For more than a decade, the global health community has treated the scale gap facing women-led and under-represented innovation founders, as a financing problem. That diagnosis is incomplete. Despite growing attention, women founders still receive a dismal 2% of global venture funding, and progress remains slow. Patterns such as this are not just persistent, they are no longer acceptable.
This is not just a funding gap. It is a system failure.
“The sector continues to operate on a flawed assumption. The belief that better support to founders will unlock scale overlooks the deeper structural constraints that determine whether innovation is adopted at all.”
Pradeep Kakkattil, Founder and CEO, HIEx
Many high-potential ventures are not failing because funding is absent. They are failing because the systems that determine scale, including public procurement, regulation and financing, are not built to move proven solutions beyond pilots into widespread adoption.
These insights are not theoretical. They are reflected in global funding patterns and reinforced by the experiences of women entrepreneurs participating in the Reckitt Catalyst Program through HIEx-led engagement. Interviews and focus group discussions surfaced consistent, system-level barriers to scale.
Barriers That Go Beyond Capital
Global research reinforces that these challenges are not isolated. Evidence consistently highlights a set of structural, financial and systemic barriers that shape how women-led and underserved ventures access funding, markets and pathways to scale. These constraints are echoed in firsthand accounts shared through interviews and discussions with founders, pointing to a set of interconnected barriers that extend far beyond access to finance alone.
These include:
o fragmented and misaligned funding models
o unclear or non-existent adoption pathways into public systems
o persistent bias in how women-led ventures are evaluated
o cultural and social norms that shape perceptions of risk and leadership
o collateral, legal and regulatory constraints that restrict access to finance and markets
o misalignment of financial products with the needs of growth-stage ventures (“missing-middle”)
o under-representation in investment decision-making and limited access to networks and sponsorship.
These barriers do not operate in isolation. They reinforce one another, shaping how innovation is funded, assessed and ultimately adopted and scaled.
Beneath these structural constraints sits a more persistent challenge. Entrenched attitudes shaped by unconscious bias continue to influence decision-making. Across investment and public-sector systems, innovation led by women and underserved founders is still frequently perceived as higher risk. This affects how opportunities are evaluated, increases the burden of proof placed on founders, and slows decision-making.
These barriers do not operate in isolation. They reinforce one another, shaping how innovation is funded, assessed and ultimately adopted and scaled.
Beneath these structural constraints sits a more persistent challenge. Entrenched attitudes shaped by unconscious bias continue to influence decision-making. Across investment and public-sector systems, innovation led by women and underserved founders is still frequently perceived as higher risk. This affects how opportunities are evaluated, increases the burden of proof placed on founders, and slows decision-making.
Systems Unable to Absorb Innovation
“The challenge is not the quality of innovation. It is whether the system is set up to adopt and scale it.”
Dr. Abas Hassen, Ministry of Health, Ethiopia
As Dr. Abas Hassen explains, the primary constraints are not about innovation quality, but about the systems that determine adoption and scale, including procurement, regulation, financing and delivery.
He identifies three persistent challenges: institutional resistance to change, “pilot purgatory,” and a disconnect between what external funders support and what governments can sustain.
Ethiopia’s response reflects a broader shift. Innovation is no longer treated as isolated pilots, but as a structured component of system design. Regulatory pathways, prioritization frameworks and structured testing environments are being used to embed innovation directly within the health system.
The implication is clear. Scaling innovation is not about accelerating individual ventures alone. It is about strengthening the systems that determine whether innovation is adopted at all.
The Missing Middle: From Pilot to Procurement
In many low- and middle-income countries, public systems remain the largest market for health and WASH solutions. Yet capital is deployed through models that do not reflect this reality, as scaling depends on public-sector adoption, long procurement cycles and regulatory integration rather than rapid returns.
This creates a fundamental misalignment within the financial ecosystem. Capital is structured for speed, while impact depends on long-term approaches to system integration.
At its core, the challenge is the absence of clear adoption pathways. Without structured routes from validation to procurement and system-wide use, even effective solutions struggle to move beyond pilots. This is the “missing middle,” the gap between early validation and large-scale adoption.
Across Africa, female-founded startups continue to receive a smaller share of venture funding, despite strong performance and growing demand. In 2024, they accounted for 18% of equity deals yet only received 7 % of the total funding. While male-founded ventures raised over 13 times more capital on average.
This reflects a deeper issue. It is not only about access to capital, but how risk is assessed and how systems enable scale. Founder experiences place this issue front and center.
Temie Giwa-Tubosun, founder and CEO of LifeBank, describes her company as an “orphan” within existing financing structures, too commercial for impact investors and too impact-driven for venture capital.
“Businesses like ours don’t fit into existing funding models. We fall between systems that were not designed for us.”
Temie Giwa-Tubosun, founder and CEO, LifeBank
Thato Schermer, co-founder of Zoie Health, describes a similar challenge. Even companies with strong revenue and clear demand struggle to secure funding at the right stage.
“We are often asked to keep proving our solutions, but without a clear path to scale.”
Thato Schermer, co-founder of Zoie Health
Across the cohort, these patterns are consistent. Founders described fragmented financing, unclear adoption pathways, and repeated cycles of proof, where they are asked to demonstrate impact again and again without progression toward adoption. The barrier to scale is not a lack of viable solutions. It is the systems and models that are not designed to support them.
Reducing Risk Through System Design
From a HIEx perspective, what is emerging is a different approach. It focuses, not on fixing founders, but on redesigning how systems manage risk and adopt innovation.
Rather than avoiding risk, Ethiopia is working with key partners like HIEx to manage it through structured processes. The system is “risk-aware, not risk-averse.” It uses innovation sandboxes, real-world testing environments within public systems that allow new solutions to be evaluated under controlled conditions.
These mechanisms generate decision-grade evidence while limiting system-wide exposure. They create clearer pathways from validation to adoption. When innovations are tested within public systems, they gain institutional legitimacy, reducing perceived risk for both governments and investors.
From Fragmentation to Coordination
Within this context, a more coordinated approach to scaling innovation is beginning to emerge.
Initiatives such as Reckitt Catalyst reflect this shift. Rather than focusing solely on supporting individual ventures, the program works across the systems that determine whether innovation is adopted and scaled.
The model brings together complementary capabilities:
HIEx, which connects entrepreneurs with governments and supports system integration
Yunus Social Initiative (YSI), which enables business integration and private sector pathways
Acumen America, which contributes experience in long-term and patient capital approaches.
Together, this reflects a move from fragmented support to coordinated ecosystem engagement.
Another consistent gap identified by founders is access to decision-making networks and institutional entry points. In response, the Reckitt Catalyst Program places emphasis on mentorship, intentional sponsorship and network access, recognizing that relationships and system access are often as critical as capital.
Through its cohort model, the program supports entrepreneurs working across health and WASH sectors, helping to bridge the gap between early validation and system integration.
This approach is not about replacing existing models. It is about connecting them in a broader inclusive ecosystem.
A System at an Inflection Point
The climate movement offers a clear lesson. Change did not come from better solutions alone, but from sustained pressure that redefined risk, exposed inaction, and reshaped how capital and policy decisions are made.
“It forced systems to respond and, in doing so, created a new generation of actors who now hold institutions to account.”
Pradeep Kakkattil
The implications are clear. Investors must move beyond rigid funding models and deploy capital aligned to how health systems scale. Governments must build clearer pathways for testing, procurement and adoption. Ecosystem actors must shift from supporting individual ventures to enabling system-level integration.
Women’s health and WASH innovation is at an inflection point. The challenge is not a lack of innovation, but rather a lack of systems designed to absorb and scale proven ones.
Until that changes, innovators will continue to be asked to prove what works, while the systems around them fail to do what it takes to adopt and scale those solutions.
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