Barriers to scaling health technologies in sub-Saharan Africa: Lessons from Ethiopia, Nigeria, and Rwanda

Given the importance of effectively scaling technologies in the promotion of health and innovation, the objective of our paper was to identify the barriers that can impede the process of scaling up in sub-Saharan Africa. We reviewed the published literature and collected data through semi-structured interviews of six key players in the health technology space in three sub-Saharan African countries: Ethiopia, Nigeria, and Rwanda. We analyzed the interview transcripts in light of the transition theory framework. This informative framework highlights how health technologies are nested in societal contexts, how they could be scaled up, and what factors influence changes in structure, practice, and culture. Our data analyses uncovered six barriers to scaling health technologies. These barriers included inadequate availability and accessibility of health equipment, inadequate policies and gaps in policy effectiveness, lack of financial resources, unavailability of health personnel and expertise, insufficient understanding and infrastructure to scale up effectively, and lack of community and user integration with the technology. Through the results of this study, we have created a narrative on how health technologies can be most effectively scaled in sub-Saharan Africa and provided insights for researchers, policymakers, and programme implementers on the scaling of health technologies in the region.