innovations to improve routine immunization during pandeic – VacciForm – has positive but limited test results in terms of number of testers (26 in 24 immunization sites) and duration (15 days). Therefore, it was required to undergo a validation phase prior to larger scale up. The validation or replication phase considers a restricted number of health department and health zones, representing 10-20% of the immunization staff depending on the decision of the Ministry of Health/EPI: 360 to 720 vaccinators to be selected by the national EPI team.


As per the 2018 SARA Survey, immunization services are delivered in 73% of the 966 public health centers in Benin. Immunization services are integrated into healthcare activities but there are no staff dedicated to immunizationso this task is often passed to nursing assistants. In fact, training needs for immunization activities are not adequately covered. Only 62% of the health centers had staff trained on EPI activities with a variation from 12% in Ouémé (South Health Department) to 87% in Alibori (North Health Department).

The scale up phase considers the health workforce involved in EPI activities in Benin as per the following:

Health workforce at levels

→ The replication phase should have a 18-month duration.

Vacciform replication scale-up

Senegal case study: innovation scale-up for EPI supportive supervision 2.0


Coach2PEV, our innovation on supportive supervision and performance coaching, has been tested by EPI staff (Senegal) in local operation conditions up to the immunization service point. The results revealed that the new approach of supportive supervision combining performance coaching and a mobile app complies with EPI’s requirements. The usability by testers has been verified with statistics of various functionalities tested by users, a set of bugs were identified with immediate correction and a mitigation plan. While positive testing results from both pilots, the duration of the tests was insufficient to measure the actual impacts of the innovations.


The overall satisfaction of testers was measured through an online survey, demonstrating the high level of satisfaction and acceptance of supervisors and supervisees.


Phase 1: Coach2PEV replication


To validate the feasibility of the use of Coach2PEV and its acceptance as an appropriate supportive supervision model, a replication of the pilot should be implemented on a greater number of sites to serve more users/EPI staff in the field.

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Pilot sites (in white) and Coach2PEV replication sites

Phase 2: Coach2PEV expansion


The replication of Coach2PEV to a higher number of beneficiaries was necessary to validate the innovation as an appropriate EPI supportive supervision approach. Likewise, during the replication, scale-up team documents the challenges and factors of success for the adoption of Coach2PEV by users. Thus, the scaling-up approach will respond to all challenges by specifying the conditions required for the users’ adoption of Coach2PEV.

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