AUGUST 2020
EVALUATING SAVING LIVES AT BIRTH
Evaluation Report: Rounds One to Eight 
(2011-2020) 
ACKNOWLEDGEMENTS: Evaluating SL@B, a joint program of 
the Duke Global Health Innovation Center and the Duke Global 
Health Institute Evidence Lab, is funded by the generous support 
of the Saving Lives at Birth partners: the United States Agency for 
International Development (USAID), the Government of Norway, 
the Bill & Melinda Gates Foundation, Grand Challenges Canada, 
the UK Government, and the Korea International Cooperation 
Agency (KOICA) via Cooperative Agreement 
No. 7200AA18C00019.
DISCLAIMER: This product is made possible through the generous support of the Saving Lives at Birth 
partners: the United States Agency for International Development (USAID), Grand Challenges Canada 
(GCC) (with funding from the Government of Canada), Norwegian Agency for Development Cooperation 
(NORAD), the Bill & Melinda Gates Foundation (BMGF), the UK Department for International Development 
(DFID), and the Korea International Cooperation Agency (KOICA). The contents of this report are the 
sole responsibility of the Duke Global Health Innovation Center and the Duke Global Health Institute 
Evidence Lab, and do not necessarily reflect the views of Saving Lives at Birth partners.
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Executive Summary 
1: Introduction
2: The SL@B Program in the Global Landscape: Sourcing and Funding MNH Innovations
3: SL@B’s Role in Building Innovator Capacity and Accelerating Innovation
4: SL@B-Facilitated Partnerships for Increased Innovation Impact
5: Quantifying SL@B’s Impact
6: Conclusion 
Bibliography
Appendix I: SL@B’s Theory of Change 
Appendix II: SL@B’s Impact Area Framework 
Appendix III: SL@B’s Non-financial Support 
Appendix IV: Impact Modeling Checklist
TABLE OF CONTENTS
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Figure 1: Recommendations for SL@B from the Program Evaluation 
Figure 2: Causes of Maternal and Neonatal Mortality Globally 
Figure 3: Number of Innovations, by Innovation Type and Round 
Figure 4: Funding Portfolios by Target Population
Figure 5: IDIA and SL@B Innovation Growth Stage Categories 
Figure 6: Number of SL@B Innovations, by Stage of Growth and Round 
Figure 7: Number of SL@B Innovations and Amount of SL@B Investment, by Awardee Location 
Figure 8: Total Number of Months Spent in Each Stage Across Varying Levels of SL@B Support
Figure 9: Non-Financial SL@B Support, by Percent of Innovators Reporting it as Highly Helpful
Figure 10: Non-Financial SL@B Support, by Percent of Innovators Reporting it as Insufficient
Figure 11: Number of SL@B Innovations with Public Sector Partnerships 
Figure 12: Number of SL@B Innovations with Private Sector Partnerships
Figure 13: SL@B Partnerships Support, by Percent of Innovators Reporting it as Sufficient or Insufficient
Table 1: SL@B Portfolio by Causes of Maternal and Newborn Mortality
Table 2: Number of Innovations, by Type and Stage
Table 3: Top 25 Countries with Highest Burden of Maternal Mortality Ratios, Newborn Mortality Rates, 
Maternal Deaths, and Newborn Deaths, Compared to Number of SL@B Innovations Targeting those Countries 
Table 4: Innovator Challenges, by Type of Organization and Type of Award 
Table 5: Number of Months in Each Growth Stage 
Table 6: SL@B Funding Level, by Grant Type 
Table 7: Stage of Innovators Reporting SL@B Accelerated their Achievement, by Activity 
Table 8: Illustrative Key Partnerships Formed by SL@B Innovators
LIST OF FIGURES
LIST OF TABLES
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ANC
BLA
BMGF
CE
CHX
DCID
DevX 
DFID
DGHI
ESL@B
EWEC
GCC
GFF
HIC
IDIA
IRB
JSI
KOICA
LMIC 
MGH
MNH
MNCH
MOH
NDA
NGO
NORAD
mHealth
ODA+
PIO
PMNCH
RMNCH
RMNCAH
SL@B
TOC
TTS 
UNAIDS
UNICEF
USAID
WAHO
WHO
Antenatal care
Biologic License Application 
Bill and Melinda Gates Foundation
Conformitè Europëenne 
Chlorhexidine 
Duke Center for International Development 
Development Exchange 
U.K. Department for International Development
Duke Global Health Institute 
Evaluating Saving Lives at Birth
Every Woman Every Child
Grand Challenges Canada
Global Financing Facility
High-income countries
International Development Innovation Alliance
Institutional Review Board 
JSI Research & Training Institute, Inc. 
Korea International Cooperation Agency
Low- and middle-income countries
Massachusetts General Hospital
Maternal and Newborn Health
Maternal, Newborn and Child health
Ministry of Health
New Drug Application 
Non-governmental organization 
The Norwegian Agency for Development Cooperation
Mobile health
Official development assistance, plus grants
Public International Organization
Partnership for Maternal, Newborn, and Child Health
Reproductive, Maternal, Newborn and Child Health
Reproductive, Maternal, Neonatal, Child and Adolescent Health
Saving Lives at Birth 
Theory of Change 
Transition to Scale 
The Joint United Nations Programme on HIV and AIDS
The United Nations Children’s Fund
United States Agency for International Development
West African Health Organization
World Health Organization
ACRONYMS
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Saving Lives at Birth (SL@B): A Grand Challenge for Development brings together a global community working on 
innovation to combat preventable maternal and newborn deaths and stillbirths on a global scale. Launched in 
2011, SL@B is a partnership of key global health stakeholders including the United States Agency for International 
Development (USAID), the Norwegian Agency for Development Cooperation (NORAD), the Bill and Melinda Gates 
Foundation (BMGF), Grand Challenges Canada (GCC), the U.K. Department for International Development (DFID), 
and the Korea International Cooperation Agency (KOICA). The SL@B program has funded a total of 147 innovations,*
 
of which 116 are unique, and 92 organizations addressing critical issues in maternal and newborn health (MNH) in 
low-resource settings. 
The SL@B portfolio spans different types of innovations: products, including devices and diagnostics (61%), mHealth 
solutions (11%), drugs and vaccines (12%), and service delivery approaches (16%). To fund these innovations, SL@B 
used an open call approach through which it solicited innovative ideas in the MNH field with no restrictions on types 
of organizations, geographic setting, or specific disease. Most SL@B grantees are academic institutions (40%) and 
non-profit organizations (38%), followed by for-profit (20%) and public international organizations (PIOs) (2%), with 
the majority of organizations headquartered in high-income countries (HICs, 83%) versus low- and middle-income 
countries (LMICs, 17%). Of the HIC-based organizations, 5% had their local country offices as the primary SL@B 
recipient. Awards were made based on the stage of innovation at three levels: seed, validation, and transition to 
scale (TTS) with corresponding amount of grant ranging 250,000 USD to 2 million USD. 
Two SL@B funding partners (USAID and GCC) engaged Duke University in 2018 to design and conduct an evaluation 
of the program to determine if it was achieving its intended impact and to generate data-driven recommendations 
for future initiatives. The Evaluating SL@B (ESL@B) research team designed an evaluation around four key 
evaluation questions, informed by the original call for proposals and SL@B’s theory of change (TOC)1 (see Appendix 
I for the SL@B TOC diagram):
1. How does SL@B map onto the global landscape of MNH innovation?
2. Does SL@B fill a gap in MNH innovation funding?
3. What has been the impact of SL@B on sourcing and scaling MNH innovations between 2011 and 2020? 
4. What is the potential impact of SL@B-funded innovations on MNH mortality and in the MNH ecosystem?
This final report draws from multiple data sources and analyses, many of which have been shared through earlier 
reports and briefs, including the interim synthesis report.
This evaluation utilizes a quantitative and qualitative mixed-methods approach using data from multiple sources: 
1) program data on the SL@B funding portfolio provided by USAID and GCC and validated by the ESL@B team, 2) 
extensive desk research of publicly available information on the MNH funding landscape, 3) 80 semi-structured 
interviews with key informants, and 4) data gathered from SL@B innovators through an online quantitative survey 
designed by the ESL@B team, and 5) cost data collected through an Excel-based costing tool from five SL@B TTS 
innovators to conduct cost-effectiveness analysis (CEA).2 These data informed several reports presented to SL@B 
funding partners within the past year, including the SL@B Portfolio Review and Funding Landscape Analysis, the 
Acceleration to Impact thematic brief, Summary of Key Qualitative Findings, and the Interim Synthesis Report. The 
ESL@B team reviewed and synthesized these findings, in addition to incorporating new analyses, for this final 
report. The Duke University Campus Institutional Review Board (IRB) approved three separate protocols to cover 
all research related activities [IRB #2018-0370 (existing data), IRB #2018-0617 (interviews), and IRB #2019-0546 
(quantitative survey)].
PURPOSE OF THE EVALUATION 
DATA COLLECTION, METHODS, AND LIMITATIONS
EXECUTIVE SUMMARY
* At the time of writing this report, one award in Round 8 to Ona Kenya was still under negotiations, and so has been excluded from all analyses in this evaluation.
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Putting SL@B in context, the program, totaling 77 million USD in innovator support alone* between 2011 and 2020 
represents a small amount of funding within the reproductive, maternal, newborn and child health (RMNCH) space. 
Funding for RMNCH just in 2011, the year in which SL@B was launched, through official development assistance 
plus grants from the BMGF (ODA+) was 12.2 billion USD, which increased to nearly 16 billion USD in 2017, the latest 
year for which funding information is available.3,4 The global MNCH space within which SL@B operates is covered by 
broader cross-sector innovation funding as well as MNCH-specific funding. The SL@B program’s focus on newborns 
is a distinguishing feature in the field. Because this is relatively rare, the ESL@B team examined the wider space of 
innovation funding for MNCH. 
Below is a summary of the key findings for the first two evaluation questions, which have significant overlap.
1. How does SL@B map onto the global landscape of MNH innovation?
2. Does SL@B fill a gap in MNH innovation funding?
Broadly speaking, SL@B tended to fund more early-stage and product-based innovations, which historically mapped 
the program as a unique player within the MNH innovation landscape. While the funding landscape for MNH has 
changed significantly since the program’s inception in 2011, SL@B continues to fill a funding gap as one of the few 
open-call programs that funds through innovation growth stages and offers value-added technical support. 
i. Innovations funded by the SL@B program target 80% of the most common causes of newborn death and 
60% of the most common causes of maternal death. 
ii. Compared to a study sample of 227 funded MNCH programs across 32 funders, the SL@B program was 
more likely to fund product and technology innovations. The majority of SL@B awards went to product￾based innovations (61%), with the remainder going to service delivery approaches (16%), drugs and vaccines 
(12%), and mHealth solutions (11%). In interviews, some MNH experts shared a concern that this focus on 
product and technology innovations creates a risk of developing a portfolio of standalone devices instead of 
integrated solutions. Interview data also note that the SL@B program should leverage its unique convening 
power to bring product-based innovations into the fold of integrated health systems.
iii. The SL@B program appears to fund a greater proportion of early-stage innovations than most other MNCH 
funders. Most SL@B awards (86%) have gone to innovations in the first three stages of growth (ideation, 
research and development, and proof of concept), helping to fill a critical funding gap in the early-middle 
growth stages. Interviews with MNH experts indicate that SL@B’s focus on early growth stages has provided 
an opportunity to test ideas and produce viable solutions that otherwise would likely not exist. 
iv. Analysis of the private equity and venture capital investment landscapes for MNH in Kenya and India (two of 
the most common target countries for SL@B innovations) indicate this field has dramatically changed since 
the launch of SL@B in 2011, with increased attention to MNH and willingness to invest in these markets. 
For transparency, we note several research limitations. The evaluation was largely retrospective in nature, with an 
emphasis on analysis of existing data collected over the course of the program and a review of publicly available 
data. Primary data collection included an online survey for innovators, which is subject to missed data from those 
innovators who did not respond as well as self-report bias; however, our response rate of 54% is considered high for 
an online survey. Likewise, primary data collection via key informant interviews could have been subject to self-report 
bias; however, the sample size was high enough to reach data saturation (no new themes emerging) which lends 
strength to our reported findings. Furthermore, quantifying SL@B’s impact on reducing mortality via cost-effective 
innovations at a portfolio level was not feasible due to the limitations of effectiveness data for early stage innovations 
and access to accurate cost data which was innovator-dependent. While CEA for the portfolio was not feasible, CEAs 
for four selected innovations are being conducted. Lastly, innovation as a concept is not clearly or consistently defined 
across data and literature sources, and there is limited evidence regarding time to impact or scale of global health 
innovations, adding difficulty in establishing clear benchmarks for impact metrics of the evaluation.
KEY FINDINGS 
* Between 2011 and 2019, the SL@B partnership invested 77 million USD in direct innovator support, making up the bulk of the partnership funds. This does not include 
investments towards other non-financial support provided to innovators such as the DevelopmentXChange meetings (travel, conference fees, logistics, etc.), Xcelerator support 
to innovators, SL@B application, review, and selection processes, grants administration, communications and IT support, etc.
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v. Interviews with MNH experts indicate that SL@B’s open-call approach has fostered interdisciplinary 
collaborations, setting it apart from other MNCH funders, including the individual agencies of the SL@B 
partnership. Data from the SL@B innovator survey indicate that the open call may also attract teams that 
include members outside of the health field to MNH innovation.
vi. Despite the open-call approach, the SL@B review and selection process has tended to fund a higher 
proportion of innovations originating in high-income countries (HIC) (83%) than low and middle-income 
countries (LMIC) (17%). Of the innovations from HIC-based organizations, 5% have LMIC-based country 
offices as SL@B’s prime recipient. No known portfolio balance or target ratio for the SL@B portfolio of 
funded innovations was established. Interview data with MNH experts suggest that a more balanced 
LMIC:HIC ratio would be ideal. Interviewees noted that solutions designed by LMIC-based teams may be 
more likely to be viable, sustainable, and cost-effective.
vii. The non-financial support provided by the SL@B program (e.g. Xcelerator workshops,*
 and targeted 
connections made by grant managers) is highly valued by innovators, and distinct in the field of MNH 
innovation funding.
Key findings for questions three and four are presented together, as they also have significant overlap.
3. What has been the impact of SL@B on sourcing and scaling MNH innovations between 2011 and 2020?
4. What is the potential impact of SL@B-funded innovations on MNH mortality and the MNH 
ecosystem?
While it is premature for most of these early-stage SL@B innovations to have had a significant impact on global 
MNH mortality rates, SL@B has been able to source and support innovations toward market entry and position for 
scale via both financial and non-financial technical support and transformative partnerships. 
i. Expert interviews demonstrate that the SL@B program is seen as a major driver of innovation and a 
critical convening platform of both development organizations and a community of innovators. Further, 
the sourcing strategy has brought in several innovators who are first-time entrants to the MNH arena, 
proposing novel solutions to address maternal and newborn mortality.
ii. Interview data indicate that the SL@B program has leveraged both public and private sectors to increase 
attention to (and funding for) MNH innovations. Through SL@B’s convening power and networks, the program 
has catalyzed multi-sectoral collaborations and partnerships for several high-impact innovations that are 
progressing towards scale, thus improving their path to sustainability even as their SL@B funding period ends. 
iii. It is difficult to assess SL@B’s potential impact on maternal and newborn mortality, given the early growth 
stages funded in the SL@B program. Many SL@B innovators are not yet scaling but are still working towards 
market entry. Of respondents to the SL@B innovator survey, only 28% are operating in at least one market 
and 15% are operating in at least two markets globally. Longer timeframes are needed for an assessment of 
the program’s potential impact on mortality. 
iv. Preliminary data from the CEA indicate that grantees with TTS SL@B awards are interested in having cost￾effective analyses of their innovations in order to leverage further funding to scale. The SL@B program 
has sourced and scaled some cost-effective innovations; however, impact estimates for most grantees are 
premature given their early stage of growth (and evidence level) in the scaling pathway. 
v. Diverse stakeholders value SL@B’s early-stage funding to establish proof-of-concept and the program’s intentional 
approach to progressively fund an innovation through growth stages in order to support a scaling pathway.
vi. The SL@B program appears to accelerate progress through key milestones and growth stages: innovators 
on average moved through growth stages more quickly during their SL@B funding period than innovators in 
the same growth stages either before or after their SL@B funding period. 
vii. Survey data show that innovators credit SL@B’s financial and grants management support (e.g. regular 
check-ins with SL@B program officers, capacity building workshops, connections) with accelerating their 
trajectory. Specifically, innovators credit SL@B’s financial support with accelerating the achievement of 
several key milestones, including validation studies (90%), prototype/program development (89%), and 
usability studies (88%). 
* The Xcelerator program is a key element of the non-financial support provided by the SL@B partnership through VentureWell since 2017 (and Duke University in 2018 and 
2019) to provide training and capacity building to SL@B innovators to develop and scale their innovation.
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viii.Interviews with innovators identified several non-financial SL@B supports that innovators credit with 
accelerating their growth, including the push to think about scaling plans early, having SL@B as a ‘champion’ 
to attract new funding/partners, introductions to commercialization and implementation partners via the 
DevelopmentXChange (DevX),*
 creating a peer network of innovators, and opportunities to participate in 
Xcelerator workshops and mentorship meetings.
ix. The non-financial supports rated as most helpful by respondents to the SL@B innovator survey include the 
Xcelerator workshops, the DevX events, and pitch support. Interview data indicate that the SL@B program 
could expand the non-financial scope of support to be even more proactive about facilitating partnerships 
that support scaling, including those with private sector organizations, national and sub-national public 
sector health organizations, and organizations with local expertise.
TOP RECOMMENDATIONS FOR MOVING FORWARD
1.
Each section of this report includes recommendations pertaining to specific thematic areas within the evaluation. 
The ESL@B team has further distilled and synthesized these data-driven recommendations into those of highest 
priority for overall program improvement. 
Define more precisely and publicly SL@B’s program goals, strategy and success metrics over time for 
funded innovations at both the grantee and portfolio levels.
i. Revisit and revise the SL@B Theory of Change (TOC) to update and more clearly define program goals 
and measurable indicators of success, and use the TOC to align expectations and priorities across 
SL@B partners. Donor perspectives evolve over time and an agreed-upon TOC will support long-term 
planning, investment strategies, and stronger impact metrics. 
a. A key issue for SL@B funding partners to specifically address is the tension between addressing the 
most pressing health needs, and scalability and sustainability of innovations. Some of the greatest 
needs in MNH are in settings (e.g., fragile states) and among populations (e.g., low-income and 
vulnerable populations) where innovations may have transformative impact but would be unlikely 
to be financially sustainable without long-term public sector and/or donor funding. In contrast, 
innovations that have the highest potential to be scaled sustainably, may be more likely to prioritize 
customers or beneficiaries in higher wealth quintiles and operate in more stable (and prosperous) 
environments. The SL@B program (and other global health innovation programs) can have the 
most impact by developing clear expectations and targets, at both individual grant and portfolio 
levels, for health impact, scalability, and sustainability. These important decisions will influence 
SL@B’s priority markets and the types/stages of innovations sourced. 
ii. Capture better data prospectively at innovation and portfolio levels over time with clear indicators 
for outputs and outcomes for each growth stage. Having better data would enhance the ability 
to benchmark and measure pathways and timelines for milestones, better understand program 
successes and challenges over time, and facilitate continued adaptive program implementation and 
learnings. This approach could also help influence the broader MNH and global health innovation fields 
and lead to stronger data and evidence for innovation beyond the SL@B program.
iii. Set and manage stakeholders’ expectations including innovators, external partners, and internal 
stakeholders about program goals, timelines, target success rates, and potential for sustainability by 
different types for innovations trying to scale in LMICs. 
a. Set realistic metrics for three to five years for early-stage innovations, including those that could 
be transformative, which are unlikely to include mortality reduction as a primary outcome. The 
unifying theme of “saving lives at birth” is powerful in setting an aspirational vision, but may also 
unintentionally set unrealistic expectations about what is feasible or achievable in the short to 
intermediate term for an innovation program. 
b. Establish success metrics and clear and quantified risk tolerance guidelines grounded in realistic 
understandings of timelines and failure rates for innovations to facilitate alignment among 
stakeholders.
* The DevelopmentXChange (DevX) is an annual event organized by the SL@B partnership every year since 2011. It has been traditionally held at USAID headquarters
in Washington, D.C. and attended by SL@B innovators, SL@B finalists, and potential scaling partners for SL@B innovations.
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2.
3.
Strengthen proactive engagement and buy-in of public and private sector stakeholders in targeted 
LMICs to prioritize MNH challenges, co-design innovations, co-select innovations, and support scaling of 
integrated solutions into specific country contexts.
Address continued gaps beyond current SL@B program to support sustainable scaled innovations
i. Recognize the continued gap between exit from the SL@B program and actual scale. The SL@B 
program currently serves innovations up to a certain point (TTS being the most advanced stage), but 
even most successful TTS innovations will not be operating at scale at the end of their SL@B funding 
period. The SL@B program could address this issue in several ways, including:
a. Developing an additional funding category for post-TTS.
b. Building strong ecosystem partners in LMIC markets to take on innovations after exiting SL@B. 
c. Proactively facilitating hand-offs to other funders. Implementation programs supported by SL@B 
funding partners (including USAID, GCC, and BMGF) could become natural handoff partners. 
ii. Leverage existing and growing networks and platforms such as Every Woman Every Child (EWEC) and 
Partnership for Maternal, Newborn and Child Health (PMNCH), as well as the growing number of funders 
for MNH innovation. Doing so would offer SL@B a significant opportunity to strengthen its approach to 
later-stage growth and scaling beyond its current approach through TTS funding and support.
iii. Facilitate integration of promising innovations. This is a key step in improving the scale and adoption 
of innovations especially in target LMICs. Innovations are more likely to be used when combined 
with other successful interventions or existing workflows. The SL@B program has been supportive of 
these efforts, but creating clear pathways and provisions for innovations to gain acceptability, and be 
adopted or integrated in health systems will help accelerate time to scale in target countries. Scaling 
requires alignment across regional, national, and subnational policies, strengthening of sustainable 
financing, building of appropriate health system capabilities and competencies, and the deployment 
at scale of multiple complementary innovations that address complex health challenges. The scaling 
journey is exceedingly difficult for innovators to navigate, and a stronger program emphasis on active 
facilitation of integration and scaling could be a differentiated value for SL@B or other programs.
i. As SL@B considers its geographic prioritization, collaborations with national and sub-national public 
and private sector stakeholders are important to identify current MNH gaps and opportunities for 
improvement, as well as garner support and co-lead programs. 
a. Engage local ministries early, jointly determine priorities, and curate validated innovations that can 
be scaled in different countries based on need.
b. Build on this LMIC engagement to increase in-country support for target markets, to help 
innovators better understand the context, get real-time insights on the ecosystem, and make 
targeted connections.
ii. Strengthen demand-driven innovation sourcing combined with the open call approach to source diverse 
innovations and ideas, so that SL@B can build on its strengths and increase its impact in key LMICs. 
iii. Give some precedence to LMIC-based innovators while strengthening their capacity to implement and 
scale innovations to re-balance HIC-driven SL@B solutions and to address the issue of sustainably 
scaling integrated solutions. Achieving stronger local innovation capacity in LMICs would be a positive 
outcome for the SL@B program to complement the direct impact of the innovations funded.
iv. Convene an integrated marketplace for innovations at the LMIC country or regional level with local 
stewardship and ownership of the platform. 
a. SL@B’s open call approach could include supplemental targeted calls based on regional priorities 
and needs. 
b. Convening a regional marketplace would provide an opportunity for increased visibility for the 
SL@B program and for countries to select the most impactful innovations for their context.
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Figure 1. Recommendations for SL@B from the Program Evaluation 
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Saving Lives at Birth (SL@B): A Grand Challenge for Development brings together a global community to 
combat preventable maternal and newborn deaths and stillbirths on a global scale. Launched in 2011, SL@B 
is a partnership of key global health stakeholders including Grand Challenges Canada (GCC), the United States 
Agency for International Development (USAID), the Norwegian Agency for Development Cooperation (NORAD), 
the Bill and Melinda Gates Foundation (BMGF), U.K. Department for International Development (DFID), and Korea 
International Cooperation Agency (KOICA).5 As a grand challenge, the approach of SL@B has been to source 
pioneering innovations to address critical MNH challenges, including newborn survival by accelerating progress 
towards sustainable solutions.6
SAVING LIVES AT BIRTH: A GRAND CHALLENGE
INTRODUCTION
Global Maternal and Newborn Health Priorities
In 2015, over 300,000 women died due to complications of pregnancy and/or childbirth.7 Nearly all (99%) of those 
deaths occurred in LMICs, where women from rural, poor communities are the most impacted.8 The majority of 
maternal deaths are also preventable or treatable; they occur because too many women in low-income countries 
lack access to emergency obstetric care, skilled birth attendants, high-quality antenatal care (ANC), and family 
planning services.8
The World Health Organization (WHO) estimates that 2.5 million infants die within the first month of life in a 
year.9 Stillbirth accounts for additional 2.6million deaths annually.10 Overall, newborn deaths make up 46% of all 
child deaths globally. The vast majority of these were preventable, occurring due to preterm birth complications, 
pneumonia, or acute intrapartum related emergencies, such as birth asphyxia.11 See Figure 2 for the most 
common causes of neonatal and maternal mortality globally. Babies born in LMICs are at much greater risk of 
death than those born in HICs; children born in the WHO’s Africa Region are six times more likely to die in their 
first year than those born in the WHO’s European Region.12
Figure 2: Causes of Maternal and Neonatal Mortality Globally
Source: Estimates from L.Say, et al. (2014)13 for Maternal Mortality, and Liu, et al. (2016)11 for Neonatal Mortality.
Panel A: Causes of Maternal Mortality Panel B: Causes of Newborn Mortality
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The SL@B funding partners engaged Duke University in 2018 to design and conduct an evaluation of the SL@B 
program to determine how well it was achieving its intended impact and to generate data-driven programmatic 
recommendations for future iterations of the program. The multi-disciplinary team of researchers and evaluators 
at the Duke Global Health Institute’s Evidence Lab and the Duke Global Health Innovation Center designed an 
evaluation with four key evaluation questions, informed by the original call for proposals and SL@B’s Theory of 
Change (see Appendix I for the SL@B TOC diagram):1 
1. How does SL@B map onto the global landscape of MNH innovation?
2. Does SL@B fill a gap in MNH innovation funding?
3. What has been the impact of SL@B on sourcing, supporting, and scaling MNH innovations between 2011 
and 2018?
4. What is the potential impact of SL@B-funded innovations on MNH mortality and in the MNH ecosystem? 
This final report utilizes a mixed-methods approach using quantitative and qualitative data collected through 
multiple sources: 
1. Program data on the SL@B funding portfolio, provided by USAID and GCC and validated by the ESL@B team. 
2. Extensive desk research and review of the MNH funding landscape, including a dataset that the ESL@B 
team created from publicly available information on a sample of 227 MNCH programs funded by 32 key 
funders between 2011-2018; as well as data on public and private investments in MNH in India and Kenya 
collected from the Pitchbook database, which aggregates data on venture capital, private equity, and 
various public sector investors.
3. Data collected through 80 semi-structured interviews, including with 33 SL@B innovators and 
implementing partners, of which 17 are based in LMICs, 19 RMNCAH funders, 28 global MNH experts, 
non-SL@B innovators, and SL@B funding partners. Innovator interviews largely (though not exclusively) 
focused on those operating (or planning to operate) in Kenya, Ethiopia, and India.
4. Data collected from SL@B innovators through an online survey to measure their progress through growth 
stages, scale, challenges, and successes accomplished before, during, and after their grant period.
5. Cost data collected from five SL@B transition to scale (TTS) innovators through an Excel-based costing tool 
to conduct cost-effectiveness analysis (CEA).2
The ESL@B team analyzed the data collected from the sources listed above and presented results in several 
previous reports to SL@B funding partners, specifically the SL@B Portfolio Review and Landscape Analysis report, 
the Acceleration to Impact thematic brief, the Summary of Key Findings from In-depth Interviews report, and the
Interim Synthesis Report. The ESL@B team further synthesized these findings, in addition to incorporating new 
analyses, for this final report. 
The Duke University Campus Institutional Review Board (IRB) approved three separate protocols to cover all 
research related activities [IRB #2018-0370 (existing data), IRB #2018-0617 (interviews), and IRB #2019-0546 
(quantitative survey)]. All key informants gave written informed consent to participate. 
PURPOSE OF THE EVALUATION
DATA, METHODS, AND LIMITATIONS 
SL@B’s Focus on Innovation to Address Maternal and Newborn Mortality
The SL@B program emphasizes the importance of developing, validating, and scaling promising social and busi￾ness innovations, with a primary focus on science and technology, service delivery, and demand creation to solve 
complex challenges. Since its launch in 2011, SL@B has funded 147 innovations,*
 of which 116 are unique, from 92 
innovators solving for critical MNH needs in low-resource settings. These projects, including diagnostics, drugs, care 
delivery models, and other types of innovations, tackle the major causes of maternal and neonatal mortality and 
stillbirths. While the diverse portfolio includes innovations across growth stages and at various levels of scale, many 
are relatively early in development. Accordingly, the SL@B funding partners have designed the program to combine 
financial, technical, and strategic support for innovations on the path from idea to operating at scale. 
* At tthe time of writing this report, one award in Round 8 to Ona Kenya was still under negotiations, and so has been excluded from all analyses in this evaluation.
12
The structure of this final report is informed by key areas of interest for the SL@B partners, as described in the 
SL@B TOC and the SL@B Impact Areas Framework (please see Appendix I for the TOC diagram and Appendix II for 
the Impact Areas Framework). 
The report is organized as follows: 
• Section 2 describes the SL@B program in relation to the global MNCH landscape
• Section 3 details SL@B’s role in building innovator capacity and accelerating innovations
• Section 4 highlights partnerships created by SL@B innovators and the role SL@B played in facilitating 
partnerships for increased innovation impact
• Section 5 outlines the work done to quantify SL@B’s impact
• Section 6 concludes with a discussion presenting additional perspectives to inform program design and 
elements
The ESL@B team provides recommendations for the SL@B program at the end of each section, informed by 
the findings in that section. We have also distilled these data-driven thematic recommendations into a priority 
list of potential program changes, presented in the Executive Summary. The discussion section encompasses a 
broader perspective of the ESL@B team members on the SL@B program and future directions beyond data-driven 
observations presented in the report. 
STRUCTURE OF THIS REPORT
LIMITATIONS 
For transparency, we note several research limitations. The evaluation was largely retrospective in nature, with an 
emphasis on analysis of existing data collected over the course of the program and a review of publicly available 
data. Primary data collection included an online survey for innovators, which is subject to missed data from those 
innovators who did not respond as well as self-report bias; however, the survey received a response rate of 54%, 
which is considered high for an online survey. Likewise, primary data collection via key informant interviews could 
have been subject to self-report bias; however, the sample size was high enough to reach data saturation (no new 
themes emerging) which lent strength to our reported findings. Furthermore, quantifying SL@B’s impact on reducing 
mortality via cost-effective innovations at a portfolio level was not feasible due to the limitations of effectiveness data 
for early stage innovations and access to accurate cost data which was innovator-dependent. While portfolio-level CEA 
was not feasible, CEAs for four selected innovations is being conducted. 
The ESL@B team found that there is no clear or consistent definition of innovation as a concept, and that there is 
limited evidence regarding time to impact or scale for global health innovations, adding difficulty in establishing 
clear benchmarks. When possible, categorizations such as stage of growth were determined by the ESL@B team 
using available descriptions of projects based on established sources such as the International Development 
Innovation Alliance (IDIA) for growth stages.14 Finally, the SL@B program’s selection process and criteria are outside 
the scope of this report as the ESL@B team was asked not to review or analyze this data for the evaluation.
13
• Innovations funded by the SL@B program target 80% of the most common causes of newborn death and 
60% of the most common causes of maternal death. 
• Compared to a study sample of 227 funded MNCH programs across 32 other funders, the SL@B 
program was more likely to fund product and technology innovations. In interviews, some MNH experts 
shared a concern that this focus on product and technology innovations creates a risk of developing a 
portfolio of standalone devices instead of integrated solutions. 
• The SL@B program appears to fund a greater proportion of early-stage innovations than most other 
MNCH funders, helping to fill a critical funding gap in the early-middle growth stages. Interviews with 
MNH experts indicate that SL@B’s focus on early growth stages has provided an opportunity to test ideas 
and produce viable solutions that otherwise would likely not exist.
• Analysis of the private equity and venture capital investment landscapes for MNH in Kenya and India 
(two of the most common target countries for SL@B innovations) indicate this field has dramatically 
changed since the launch of SL@B in 2011, with increased attention to MNH and willingness to invest in 
these markets. 
• Interviews with MNH experts indicate that SL@B’s open-call approach has fostered interdisciplinary 
collaborations, setting it apart from other MNCH funders, including the individual agencies of the SL@B 
partnership. Data from the SL@B innovator survey indicate that the open call may also attract teams that 
include members outside of the health field to MNH innovation.
• Despite the open-call approach, the SL@B review and selection process has tended to fund a higher 
proportion of innovations originating in high income countries (HIC) (83%) than low-and middle-income 
countries (LMIC) (17%). Of the HIC-based organizations, 5% have LMIC-based country offices as SL@B’s 
prime recipient. No known portfolio balance or target ratio for the SL@B portfolio of funded innovations 
was established. Interview data with MNH experts suggest that solutions designed by LMIC-based teams 
may be more likely to be viable, sustainable, and cost-effective.
• The non-financial support provided by the SL@B program (e.g. Xcelerator workshops,*
 targeted 
connections made by grant managers) is highly valued by innovators, and distinct in the field of MNH 
innovation funding.
KEY FINDINGS
THE SL@B PROGRAM IN THE GLOBAL 
LANDSCAPE: Sourcing and Funding 
MNH Innovations
2
* The Xcelerator program is a key element of the non-financial support provided by the SL@B partnership through VentureWell s ince 2017 (and Duke University
in 2018 and 2019) to provide training and capacity building to SL@B innovators to develop and scale their innovation.
14
It is important to consider the contributions and value of the SL@B program within the contexts of both 
the broader RMNCH ecosystem and the grand challenge approach. In examining SL@B’s position within the 
broader RMNCH landscape, we recognize that the SL@B program, totaling 77 million USD from 2011 to 2020, 
is a small program in the global RMNCH landscape. In 2011, funding from official development assistance and 
grants from BMGF (ODA+) for RMNCH was 12.2 billion USD, which increased to nearly 16 billion USD in 2017, 
the latest year for which funding information is available.3,4 Of this, funding for MNH in 2017 was 3.1 billion 
USD and approximately 2 billion USD in 2011.4 Despite such a large investment , an additional 33.3 billion USD 
per year is needed to achieve the targets set in the EWEC Global Strategy and SDG goals for RMNCH.15 As many 
funders do not differentiate targeted innovation funding within their portfolios, it is difficult to accurately 
say what percentage of global ODA+ funds have been spent on MNH-focused innovations. While the SL@B 
portion of funding for innovation is relatively small in the larger MNH funding landscape, it aims to achieve 
sizable impacts in terms of improving and saving lives, calling attention to neglected MNH needs in LMICs, and 
popularizing innovation to address those needs. 
SL@B’s sourcing and funding strategy in the global landscape of MNH funders 
To better understand trends in MNCH innovation funding, how the SL@B portfolio compares to the larger landscape 
in terms of health priorities and stages of growth, and the role played by the SL@B program within this field, the 
ESL@B team developed a funding landscape data matrix by collecting and analyzing publicly available information 
on 32 funders of MNCH programs and a sample of 227 projects supported by these funders between 2011 and 
2018. The ESL@B team selected the sample of 32 MNCH funders for desk research with input from USAID and GCC. 
Selection criteria included funders who had funded at least one MNCH innovation between 2011 and 2018 and 
focused on three types of funders: philanthropic, investment (debt and equity), and development aid organizations 
that fund individual organizations. In addition, the team conducted 25 semi-structured interviews with funders and 
both SL@B and non-SL@B innovators. 
Taken together, analysis of the composition of the SL@B portfolio and the broader funding landscape provides 
insights on the role played by the SL@B program in meeting funding needs in the MNCH field, and determining 
whether there are remaining gaps in the funding landscape for MNCH innovation.
Who and what does SL@B funding target?
Type of organizations. 
Most global MNH funders invest in a variety of organization types, including non-profits, for-profits, and academic 
organizations. Some also fund governments, though this is not as common. Analysis of the MNH funding data 
matrix described earlier and key informant interviews indicate that philanthropic grant funders are more likely than 
equity or debt funders to source university-based projects. 
Similar to other philanthropic funders, a large portion of SL@B awards went to university-based innovators (n=59), 
followed closely by non-profit organizations (n=56). About a fifth of the portfolio (n=29) is for-profit organizations, 
and three innovations are from public international organizations (PIOs).
Despite the majority of SL@B innovations being university-based, the SL@B program has funded different types of 
organizations across its eight funding rounds as described above. Other funders emphasized the need for diverse 
organizations as well; they noted that no single type of institution can drive change, which can only be accomplished 
by a combination of many. Having said that, most funders report that they value potential for impact and mission 
alignment as opposed to the type of organization when deciding which projects to fund. 
Type of innovation.
For this analysis, innovations are categorized into four primary types: 
1. Drugs and vaccines
2. Products (including devices and diagnostics)
3. mHealth (including digital health and eHealth)
4. Practice and approach (including care delivery and behavior change) 
CONTEXT FOR ASSESSING VALUE OF SL@B IN GLOBAL MNH LANDSCAPE
15
The innovation types were selected in consultation with USAID. While these categories are comprehensive, they are 
not mutually exclusive. For example, many of the mHealth innovations focus on care delivery and behavior change 
and could also be categorized as practice and approach models. For this analysis, the ESL@B team classed each 
innovation under one primary category for innovation type and growth stage, though many could very well fit into 
more than one at the same time. 
The SL@B program has maintained a strong focus on products, including devices and diagnostics. Across the eight 
rounds of SL@B, 60% of awards went to product innovations (n=89). Practice and approach innovations received 
16% of awards (n=24). Innovations primarily classed as drugs/vaccines (n=18), and mHealth (n=16) are evenly 
represented, each making up about 12% of the awards made. 
Key informants interviewed for this evaluation expressed concerns that the majority of SL@B funding went to 
product-based innovations, given that the program was designed to source solutions of many types, not just 
technology. MNH experts in particular noted that there is a risk that new products and technologies will exist in 
the market as standalone devices, which will not be sufficient to solve MNH issues. These informants noted the 
importance of integrating innovations into more comprehensive solutions that augment the financial, policy, and 
care delivery systems of healthcare. 
It is the intention of the SL@B program to grow product-based innovations into integrated and bundled innovations 
through its staged funding approach. Notable examples of innovations that started off as a product in earlier 
rounds, but have grown into integrated solutions are the Bili-Kit (Little Sparrows), Pratt Pouch (EGPAF), and bubble 
CPAP (Rice University). Similarly, Chlorhexidine (JSI) and the Universal Anesthesia Machine (Gradian) are on their 
way to integration into the national health policy of their respective implementation countries. Similar efforts are 
underway for other innovations as the SL@B portfolio matures.
The following quote from a key informant reiterates 
the need to strengthen the health system so that 
innovations could be easily integrated. 
Figure 3: Number of Innovations, by Innovation Type and Round
Source: Duke University analysis of SL@B program information provided by USAID and GCC 
“But again, it depends on the strength of the systems; you 
could have the best innovation in the world, but if you 
don’t have a strong system to implement it, then, that’s 
just not going to work.” – HIC MNH expert
16
Figure 4: Funding Portfolios by Target Population
Source: Global MNCH Funders’ Population Focus compiled by ESL@B team from public data available online; SL@B Population Focus received from SL@B 
program and validated by ESL@B team.
* SL@B as a program is primarily focused on addressing MNH issues around the time of childbirth, although some innovations cover the broader spectrum 
including child and reproductive health i.e. MNCH or RMNCH. When putting SL@B in the context of the global ecosystem, it’s hard to parse out MNH since 
most global health data encompasses RMNCH. Therefore, in this report, we use MNH when it’s specific to SL@B and MNCH or RMNCH when referring to SL@B 
in relation to the broader ecosystem.
** Most funders of MNCH projects are not specifically focused on MNH but include it as a part of a larger portfolio of projects focusing on a variety of RMNCH 
and systems strengthening issues.
Disease focus. 
The SL@B portfolio addresses the most common causes of maternal and neonatal deaths across the eight 
rounds, targeting 80% of the most common causes of neonatal death and 60% of the most common causes of 
maternal deaths. 
Despite the fact that the SL@B portfolio addresses the most common causes of maternal and neonatal mortality, a 
few key informants noted that there is still a gap in addressing stillbirth, a major contributor to mortality. This gap 
highlights the need for more innovations directly addressing stillbirth in the SL@B portfolio as well as in the larger 
MNH ecosystem. While a significant number of SL@B innovations may have the potential to contribute to reductions 
in stillbirths, that indicator is not routinely monitored or reported on by the innovators. Categorizing innovations by 
their potential impact on stillbirths was outside the scope of work for this evaluation.
“One of the most fundamental questions [of the SL@B program], even before you get to the nitty-gritty of a life saved is – here are the 
three groups: 300,000 maternal deaths, quite a lot around the time of birth, 2.6 million stillbirths, half of which during 24 hours when 
the woman is in labor, and then neonatal death, 2.6 million of which about 40% of the first couple of days. So, of those, what’s the 
match between the inputs and whether they’re addressing the biggest things.” 
– HIC MNH expert
Panel A: Global MNCH Funder 
Population Focus
Panel B: SL@B Population Focus
Population focus.
Most funders of MNCH projects are not specifically focused on MNH but include it as a part of a larger portfolio of 
projects focusing on a variety of RMNCH and systems strengthening issues.* As indicated in Figure 4 below, over 
half (56%) of the projects reviewed** target maternal, newborn, infant, and child health broadly. The remaining 
projects are split between those that focus specifically on neonatal or maternal causes. The SL@B portfolio, on 
the other hand, is generally equally split with a primary focus on maternal health (37%), followed by maternal and 
newborn health (34%), and then newborn health (29%). 
17
SPECIFIC FOCUS COUNT % OF PORTFOLIO
Maternal 56 38.2%
 Postpartum hemorrhage 13 8.8%
 Pre-eclampsia 11 7.5%
 Intrapartum complications 7 4.8%
 Health service delivery 6 4.1%
 Reproductive health 6 4.1%
 Other (diagnostic tests, vaccine/drug delivery) 6 4.1%
 Micronutrient deficiency 5 3.4%
 Infection 1 0.7%
 Prematurity 1 0.7%
Maternal & Newborn 49 33.3%
 Health service delivery 26 17.7%
 Intrapartum complications 8 5.4%
 HIV/PMTCT 5 3.4%
 Infection 4 2.7%
 Respiratory distress 3 2.0%
 Other (diagnostic tests) 2 1.4%
 Micronutrient deficiency 1 0.7%
Newborn 42 28.5%
 Respiratory distress 16 10.9%
 Jaundice 8 5.4%
 Infection 5 3.4%
 Health service delivery 4 2.7%
 HIV/PMTCT 4 2.7%
 Prematurity 4 2.7%
 Other (drug delivery) 1 0.7%
Grand Total 147 100%
Source: SL@B portfolio targets of maternal and newborn mortality provided by USAID and GCC and validated by ESL@B team.
Table 1: SL@B Portfolio by Causes of Maternal and Newborn Mortality 
For this evaluation, “For this evaluation, the ESL@B team used six stages of growth for innovations as defined by the 
International Development Innovation Alliance. 
1. Ideation: Define problem, scan landscape, develop initial ideas
2. Research and Development: Develop specific innovative solution 
3. Proof of Concept (POC): Field test innovation to assess potential 
4. Transition to Scale (TTS): Refine model, develop partnerships to enter market
5. Scaling: Replicate or adapt to increase impact
6. Sustainable Scale: Wide-scale implementation, sustained by ecosystem 
Stage of growth and development
Table 1 shows types of diseases and conditions targeted by SL@B.
18
For initial analyses, the ESL@B team defined four growth stages for innovations in the SL@B program based on the 
scaling stages developed by the SL@B program partners. In later analyses, in consultation with the SL@B funding 
partners, the ESL@B team transitioned from the SL@B growth stage categories to the IDIA framework for the analyses 
presented in this report.14 Figure 5 shows an approximate alignment between the different growth stage frameworks.
Most MNCH funders included in this analysis are either agnostic to stage of growth of the innovation (from ideation 
to sustainable scale) or have a specific focus on the later growth stages. Across the sample of non-SL@B MNCH 
innovations, funding awards could be divided into thirds, with 36% going to the three early stages (ideation, R&D, 
and proof of concept), about 30% going to transition to scale stage projects, and about 34% going to scaling stage 
projects. However, growth stage data for the projects included in the funding landscape sample were limited in 
availability and difficult to verify. Therefore, any analysis of growth stages among other MNCH funders included in 
this research is only suggestive.
Interviews with SL@B innovators revealed that a number of funders have provided early-stage support but many 
of these (including DFID, National Institutes of Health, National Sciences and Engineering Research Council, and 
the Wellcome Trust) are more likely to source innovations within large established institutions, such as universities, 
rather than start-ups. Further, early-stage support may be more likely to fund HIC-based teams, rather than LMIC￾based enterprises. Thus, LMIC-based social enterprises (for-profit and not-for-profit) may have fewer options for 
early-stage funding until they are able to show proof-of-concept or validation. 
In contrast to most funders in the landscape, the SL@B program funds a greater proportion of early-stage 
innovations. The ESL@B team used program data to determine the IDIA growth stage for each awardee at the time 
of award. For this analysis, we examined each innovation as distinct (n=147), including those that received multiple 
awards. Additionally, we class each innovation under one primary growth stage, but could fit into more than one at 
the same time.
Table 2 shows the distribution of innovations in the SL@B portfolio by type and stage of innovation. Approximately 
47% of innovations funded are in the ideation (n=3) and research and development (n=66) stages; but along with 
proof of concept (n=57), early-stage innovations make up 86% (n=126) of the SL@B portfolio from rounds one 
through eight. This concentration of early-stage innovations is reflected in product-based innovations as well: 
making up 61% of SL@B innovations (n=89); about 93% of product-based innovations are in the early stages of 
scaling: ideation, research and development, and proof of concept (n=83). 
Figure 5: IDIA and SL@B Innovation Growth Stage Categories 
Table 2: Number of Innovations, by Type and Stage 
TYPES/ STAGES IDEATION RESEARCH & 
DEVELOPMENT
PROOF-OF￾CONCEPT
TRANSITION￾TO- SCALE
SCALING TOTAL
Drugs & Vaccines 1 9 5 1 1 18
mHealth - 7 6 2 1 16
Practice/Approach 1 6 8 8 1 24
Products 1 44 38 7 - 89
Total 3 66 57 18 3 147
Source: SL@B program information provided by USAID and GCC, and validated by the ESL@B team.
IDIA 
Scaling 
Stages
1. Ideation 2. Research & 
Development 
3. Proof-of-Concept 4. Transition to 
Scale 
5. Scaling 6. Sustainable Scale 
Define problem, 
scan landscape, 
develop initial 
ideas
Develop 
specific 
innovative 
solution
Field test innovation 
to assess potential 
Refine model, 
develop 
partnerships to 
enter market
Replicate 
or adapt to 
increase impact
Wide-scale 
implementation 
sustained by 
ecosystem
Growth 
Stages 
Applied 
by SL@B 
1. Development 2. Validation 3. Early Adotpion 4. Scaling
Research and development of 
initial idea, create prototype 
Establish proof￾of-concept, field 
testing, clinical trials 
Entry into target 
market, demand 
generation 
Increase impact 
in original and/
or new markets 
19
Source: SL@B program information provided by USAID and GCC, and analyzed by the ESL@B team
Figure 6 shows that although the proportion of early-stage (ideation, research and development, and proof of 
concept) innovations was high in rounds one through four, accounting for over 80% of funded innovations in round 
one (n=21), in later rounds, SL@B funding trended towards later stages of development. This trend can be partly 
accounted for by SL@B’s maturing portfolio. Twenty-five innovations (17% of all SL@B innovations) that received 
early-stage funding in rounds one through five received follow-on later-stage funding from SL@B in rounds four 
through eight. 
Figure 6: Number of SL@B Innovations, by Stage of Growth and Round 
How does SL@B fund by stage of growth? 
Type of award.
In the first four rounds, SL@B awarded two types of grants: seed and TTS. The proportion of seed grants in this 
period varied between 80% and 90%, with TTS grants making up the balance. However, several of the TTS awardees 
in these earlier rounds were still in early stages of growth (ideation, research and development or proof-of-concept, 
rather than an actual TTS stage), and were not yet poised for scale in one or more markets. 
Starting in round five, the SL@B program introduced validation grants to distinguish purely development 
grants from those that are past the idea stage and ready to test the prototype or validate their model. After the 
introduction of validation grants, the proportion of TTS grants increased significantly, from 13% in round four to 
31% in round seven, while seed grants decreased from 87% to 25% in round seven. Only validation and TTS awards 
were offered in the request for proposal (RFP) for round eight, with all final awards ending up being TTS. Validation 
grants constituted two-thirds of all grants in round five, but this reduced to 44% in round seven. Of the number of 
grants awarded across the eight rounds, nearly two-thirds of awards were seed grants (n=93), about a fifth were 
validation grants (n=28), and 18% were TTS grants (n=26). 
Overall, these findings indicate that the SL@B program 
built a distinct portfolio as compared to the wider 
funding landscape by sourcing and funding more 
innovations in the earliest stages (ideation, research and 
development, and proof of concept). Most key informants 
expressed the importance of targeted funding at such an 
early stage and having the opportunity to test their ideas 
and produce viable solutions. 
“[SL@B has] managed to roll out funding for 
a variety of good ideas to people and groups 
who otherwise would not have had a chance 
of getting any funds… it did bring in interesting 
innovations which would otherwise have not 
seen the light of day.” – HIC MNH expert
20
Where is SL@B funding targeted? 
Among the global MNH funders reviewed, most target key countries with high levels of MNH need, including India, 
Nigeria, Mexico, Uganda, and South Africa. The SL@B portfolio targets many, but not all countries with the highest 
maternal and neonatal deaths, even when looking at the top 25 countries with the greatest burden in terms of 
absolute numbers. The ESL@B team also examined the overlap between the countries with a high proportion of 
proposed SL@B innovations and global maternal and neonatal mortality ratios. There is very little overlap between 
countries with the greatest burden of maternal and neonatal mortality ratios and those countries targeted for 
implementation by SL@B-funded innovations. Panels A and B in Table 3 show that SL@B is better represented 
when examining countries by absolute numbers of maternal and neonatal mortality. 
It is likely that there is a discrepancy between the countries that SL@B has tended to focus on (e.g. Kenya, Uganda) 
and countries with highest burden (especially in terms of rates and ratios) because of SL@B donors’ and HIC 
awardees’ established connections on the ground, better infrastructure for testing and validating innovations in 
countries like Kenya and Uganda relative to difficult-to-reach/poorly-resourced locations, and a reluctance to work 
in conflict/fragile states. 
Beyond the countries that SL@B targets, it is important to assess the subgroups that the innovators reach 
with their innovations. The ESL@B team attempted to use the EquityTool—a simplified version of the Wealth 
Index from the Demographic and Health Survey (DHS) which is widely regarded as the gold standard of population 
health and development in low income settings—to examine whether SL@B grantees were addressing equity within 
their beneficiary groups.18 Although this ended up not being feasible at the portfolio level, we did pilot its use with 
one product innovator, and results indicated that more than half of the beneficiaries (67%) are above the two lowest 
wealth quintiles. While this innovator worked in a lower-resource country, they did not necessarily primarily serve 
the most vulnerable. 
It is worth noting that this analysis was conducted based on midline data collected from an urban intervention 
site of the innovation. The reach of this innovation could change as it makes progress towards scale. For example, 
an innovation might start in an urban area for convenience and sustainability purposes and move to rural and/or 
underserved areas as it scales, thereby reaching a more vulnerable population. 
Nonetheless, addressing equity is a challenging but necessary gap that must be addressed to have a measurable 
impact on global mortality. While a larger portfolio-level analysis is needed for a comprehensive understanding of 
the SL@B’s program ability to address health inequalities within low-resource countries, our example indicates the 
need for innovations to collect data on their beneficiaries because working in countries with high maternal 
and neonatal mortality ratios might not suffice to address the need of the most vulnerable. 
Other aspects that need to be considered regarding achieving equity are sustainability and business models of an 
innovation. If an innovation is solely targeting the most vulnerable, it may never be sustainable and might require 
dependence on other entities. Therefore, the sustainability of the business model is often dependent on the type of 
beneficiaries an innovation intends to reach.
21
Table 3: Top 25 Countries with Highest Burden of Maternal Mortality Ratios, Newborn Mortality Rates, Maternal 
Deaths, and Newborn Deaths, Compared to Number of SL@B Innovations Targeting those Countries 
Source: Estimates from WHO, UNICEF, UNFPA, World Bank Group, and UN Population Division
Panel A: Top 25 Countries by Maternal Mortality Ratios and Newborn Mortality 
Rates, Number of SL@B Grants16,17 MMR per 100,000; NMR per 1,000 live births 
Country MMR NMR Number of SL@B Grants 
South Sudan 1,150 83 0
Chad 1,140 45 0
Sierra Leone 1,120 43 1
Nigeria 917 46 4
Somalia 829 80 0
Central African Re￾public 829 70 0
Mauritania 766 65 0
Guinea-Bissau 667 56 0
Liberia 661 1
Afghanistan 638 46 0
Côte d'Ivoire 617 42 0
Gambia 597 51 0
Guinea 576 41 0
Mali 562 41 1
Burundi 548 0
Lesotho 544 50 0
Cameroon 529 1
Tanzania 524 9
Niger 509 0
Eritrea 480 0
Haiti 480 0
DR Congo 473 42 1
Zimbabwe 458 0
Eswatini 437 0
Ethiopia 401 4
Comoros 73 0
Angola 55 0
Pakistan 52 6
Djibouti 52 0
Equatorial Guinea 51 0
Botswana 50 0
Turkmenistan 49 0
Micronesia 41 0
Kiribati 41 0
Yemen 39 0
Panel B: Top 25 Countries by Number of Maternal and Neonatal 
Deaths, Number of SL@B innovations 7
 
Country Maternal 
Deaths 
Newborn 
Deaths 
Number of 
SL@B Grants 
Nigeria 67,000 336,372 4
India 35,000 631,754 17
DR Congo 16,000 144,291 1
Ethiopia 14,000 124,323 4
Tanzania 11,000 57,118 9
Indonesia 8,600 74,921 1
Pakistan 8,300 309,419 6
Afghanistan 7,700 54,890 0
Chad 7,300 0
Uganda 6,000 42,158 13
Côte d'Ivoire 5,400 37,360 0
Bangladesh 5,100 59,954 10
Niger 5,100 38,845 0
Somalia 5,100 48,764 0
Kenya 5,000 38,579 29
China 4,900 90,359 1
Cameroon 4,700 30,246 1
South Sudan 4,500 31,832 0
Mali 4,400 31,943 1
Sudan 3,900 50,820 0
Mozambique 3,100 43,458 0
Angola 3,000 67,375 0
Sierra Leone 2,900 1
Madagascar 2,800 0
Ghana 2,700 11
Egypt 40,898 1
Philippines 38,680 1
Yemen 34,083 0
Myanmar 30,569 0
22
Origin of innovation. 
Most global funders source innovations across multiple geographic regions, 
while a few formally target specific countries or regions. These funders often 
informally target organizations in geographies where they have stronger 
partnerships or believe there is untapped potential. Most global funders are 
open to funding teams headquartered in HICs as well as LMICs, provided the 
project targets LMIC populations. 
Global MNH funders identify and source innovations through different 
methods such as word-of-mouth and on-the-ground networks, in addition 
to putting out calls for proposals for specific focus areas at times. Relying 
on connections and networks serves a range of purposes for these funders, 
mainly sourcing local innovations and partners in LMICs and establishing 
long-term relationships on the ground. Despite this approach, some funders 
find it difficult to find institutions and innovators in LMICs who are a good fit 
for their funding program. 
SL@B has an open call approach that aims to source innovations 
from diverse geographic settings, especially from LMICs. However, the 
SL@B review and selection process has tended to yield and fund a higher 
proportion of innovations originating in HICs. Of the HIC- based innovations, 
5% of them have their LMIC country offices as primary SL@B recipients. 
Between rounds one and eight, only 17% of funded innovations (n=25) were 
from teams whose headquarters are based in LMICs, who received 19% of 
the overall funding. The proportion of innovations from LMICs has fluctuated 
across rounds, highest in round eight (33%) followed by round one (25%), 
and lowest in round six (6%). The program seems to have made a significant 
shift in round seven in terms of the amount of funding awarded to LMICs: 
while innovations from LMICs made up 13% of round seven innovations, 
they received 36% of the funding amount disbursed; Figure 7 shows the 
distribution and investment of funding across rounds. 
Figure 7: Number of SL@B Innovations and Amount of SL@B Investment, by Awardee Location
Source: SL@B program information provided by USAID and GCC, and analyzed by the ESL@B team
The ESL@B team classified 
innovations as either one in a 
low and middle-income country 
(LMIC) or high-income country 
(HIC) based on the registered 
headquarters of the primary 
organization listed on the award. 
Even if some of the HIC-based 
organizations have operations 
led by a local country office, we 
classify such entities as HIC￾based as they have access to 
stronger networks for fundraising 
and may be more competitive 
in submitting grant applications 
than other LMIC-based 
organizations. However, this 
classification could potentially 
miss the fact that country offices 
are the primary recipients of 
the award, their leadership 
and staff have autonomy in 
decision-making, and that the 
innovation itself is embedded in 
LMIC-settings. The ESL@B team 
identified six out of the 122 (5%) 
HIC based innovations as having 
LMIC country offices as the 
primary recipients.
Box 1. Classifying Innovations 
Based on Headquarters of 
Primary Award Recipient
Each round has two vertical bars: within each round, the bar on the left shows the number of SL@B innovations funded in that round, and the bar on the right shows the total 
amount invested (in million USD). For both of these variables, the graph further shows the distribution between HICs (gray bar) and LMICs (purple bar). 
23
Interview data also indicate challenges that LMIC innovators face, which may help to explain the lack of LMIC 
representation within the SL@B portfolio: 
• Limited access to information and awareness about funding opportunities through traditional funding 
announcement mechanisms such as SL@B in LMICs.
• Inability of many LMIC innovators to regularly participate in international conferences and events such as 
DevelopmentXchange (DevX)*
 or other workshops (mostly 
due to visa, logistics, and financial issues) that connect 
them with the larger innovation community, broaden their 
understanding around MNH innovation, and link them 
with funding opportunities.
• LMIC organizations that are not well-known or have 
strong track records might be judged less favorably than 
those (especially HIC-organizations) with better known 
capabilities by the review panels on measures such as 
feasibility and likelihood of success. 
• LMIC innovators find it challenging to compete with more experienced, better trained, and better resourced 
HIC innovators in terms of writing winning proposals and executing grants.
• Grant/financial managers working with LMIC innovators may need to provide increased levels of management, 
capacity building, and time commitment. 
Among key informants who were asked about the 
composition of LMIC and HIC innovators in the SL@B 
portfolio, there was a clear consensus that this ratio 
was not ideal. Two-thirds of key informants underlined 
the importance of a more balanced portfolio in terms 
of innovator origin. Expert opinion from interview data 
suggests that people based in resource-limited settings are 
more likely to have a deeper understanding of the cultural 
and health ecosystem contexts, including constraints and 
barriers that innovations might face in moving to scale. 
Most key informants believed that innovations designed 
by LMIC innovators for LMIC contexts are more likely to 
be feasible, sustainable, and cost-effective. That said, 
the aggregate quantitative data to additionally support 
these expert opinions is still pending at the global level. Future longitudinal meta-analyses on the sustainability of 
innovations from multiple grand challenges and accelerators could further illuminate this issue. 
It is difficult within the current SL@B program data to measure the relative success of LMIC￾based and HIC-based teams in achieving key milestones on the path to feasibility and scale. This 
may be a consideration for partners when developing future iterations of the monitoring and 
evaluation strategy. As noted elsewhere in this report, a strong monitoring plan with growth 
stage-specific milestones can help the funding program identify factors that facilitate scale. 
Interview data suggest that “on-the-ground” expertise could influence the design phase of innovations and save 
time during the seed and validation (iteration) phases. 
 “I think there should be a better balance for sure. 
You know, people from high-income countries are 
trying to develop innovations that they think would be 
appropriate for low-income countries and sometimes 
they’re successful and sometimes they’re not. People 
from low-income countries know exactly what the 
situation is, and they know what the possibilities are 
and constraints are; so, they might design with those 
constraints in mind to come up with solutions. So, I 
definitely think that there should be a better balance.” 
– LMIC MNH expert 
“We cannot develop an innovation just based out of our lab. Biomedical engineers will only actually have a clearer idea of what’s 
not working when they have conversations with target users as to how to make it work and then come back with a solution.” – 
HIC MNH expert 
“I think there are two or three barriers for LMIC. One 
is they’re openly competing with people like me [a HIC 
innovator at a big academic institution] who write 
grants for a living, companies for medical devices 
with 30 years even sometimes 40 years of experience 
designing medical devices, people like PATH, JHPIEGO, 
or FHI360. These are, you know, very experienced.” 
– SL@B innovator (drug)
* The DevelopmentXChange (DevX) is an annual event organized by the SL@B partnership every year since 2011. It has been traditionally held at USAID headquarters in 
Washington, D.C. and attended by SL@B innovators, SL@B finalists, and potential scaling partners for SL@B innovations.
24
Box 2. Investment Funding for MNH 
The analyses above draw on a sample of funders primarily made up of philanthropic and development funders. To 
better understand the investment (rather than philanthropic) ecosystem for MNH and how it has changed since the 
launch of the SL@B program, the ESL@B team conducted an analysis of private and public investment (including 
debt and equity) targeting the maternal and neonatal health industry in Kenya and India. The team chose these 
countries because of the high proportion of SL@B-funded innovations targeting these markets. Using data from 
Pitchbook*
, the team identified the “top ten” investors in organizations focused on MNH from 1990 to 2011 and 
compared these investment organizations with the top ten investors from 2011 to 2019 with the same MNH focus. 
For this analysis, investors consisted of venture capital, private equity, and public sector organizations who invested 
in organizations focusing on MNH. 
The analysis shows that the investment landscape for MNH in Kenya and India has dramatically changed since 
the launch of SL@B in early 2011, indicating increased attention on MNH issues and willingness to invest in these 
markets. Of note, while Kenya and India are among the top target countries for proposed SL@B innovations, both 
are middle-income countries. Lower-income countries may not necessarily see these burgeoning investment 
opportunities as readily until further development and infrastructure become available, as seen in India and Kenya 
in the last quarter of the twentieth century.
According to Pitchbook data, prior to 2011, there were only 7 investors (of 106 investing in MNH) that made any 
deals in MNH enterprises within LMICs. This has increased nearly ten-fold, with over 70 investors out of 165 that 
made active deals as of 2019. From 2006-2010, the first time period in which any investment was made in MNH 
enterprises within India or Kenya, the ‘top ten’ list of investors were all privately-held venture capital firms or 
merchant banks that collectively invested $17 million USD in four distinct MNH-related companies, mainly hospitals, 
maternity services, or genomic-related companies. After SL@B’s debut, in early 2011 through 2014 and from 2015 to 
the end of 2019, the ‘top ten’ list of investors include venture capital funds, governments, accelerators/incubators, 
and not-for-profit venture capitalists who collectively invested more than $82 million in 22 MNH enterprises. The 
funded enterprises included social-impact organizations, innovators based in LMICs, and a greater inclusion of 
seed/early stage innovations. 
The investors themselves in 2019, compared to pre-2011, are not isolated to HICs but also represent domestic 
investment firms that are based in India and Kenya. In less than a decade, the amount invested has increased 
exponentially, indicating that this industry is still growing within LMICs such as India and Kenya. These investments, 
along with a growing atmosphere supporting innovation in India and Kenya, has led to a significant increase in the 
number of maternal and newborn services and innovations, and has played a role in the improved health outcomes 
over the past ten years.
These findings indicate that SL@B-funded innovations in 2019 will exit the SL@B program into a vastly different 
funding ecosystem than those funded in earlier rounds. These changes may increase the number of potential 
follow-on funding partners who can take up successful SL@B innovations in markets like India and Kenya.
*Pitchbook is a platform that gives access to comprehensive private & public capital market data. 
“There’s also a very important recognition that local organizations require more hand-holding, more intense management. 
Sometimes these organizations may not have the institutional and financial wherewithal. They may, but we have had experiences 
where it’s been more of a challenge.” – SL@B funding partner
25
SL@B differentiators
Distinct portfolio by innovation type and stage of growth
As noted earlier, the SL@B portfolio is distinct from the wider funding landscape in both type of innovation and 
stage of growth. Compared to the study sample of 227 funded MNCH programs across 32 other funders, the 
SL@B program is more likely to fund product innovations (such as diagnostics and devices) and far less likely 
to fund practice/approach or health system support innovations. In addition to a concentration of product 
innovations in the SL@B portfolio, the program appears to fund a greater proportion of early-stage innovations 
than other funders. 
This analysis implies that SL@B may help fill a critical need in the ecosystem for early-stage innovation support 
(one of the gaps in the MNCH funding landscape noted above). However, it is important to note that SL@B’s focus 
on early-stage, product-based innovations originating within universities could lead to longer time-frames for scale 
and sustainability relative to other funders’ focus on innovations in health practice and health systems support. 
Health priorities
The desk review of funded projects in this space demonstrates that, like SL@B, several funders focus on key MNH 
issues, such as sepsis, birth asphyxia, preterm birth, low birth weight, and postpartum hemorrhage. However, a 
substantial portion (nearly 70%) of the MNCH projects funded by non-SL@B funders included in this review focus 
on strengthening health infrastructure and integrated service delivery approaches (such as improving integrated 
maternal and newborn care). Compared with the broader field of MNCH funding, SL@B has a relatively smaller 
focus on infrastructure projects: practice and approach innovations (16%) and mHealth innovations (10%). 
Grantee support
The SL@B program stands out from the wider field with the integration of non-financial support. Interview data 
indicate that other funders do provide some level of non-financial support, typically consisting of connections to 
potential investors and collaborators, technical assistance, in-house corporate expertise, and consulting. SL@B’s 
accelerator program, however, stands out with its focus on MNH and the opportunity to provide early-stage scaling 
support. In interviews, grantees specifically mentioned the value of SL@B’s accelerator support and the focus on the 
scaling process. 
OPPORTUNITIES FOR PROGRAM IMPROVEMENT 
Even though the open call approach differentiates SL@B from other funders and promotes interdisciplinary 
collaborations, it may hamper implementation and scale of the innovations. By not having a pre-defined process 
or mechanism for involving LMIC-based stakeholders, such as national and sub-national governments in targeted 
agenda setting, SL@B faces challenges identifying what LMIC stakeholders perceive as the most viable innovations 
and those that respond to key MNH needs in contexts where innovations could have the most impact. This 
means that the portfolio is driven by supply-side rather than demand-side factors. Although key informants 
commend SL@B’s open call approach for facilitating a process 
that sources a range of ideas, over half stated that a more 
targeted approach (when it comes to defining the specific 
problem) would be a better sourcing strategy for SL@B. A 
targeted approach, such as having a call to address one specific 
problem or disease relevant to a particular setting, would 
enable SL@B to set priorities and fund innovations that could 
be more applicable on the ground in places with the greatest 
need. However, this approach would not necessarily target 
those innovations that are most likely to secure investment or 
sustainable funding long-term. 
“I think we should first have an assessment, then 
identify special critical areas, and then focus on 
those. Otherwise, even if we have innovations, 
we will end up without a significant impact after 
spending all that time and resources. There are 
areas which we really, really need immediate 
solutions for in newborn and maternal issues.” 
– LMIC MNH expert
26
RECOMMENDATIONS FOR SOURCING AND PORTFOLIO BUILDING
1.
2.
SL@B could consider issuing targeted, demand-driven innovation calls, such as based on disease 
burdens and/or geographic priorities. To seed innovation that can tackle priority MNH needs in 
the areas of highest need, SL@B should explore the possibility of making its calls more targeted and 
demand-driven in the following ways:
Acknowledging that SL@B’s open call intended to source innovations with no restrictions on geographic 
settings including LMICs, SL@B could consider a number of strategies to address the lack of LMIC-led 
innovations in its innovation portfolio.
• SL@B could deeply engage key public and private sector LMIC stakeholders in priority countries 
to identify the greatest challenges faced on the ground, relevant national and sub-national 
priorities, and the contextual factors or constraints that are most critical to determining successful 
implementation and scaling. These inputs could help to inform targeted calls for innovations that 
better match the needs and priorities in the target markets, provide insights into the types of 
non-financial support that would be most meaningful for innovators, and also develop stronger 
communities of key stakeholders that could enable the development of more integrated, 
comprehensive solution sets with the highest potential to reach scale and sustainability. 
• SL@B could more proactively reach out to specific local universities, research institutions, and 
innovation intermediaries (e.g., incubators, accelerators) in target countries so that local researchers 
and innovators are made aware of the funding opportunity. 
• SL@B could engage with local bilateral donor missions to increase visibility of the program and 
attract local innovators and partners, taking more advantage of the capabilities and networks of all 
SL@B funding partners. 
• To involve more innovators from LMICs, SL@B could provide more targeted technical support
during the application and selection phase. 
• SL@B could organize pre-proposal workshops targeting LMIC innovators where they can develop 
grant writing skills and get a better understanding of proposal development. 
• SL@B could hold regional convenings in target LMICs/regions similar to DevX (e.g. in East Africa) that 
are accessible to more LMIC innovators, increasing awareness of funding opportunities, technical 
support, and potential partnerships. Holding a platform like DevX in an LMIC context not only 
increases awareness, but also serves as a great networking platform that facilitates peer-to-peer 
learning, identifying mentors, and forging critical partnerships for growth. 
27
SL@B’S ROLE IN BUILDING INNOVATOR 
CAPACITY AND ACCELERATING INNOVATION
• Overall, the data from this evaluation indicate that SL@B has made significant achievements in both building 
the capacity of innovator teams and accelerating the trajectory of MNH innovations to market entry.
• Diverse stakeholders value SL@B’s early-stage funding to establish proof-of-concept and the program’s 
intentional approach to progressively fund an innovation through growth stages in order to support a 
scaling pathway. 
• The SL@B program appears to accelerate progress through key milestones and growth stages: innovators on 
average moved through growth stages more quickly during their SL@B funding period than did innovators in 
the same growth stages either before or after their SL@B funding period. 
• Survey data show that innovators credit SL@B’s financial and grants management support (e.g. regular 
check-ins with SL@B program officers, capacity-building workshops, connections) with accelerating their 
trajectory. Specifically, innovators credit SL@B’s financial support with accelerating the achievement of 
several key milestones, including validation studies (90%), prototype/program development (89%), and 
usability studies (88%). 
• Interviews with innovators identified several non-financial supports that innovators credit with accelerating 
their growth, including the push to think about scaling plans early, having SL@B as a ‘champion’ to attract new 
funding/partners, introductions to commercialization and implementation partners via DevX, creating a peer 
network of innovators, and opportunities to participate in Xcelerator workshops and mentorship meetings.
• The non-financial supports rated as most helpful by respondents to the SL@B innovator survey include the 
Xcelerator workshops, the DevX events, and pitch support. The supports rated as least sufficient include 
connections with the private sector and manuscript editing. 
KEY FINDINGS
What did SL@B set out to achieve in this area? 
Building capacity of innovators and accelerating innovations to market is a goal of the SL@B program. The SL@B 
TOC defines acceleration of innovations as rapid scale up of effective ideas/interventions, leading to safe and 
healthy pregnancy and birth for every woman and her child, especially in hard-to-reach communities. The SL@B 
Impact Area Framework*
 [see Appendix II] further defines this as bringing innovations to scale faster (reducing the 
time to scale), further (broader reach or level of scale), and/or more equitably (including marginalized populations). 
Building the capacity of innovators to diagnose and navigate challenges along the scaling trajectory is an important 
part of the SL@B acceleration strategy. The SL@B Impact Area Framework defines successful innovator capacity 
building as the development of innovators’ capacity across core skill sets (e.g. business model, manufacturing, or 
supply chain knowledge) and how that is translated into broader learnings for the field (e.g. accelerators or shared 
knowledge products). 
As context, it is important to note that there is very little data available in the literature regarding scaling 
pathways, milestones, and timelines, and much of what does exist relevant to LMICs is based on qualitative 
case studies. What can be gleaned from the existing literature is that the average time from initial development 
of an idea to market entry and then scale differs by type of innovation and target market. Looking primarily at 
high-income markets, drug development takes an average of 24 years from initial discovery to demonstration of 
effectiveness.19 Clinical practice innovations take an average of 17 years from the first publication of evidence to 
wide adoption.20 Medical devices have the shortest timeline, with an average eight years from initial conception to 
regulatory approval.21 The literature also indicates that these timelines are longer for innovations entering LMICs, 
for those targeting rural populations, and for those trying to scale through public health systems. 
3
* USAID leadership shared the SL@B Impact Framework listing Key Dimensions of Interest, in Powerpoint via email communication, with the ESL@B team in January 2019 (mid 
evaluation time) which was different from the SL@B TOC.
28
Primary challenges faced by innovators
Analysis of data in awardee reports indicates that challenges differ by stage of growth and type of organization, 
though several are consistent across all innovators. Table 4 lists cross-cutting challenges, as well as issues specific 
to type of organization or type of award. 
There are no suitable comparison or benchmark data available in the literature for the SL@B innovation portfolio on 
timeline, scaling pathway, or milestones. Given the lack of robust data in this area, the ESL@B team has worked to 
answer questions related to this impact area with milestones targeted by the SL@B program and the self-attribution 
of innovators. 
Table 4: Innovator Challenges, by Type of Organization and Type of Award (n=55)
Source: Analysis by the ESL@B team using data from 55 awardee reports submitted to USAID and GCC.
CHALLENGE TYPE OF ORGANIZATION TYPE OF AWARD
University Non-profit For-profit Seed Validation TTS
Lack of funding to support innovation growth X X X X X X
Product development and technical issues X X X X X
Recruiting and retaining staff X X X X
Feasibility and acceptability of innovation X X X X X
Local implementation country issues
Insufficient infrastructure or materials in target country X X X
Country instability X X X
Logistics related to trial or implementation X X X X
Delays in regulatory approval X X X
Lack of interest in take-up in target country X X
Has SL@B accelerated the achievement of milestones or growth? 
Given the focus on early growth stages in the SL@B program, many SL@B innovators are not yet scaling but are still 
working towards market entry. Of respondents to the SL@B innovator survey conducted by Duke University in 2019, 28% 
are operating in at least one market and 15% are operating in at least two markets globally. To account for the relatively 
early nature of SL@B-funded innovations, the ESL@B team primarily relies on indicators of growth stage and achieve￾ment of milestones, rather than scale (e.g. number of products sold or patients reached), as measures of growth. 
Innovator trajectories before, during and after SL@B participation
The quantitative survey administered in July 2019 was designed to measure progress through growth stages and 
scale, and assess challenges, and successes accomplished before, during, and after their grant period. Administered 
to 113 innovators, the survey yielded an overall 54% response rate (n=61). Based on the data, SL@B innovators on 
average spent 54 months in the development stage, 46 months in the validation stage, 53 months in early adoption 
stage, and 47 months in the scaling stage. Given reaching and remaining in the scaling stage is the final goal for 
many of the innovators, this latter number reflects how many months, on average, the teams have been working on 
activities in this stage up to July 2019, rather than number of months spent in this stage before moving on. There 
was wide variation across the portfolio within all four growth stages. 
Table 5: Number of Months in Each Growth Stage
Source: SL@B innovator survey developed and administered by the ESL@B team
*Responses in this category reflect how many months awardees have been in the scaling growth stage up to the time of the survey (Jul 2019), rather than how 
long it took to complete it.
GROWTH STAGE MEAN, MONTHS 
[YEARS]
MIN, 
MONTHS
MAX, MONTHS 
[YEARS]
Development (n=50) 54 [4.5 yrs] 1 116 [24 yrs]
Validation (n=39) 46 [3.8 yrs] 1 72 [6 yrs]
Early Adoption (n=18) 53 [4.4 yrs] 2 120 [10 yrs]
Scaling (n=19)* 47 [3.9 yrs] 1 84 [7 yrs]
29
While there is no comparison group available for this analysis, the survey data allow comparison of innovators who 
worked on activities within each growth stage during their SL@B funding period with those who worked on those 
growth stage activities outside of their SL@B funding period. The findings presented in Figure 8 below compare 
innovators reporting at least 75% of activities within any given growth stage taking place during SL@B funding with 
those reporting less than 75% of the activities taking place during SL@B funding. 
Results indicate that SL@B funding helps to accelerate progress through growth stages overall. (This analysis does 
not include the “introduce and scale” stage, as the goal for most innovators is to reach that stage, rather than 
progress out of it.) The average time taken to complete activities and time spent within growth stages was shorter 
for innovators who reported that more than 75% of those activities took place during the funding period compared 
with those who reported that less than 75% of those activities were conducted during the SL@B funding period. 
Innovators conducting activities within the SL@B funding period completed them on average more quickly than 
those conducting activities outside the SL@B funding period. 
Source: SL@B program information provided by USAID and GCC
Figure 8: Total Number of Months Spent in Each Stage Across Varying Levels of SL@B Support 
Source: SL@B innovator survey developed and administered by the ESL@B team
SL@B’s Financial and Grants Management Support
The SL@B program awards financial support in three categories, as detailed below in Table 6.
Table 6: SL@B Funding Level, by Grant Type
SL@B AWARD TYPE AMOUNT OF FINANCIAL 
SUPPORT
# OF AWARDS
(ROUNDS 1-8) 
Seed Up to $250k for up to 2 years 93
Validation Up to $250k for up to 2 years 28
Transition to Scale (TTS) Up to $2 million for up to 4 years 26
>75% of activities conducted during SL@B funding period <75% of activities conducted during SL@B funding period
30
Source: SL@B innovator survey developed and administered by the ESL@B team
Note: Table includes only those activities for which the number of respondents was 15 or higher. Number of respondents for funding and grants management 
are provided in that order.
Overall, respondents to the innovator survey credited SL@B’s financial support with accelerating their achievement 
of certain activities and milestones. In addition, they also found grants management support (e.g. regular check-ins 
with SL@B program officers, non-financial support) valuable to accelerate their trajectory. Table 7 presents the 
percent of innovators reporting that participation in SL@B accelerated their progress in achieving key milestones. 
Table 7: Stage of Innovators Reporting SL@B Accelerated their Achievement, by Activity
ACTIVITY/MILESTONE
PROGRESS ACCELERATED BY SL@B # OF AWARDS 
Funding Grants management
Problem identification (n=30, 28 respectively) 73% 61%
Prototype/program development (n=38, 36) 89% 61%
Preclinical development (n=17, 16) 59% 50%
In-country IRB approval (n=15, NA) 67% NA
Usability study (n=17, 17) 88% 65%
Feasibility study (n=20, 18) 80% 56%
Validation study (n=18, 17) 94% 47%
Dissemination of results at international meetings/
conferences (n=16, 16) 56% 38%
Dissemination of results at meetings/conferences 
held in western countries (n=18, 18) 61% 39%
All innovators interviewed for the Acceleration to Impact research brief who were asked about whether participation 
in SL@B accelerated their timeline to market entry and scale, stated that it did. Data from these qualitative interviews 
(n=11) indicate that the SL@B program accelerated their trajectory through several key features.
• SL@B’s application process initiated early thinking about scaling plans and partners.
• The Xcelerator workshops and mentorship increased their understanding of scaling pathways and preparation 
for the scaling process.
• Many innovators found commercialization and implementation partners through direct introductions from 
SL@B funders and through DevX. Participating in DevX also led to important peer networks. 
• SL@B’s role in championing projects helps innovators attract additional attention and support, including from 
other funders.
• The evidence that innovator teams were able to build through their SL@B grant allowed them to secure other 
funding and strategic partnerships.
While several innovators in this interview sample noted that they probably would have gotten to market eventually, 
they believe that SL@B funding sped up their trajectory. Two innovators in the sample of eleven stated that their 
project would not exist without SL@B funding. 
The case study of BEMPU Health’s TempWatch (below) illustrates how SL@B’s multi-stage funding helped accelerate 
an innovation’s pathway to scale. 
31
Bempu Health is a technology company based in Bangalore, India that develops life-saving products for 
newborns and children in LMICs.22 The company has two products that are funded by SL@B, Apneboot and 
TempWatch.This case study features the TempWatch, an electronic bracelet that continuously measures a 
newborns’ body temperature, and alerts a caregiver/ health care professional in case of hypothermia (body 
temperature below 36.5 °C). For this innovation, Bempu received both the SL@B validation grant as well as 
the TTS grant. 
Hypothermia is a major cause of newborn mortality, especially for underweight newborns in India 
and other LMICs.23 Early identification of hypothermia and subsequent treatment through Kangaroo 
Mother Care (KMC) (i.e. skin-to-skin contact between a parent and a newborn) is an evidence-based 
hypothermia management solution, particularly in LMICs.24 For KMC to be delivered in a timely manner, 
a newborn’s temperature requires frequent monitoring, especially in the first month of life.24 More often 
than not, health care providers in public and private health facilities in India are overworked and unable 
to regularly monitor a newborn’s body temperature.25 This gap in care could leave hypothermia cases 
unidentified, thus increasing the risk of newborn mortality due to lack of timely intervention.25 The Bempu 
TempWatch addresses this gap through an audiovisual alarm that continuously keeps track of a newborn’s 
temperature. It beeps and flashes an orange light in case of hypothermia to alert caregivers/ health care 
providers for a timely intervention, thus reducing risk of newborn mortality.
During the SL@B validation grant (2016 – 2018), Bempu 
gathered pilot data to validate the accuracy and feasibility 
of the TempWatch device in LMICs. Bempu reached 
close to 2,000 newborns through the study related 
data collection and sold approximately 8,000 bracelets, 
also managing to secure a procurement request of an 
additional 3,500 bracelets by the Indian government.*,25 
During the SL@B TTS grant (2018-2021), Bempu is 
scaling the TempWatch with an aim of reaching 40,000 
babies in India by the end of the grant.*
Some challenges Bempu experienced include working with 
partners such as the government and communicating the 
value of a new innovation to increase acceptability by health 
care providers and the community. 
SL@B’s support has been crucial to Bempu as 
the TempWatch progresses through the different innovation growth stages. It accelerated the 
validation process and helped facilitate identification of manufacturing partners and target market 
entry. † Bempu indicated that they received “highly helpful” support from SL@B, particularly in acceleration 
support including VentureWell and DevX, facilitation of connections to the public sector and potential non￾funding partners, highlighting the Bempu innovation in communications pieces (blogs, briefs, social media) 
as well as nominating and/or connecting Bempu for speaking / conference opportunities.†
Having forums like DevX led Bempu to meet key partners at GCC, USAID, BMGF, UNICEF, and others who then 
opened doors for them that they would not have otherwise had.*
 Overall, SL@B’s support helped them 
increase access to the MNH community and navigate challenges through the customized accelerated support. 
The CEA conducted for Bempu by the ESL@B team determined that Bempu is a cost-effective 
innovation based on the WHO threshold for cost-effectiveness.‡
CASE STUDY 1: BEMPU Health, TempWatch
* BEMPU SL@B Final Report submitted to funders, 2018, Bempu’s team communication with the E-SL@B team, 2020
† Evaluation of SL@B survey completed by BEMPU, 2019
‡
 Dixit, S., Fernholz, F., Ogbuoji, O., Shahid, M., Biru, B., Udayakumar, K., & Baumgartner, J. (2020). Cost Effectiveness Analysis: Bempu TempWatch. Durham: Evaluating Savings 
 Lives at Birth (E-SL@B) Program; Duke Global Health Institute Evidence Lab & Global Health Innovation Center at Duke University
SL@B’s staged-funding approach allowed 
Bempu to receive two rounds of grants 
that were pivotal in moving the innovation 
through validation and scale-up phases. 
Photo credit: https://www.BEMPU.com
32
In addition to the level of funding and multi-year funding duration of the SL@B program (with awards ranging 2-4 
years), innovators noted the importance of funding for operations and organizational development. SL@B awards 
allowed organizations to develop infrastructure to support the core innovation, an important differentiator
from some other types of grant funding that only allow specific types of program activities. Particularly for innovators 
without strong existing institutional support (e.g. start-ups), funding to cover operating costs and recruit a team is as 
critical as funding for direct project costs. 
For some innovators, SL@B was the first funding for their innovation and launched the project. Receipt of the 
SL@B award validated innovators’ projects internally (with their institutional leadership) and externally (with 
potential partners and other funders), allowing them to attract additional resources. As noted earlier, SL@B’s 
open call for funding also provides a “way in” for innovators who have not previously worked in the MNH or 
development space. 
Innovators interviewed for this evaluation also noted that SL@B funding allowed them to test their idea and build 
evidence that it worked. With the funding to test, iterate, and validate their innovation and develop stronger evidence, 
innovators were then able to make progress on scaling, such as forming distribution partnerships and securing 
additional funding. 
The below case study of Gradian Health Systems’ Universal Anaesthesia Machine (UAM) illustrates how one SL@B 
grantee was able to leverage SL@B’s funding to move their innovation along the path to scale, go to market with a 
much more integrated package that includes UAM training, and secure additional funding. 
“It was really definitely very catalytic early 
on, when we got our first SL@B funding 
at DevX. It really was our… first foray into 
this whole global health community.”
– SL@B innovator (drug)
“We would not have done this if it hadn’t been for SL@B... 
This [innovation] has become a foundational part of 
our strategy as we’re working with the public sector. We 
wouldn’t have gotten this kind of evidence under our belt.”
– SL@B innovator (practice and approach)
33
Gradian Health Systems is a non-profit technology company that develops and distributes medical 
equipment as well as provides product and clinical training in resource-limited settings across the world. 
Gradian received a SL@B TTS grant to improve surgical and obstetric care in Zambia by scaling their CE￾certified Universal Anaesthesia Machine (UAM) and pairing it, for the first time, with a simulation-based 
course in 2017.26,27
During obstetric cases such as C-sections, hysterectomies, and 
myomectomies, reliable anesthesia machines and well-trained health care 
providers ensure safe deliveries. However, most women in LMICs lack 
this access.*
 Evidence shows that, in these settings, ~75% of the medical 
equipment are donated and a subsequent 40% of them are not used due to 
lack of local expertise in operating the machines, and/or access to oxygen 
supplies, electricity, and spare parts.28-31 
The UAM, paired with Gradian’s capacity building model, addresses many of 
these surgical care limitations. The UAM has a built-in oxygen concentrator 
that generates its own medical-grade oxygen from room air (without external 
oxygen source) and comes with a three-year preventative and corrective 
maintenance warranty with local bio-medical technicians and spare parts, as 
well as on-site and online simulation-based training for anesthesia providers 
delivered by local trainers.32 
Despite challenges experienced related to installation sites and infrastructure 
in Zambia, Gradian installed the UAM in 32 hospitals and trained more 
than 70 anesthesia providers during the SL@B funding period.*
 As a result, 
Gradian is beginning to see this model generate public and private sector 
demand for anesthesia care capacity, the UAM, and Gradian’s simulation-based 
training in alignment with Zambia’s first-ever National Surgical, Obstetric, and 
Anaesthesia Strategic Plan.*
 The achievement during the SL@B grant period 
validated the combined UAM and training package and helped to catalyze scale to other countries 
in East Africa.*
 Furthermore, in December 2019, Gradian won a World Bank Global Financing Facility 
(GFF) award (approximately $4 million USD) to reduce maternal and newborn mortality.33 The GFF award 
will support the UAM scale up in Tanzania and Sierra Leone, which is estimated to increase access to safe 
anesthesia deliveries and surgeries by 200,000 per year.33
SL@B gave Gradian and their local partners the opportunity to field test and refine a simulation￾based product training curriculum and methodology that has revolutionized Gradian’s model and 
increased their potential for impact.* The funding, networking opportunities, and the tailored support 
received through the program catalyzed opportunities for scaling this model within Zambia and across 
other countries, such as Tanzania and Uganda.*
 The following support from SL@B were highly helpful 
to Gradian to move the UAM innovation along: increasing understanding of the market Gradian is 
targeting or working in, providing reference letters, nominating and/or connecting Gradian for speaking 
/ conference opportunities (e.g. Grand Challenges Meeting, Unite for Sight, and others), pitch support 
from professional coaches (e.g. preparation for the DevX pitch competition), highlighting UAM in 
communications pieces (blogs, briefs, social media) and promoting through media channels).*
Gradian indicated that SL@B’s support could have been strengthened in facilitation of connections to 
potential partners for scale (non-funding) and technical advising provided by USAID mission(s).*
CASE STUDY 2: Gradian Health Systems—the Universal Anaesthesia Machine (UAM)
SL@B gave Gradian a 
model for simulation￾based anesthesia training 
and helped leverage 
follow-on funding that 
has catalyzed expansion 
of the UAM and training 
programs throughout 
East, Central, Southern, 
and West Africa*
Photo credit: https://www.gradianhealth.org/
our-products/uam/
* Gradian Health Systems information derived from their SL@B Concept Note, 2017; SL@B Mid-term Report; E-SL@B Quantitative Survey, 2019; other dissemination 
documents submitted to funders between 2017-2019; communication with E-SL@B team, 2020
34
Non-Financial Support
The level and types of non-financial support offered by the SL@B program sets it apart from other MNH funders. 
This was frequently mentioned by SL@B-funded innovators as a critical factor in their successes. The non-financial 
support includes accelerator support, targeted connections to potential partners, and technical assistance. 
Innovators interviewed for the Acceleration to Impact brief noted that the SL@B program helped them to focus 
on early preparation for scale and make connections with partners, funders, mentors, and peer networks. 
Respondents to the SL@B innovator survey were asked to rank the helpfulness of the support they received from 
SL@B within a number of technical assistance categories. Figure 9 shows those areas that received the highest 
proportion of “high” helpfulness rankings. 
More detailed analysis of survey data on how helpful and how sufficient innovators rated many aspects of the non￾financial support provided by SL@B can be found in Appendix III. 
Nearly all innovators interviewed for the Acceleration to Impact brief (n=11) mentioned that the DevX event was 
pivotal. Through capacity building sessions and networking, innovators had the opportunity to make important 
connections with mentors, experts, and funders, especially as they worked to scale. Seventy-seven percent of 
respondents to the innovator survey reported that they had participated in DevX at least once. Of those who have 
attended, 60% found the forum highly helpful, while 30% found it moderately helpful. 
Connections with peers (primarily gained through DevX) is frequently mentioned by innovator interviewees as one 
of the most important benefits of participating in the SL@B program. Innovators also mentioned other peer 
networks and accelerator programs as being helpful though, for most, this was secondary to the peer networks 
developed through SL@B. 
Source: SL@B innovator survey developed and administered by Duke University
Note: Total number of survey respondents is 61. The number of innovators who reported receiving each type of support is noted in parentheses. Chart shows 
how many, of the innovators who report receiving each type of support, ranked its helpfulness as high.
Figure 9: Non-Financial SL@B Support, by Percent of Innovators Reporting it as Highly Helpful 
35
Analysis of innovator interviews indicates several activities and milestones for which SL@B’s non-financial support 
was particularly helpful.
• Identifying target markets – the program’s focus on early preparation for scale and understanding the target 
market and end use helped innovators select markets and prepare for market entry. 
• Finding external champions – innovators developed relationships through the SL@B network that helped 
facilitate the growth of their innovation. 
• Identifying commercial, manufacturing, distribution, and implementation partners – many innovators found 
commercialization and implementation partners through DevX. Others met partners through direct 
introductions from their grant manager. 
• Iterations in model and target market(s) – mentorship from the grant managers and also the technical mentors 
associated with the SL@B program helped innovators to iterate throughout. Innovators noted that this support 
often extended beyond the grant period.
OPPORTUNITIES FOR PROGRAM IMPROVEMENT
The analysis presented in this report demonstrates that many aspects of the SL@B program have been beneficial 
in accelerating the trajectory of innovations, building innovator capacity, and helping teams overcome 
challenges. However, data from interviews, as well as the innovator survey, indicate that there are also possible 
program improvements that may increase SL@B’s impact in this area. 
Analysis of the SL@B innovator survey indicates that there are a number of areas of non-financial support that 
innovators found insufficient. 
Figure 10: Non-Financial SL@B Support, by Percent of Innovators Reporting it as Insufficient
Source: SL@B innovator survey developed and administered by Duke University
Note: Total number of survey respondents is 61. The number of innovators who reported receiving each type of support is noted in parentheses. 
Chart shows how many, of the innovators who report receiving each type of support, ranked it as insufficient.
In particular, connections with the private sector emerged as an area where support could be strengthened.
These data also indicate that support with manuscripts, and support from USAID interns and local USAID missions 
are areas where innovators have found the existing support to be insufficient.
36
RECOMMENDATIONS
1. Continue to recognize the importance of non-financial support. This support is critical to acceleration and highly 
valued by awardees. It also sets SL@B apart in the field as few funding mechanisms have integrated robust 
non-financial support in the way that the SL@B program has. 
2. Maintain the intentional approach to multi-stage funding and recognition of the differing needs and timelines of 
innovations at each stage. Consider additional nuance for each stage and type of innovation. Setting specific 
success metrics for innovations at each stage (perhaps varied by type), offering supports unique to each stage, 
and moving successful innovations through to scale could increase program impact in this area. 
3. Capture better data prospectively on each innovation over time so that there is an increased ability to 
benchmark and measure pathways as well as timelines for milestones. 
4. Help innovators test the most critical assumptions and market viability as early as possible and iterate as 
needed, to improve efficiency of the support provided (fail fast mentality).
5. Provide innovators with a better understanding of the market entry process, manufacturer/distributer needs, 
commercialization, risk factors, and communication skills as early as possible. 
6. Increase in-country support for target markets, to help innovators better understand the context, get real￾time insights on the ecosystem, and build local networks. This may include ecosystem building efforts and/or 
engagement of private- and public-sector players in LMICs throughout the program cycle.
7. Manage expectations among innovators, external partners, and internal stakeholders about the timelines, 
success rates, and potential for sustainability for innovations trying to scale in LMICs, particularly those 
embedded within existing health systems. For example, if the goal of the SL@B program is to save lives in the 
near term, there is a risk that the SL@B program can set itself up to look like it has not done enough because 
lives saved is not a realistic metric within three to five years for an early-stage innovation. Building success 
metrics and risk tolerance guidelines grounded in realistic understandings of timelines and failure rates may 
help create more alignment among all stakeholders. 
8. Recognize the continued gap between exit from the SL@B program and actual scale. The SL@B program currently 
serves innovations up to a certain point but even successful TTS innovations will not be fully scaled at the end 
of their SL@B funding period. The SL@B program could address this in several ways, including developing an 
additional award category for post-TTS (i.e., scaling), building strong ecosystem partners in LMIC markets to take 
on innovations after exiting SL@B, and/or proactively facilitating hand-offs to other funders. Implementation 
programs supported by SL@B funding partners (including USAID, GCC, and BMGF) could also become natural 
handoff partners. (This recommendation is also reflected in the section on partnerships, below.)
First, it is important to note that there are several ways in which SL@B support has been instrumental in accelerating 
the trajectory of MNH innovations and building the capacity of innovator teams. Based on analysis presented in this 
report, the ESL@B team recommends that the SL@B program maintains these programmatic elements. 
In addition, the findings presented here suggest several ways in which the SL@B program could improve its ability to 
build innovator capacity and accelerate innovations. These recommendations include: 
Innovator interview data indicate other areas where the SL@B program could better support capacity building and the 
acceleration of innovations.
• Although innovators highly value the capacity building that SL@B provides, innovators interviewed for this 
analysis who received seed awards noted that earlier training in the commercialization process and 
pitfalls, business planning, and testing market viability would help them assess their needs and be better 
prepared for partnerships.
• Increasing the program’s emphasis on support for market research and the importance of being prepared 
to shift locations if needed could save innovators critical time during the proof-of-concept phase.
• Practice/approach innovations experience some important differences in the scaling trajectory but the 
acceleration support is largely tailored to product/device innovations. 
• Connections with key stakeholders in the target LMIC markets, including USAID missions, LMIC governments, 
and private sector, are underdeveloped, which hampers innovators’ ability to gain traction. Overall, the 
program would benefit from more and stronger in-country resources and networks.
37
SL@B-FACILITATED PARTNERSHIPS 
FOR INCREASED INNOVATION IMPACT
4
• Overall, innovators have benefited significantly from DevX via the convening of leading MNH ecosystem 
stakeholders, increasing their visibility, and fostering connections with key stakeholders, including other innovators. 
• Innovators highly value the capacity-building and technical assistance they receive at DevX to make pitch decks 
and business proposals, which are critical to engage with any potential partner.
• Across the SL@B program, there is an opportunity for even more proactive support for potential partnership 
identification and development, including with private sector organizations, national and sub-national public 
sector health organizations, and organizations with local expertise.
KEY FINDINGS
What are the partnerships that SL@B grantees have formed to move their innovation along 
the path to scale and sustainability?
Using data from milestone and final reports, the ESL@B team identified partnerships that SL@B innovators 
reported creating to make progress on their innovations. SL@B innovators across innovation types and growth 
stages have pursued a variety of partnerships with stakeholders in HICs and LMICs. Innovators’ responses to the 
online survey indicate that the scaling pathway of most innovations involves partners, whether through a multi￾stakeholder partnership (61%), inclusion as a policy recommendation (31%), or government procurement of the 
innovation (52%).
Overall, 92% or 107 out of 116 unique SL@B innovations have established at least one partnership in 
the public, private, or academic/research sector. Of these, two-third, or 72 unique innovations (67%) have 
established one or more partnerships with public sector stakeholders to pilot, adopt, or integrate their innovation 
into the health system. Over half of the 72 innovations have established partnerships with the Ministry of Health 
(MoH) (n=58), which is significant, given that adoption or integration of an innovation within health systems is a key 
scaling strategy, with the potential to serve hard-to-reach populations as well as large numbers (see Figure 11). 
What did SL@B set out to achieve in these areas?
In the current era of Sustainable Development Goals, the role of global partnerships to advance global health equity 
and address health challenges is well-known. Increasingly, it is acknowledged that no one stakeholder or sector 
can fully address any particular global health challenge. Across both the SL@B Impact Framework and the SL@B 
TOC is the recognition that an innovation’s pathway to scale and sustainability involves partnerships with the public 
and private sectors to create lasting impact. In SL@B’s call for proposals, the program emphasizes that “strong 
collaborations and commitments will enable and deploy more effective and sustainable solutions.”*
A key pillar of the SL@B Impact Area Framework has been the “development of partnerships that bring together 
diverse competencies, including from private sector (with co-funding) and government partners” to harness 
scientific/technological, social, and business ingenuity, and to catalyze successful implementation at sustained 
scale.Ӡ The SL@B TOC describes the facilitation of partnerships as the connections that are made both by the SL@B 
program, and by the innovators themselves. The TOC also highlights DevX as a platform for matchmaking, “both 
within the innovator community, and between innovators and potential collaborators and/or mentors.”1
To understand SL@B’s role in facilitating and fostering key connections for its innovators, the ESL@B team 
conducted a series of key informant interviews to gather data on the partnerships they have established to develop 
and scale their innovation. The team also analyzed innovators’ progress and milestone reports received from USAID 
and GCC. In addition, the team analyzed responses from innovators on the SL@B innovator survey (see data and 
methods section).
* SL@B Call for Proposals, Round 6,7, and 8
† SL@B Impact Framework Listing Key Dimensions of Interest, in Powerpoint shared by USAID with ESL@B team in January 2019
38
SL@B innovations have also been actively 
engaged in partnerships with other key 
government stakeholders, including national 
regulatory authorities, sub-national health 
authorities, and hospitals and facilities. 
Many innovations hold partnerships with 
two or more of these stakeholder groups. 
For example, Massachusetts General 
Hospital (MGH), in their implementation 
of an evidence-based training package 
on the administration and monitoring of 
ketamine for essential surgeries when no 
anesthesiologist is available, established 
partnerships with county and national 
health authorities, professional societies, 
and public and private facilities in Kenya. 
MGH works closely with the in-country 
implementing partner and county health 
authorities to identify facilities that are best 
suited to support the implementation of the ketamine training package. Thus, partnerships have been required at 
multiple levels to achieve the end goal of program implementation in a sustainable manner.
BEMPU, in scaling up distribution of their hypothermia alert bracelets engaged with multiple levels of state and 
central regulatory authorities as well as procurement bodies prior to procurement. They also had to work with 
numerous individuals and other key stakeholders to ensure that their product was approved and could be used 
within facilities in India.
Nearly 60% (n=69) of SL@B-funded innovations have one or more partnerships with a private sector entity. Across 
the portfolio, SL@B innovations have been successful in forming private sector partnerships with stakeholders 
in both HICs and LMICs, and with for-profits and non-profits (see Figure 12). For-profit partnerships include 
pharmaceutical and device manufacturers, supply chain organizations and distributors, and organizations that 
provide technical and R&D and corporate support. Non-profit partnerships that SL@B innovations have established 
have a similar representation as for-profits, but also include a significant number of local implementing partners. 
For example, BEMPU sells their hypothermia alert 
bracelets directly, and through distribution partners 
in India and LMICs. INMED, a global humanitarian 
development organization, has partnered with Little 
Sparrows Technologies, a HIC social for-profit start￾up, Brigham and Women’s Hospital, and Bilimetrix, 
an Italian-based start-up spun off from an academic 
institution to deliver the Bili-kit in low-resource￾settings in Peru. Bili-kit is a suite of technologies 
to screen, diagnose, and treat neonatal jaundice. 
Another variation of for-profit and non-profit 
partnerships is that of Mbarara University, an LMIC 
academic research institution and their innovation 
for an augmented infant air resuscitator. Mbarara 
University partnered with Philips, a HIC multinational 
technology company to produce the device, but 
also partnered with local non-profits for thought 
leadership and facilitation of local networking.
Figure 11. Number of SL@B Innovations with Public Sector Partnerships
Source: Progress and final reports from SL@B innovators received from USAID and GCC. 
Figure 12. Number of SL@B Innovations with Private 
Sector Partnerships
Source: Progress and final reports from SL@B innovators received from 
USAID and GCC. 
39
HOW DID SL@B HELP INNOVATORS MAKE CONNECTIONS AND ESTABLISH 
TRANSFORMATIVE PARTNERSHIPS FOR ITS INNOVATORS?
Beyond point-solutions to reduce maternal and neonatal mortality are global health partnerships that are critical 
to transforming health and healthcare in LMICs. Transformative partnerships are based on the principle of 
respect towards both individuals with the health need and the community in which they are embedded, elevating 
critical health issues to the core of national agendas through their shared decision-making with multi-sectoral 
partners, and seeking to create sustainable impact.34-36 
In this section, we summarize responses from innovators on the online survey on the partnerships support 
received from SL@B, as well as the voices of innovators from key informant interviews on the role that SL@B 
has played in facilitating transformative partnerships for them. We rely on innovators’ reports of these 
partnerships, but the descriptive analyses presented in this report does not examine whether and how these 
partnerships were transformative. 
Findings from Key Informant Interviews
Innovators credit two noteworthy aspects of SL@B’s support which enhanced their ability to establish key 
partnerships.
Value of DevX for Partnerships
Broadly, the value of DevX for participants related to partnerships included initiating new partnerships, 
preparing for partnerships, and having the platform to engage with future partners. All innovators in the 
interview sample (n=18) found value at DevX to both 
make partnerships and to build their capacity to engage 
with future partners. Innovators emphasized that although these 
connections emerged organically through interactions at DevX with 
industry stakeholders, they highly valued DevX as a platform that 
brings such important stakeholders together. 
Key informants noted that DevX is a great opportunity for innovators 
to come together, network, and meet potential collaborators. 
Innovators initiated important conversations at DevX, both with 
industry stakeholders that would be instrumental in moving their 
innovation forward, and with other innovators to identify areas of 
collaboration, including exploring new geographies or diversified 
focus areas. 
Of the grantees who credited DevX for facilitating their partnerships, 
one was directly facilitated by SL@B, and another one was established 
at another conference, but was strengthened at DevX. Two grantees 
mentioned that their future partner organizations sought them out 
after hearing about their innovation at DevX, but did not meet them 
there. One grantee also formed a partnership with a mentor whom 
they met through DevX, after which they identified mutual areas of 
interest and potential collaboration, and eventually established their 
partnerships as peers. 
1.
“The connection with a pharmaceutical 
company was a consequence of our first 
SL@B grant. I think it speaks to the utility 
of SL@B beyond simply the funds that are 
provided to grantees. We received the first 
grant in 2011; it was at the early stages 
of our program and it was the same year 
we were given the Peer Choice Award at 
the Development Exchange in 2011. It 
was subsequent to that we actually had 
2-3 large pharmaceutical companies 
approach us.”
-SL@B innovator (drug)
“As we were going through the SL@B 
process at the Development Exchange, 
representatives from X organization were 
there, and after SL@B, they contacted me 
and asked if we would consider working 
with them, sort of combining efforts. And 
so, we got together and talked to join 
forces.” - SL@B innovator (drug) 
“We started out as novices, you know in-country, we did not know what a business plan was, but now, we have all that. So, 
if I look at it from the human capacity, we have been able to develop as an organization, it’s significant… I have learned how 
to engage, how to package information, and how to make a business case. And that’s invaluable.” - SL@B innovator (device) 
40
Direct Matchmaking
Innovators valued the utility of SL@B providing targeted matchmaking support to connect them with 
potential collaborators. Partnerships facilitated through direct matching by SL@B are also mentioned as an 
important assumption in the TOC for innovations to scale sustainably. 
The SL@B program has also facilitated connections to other partners for its grantees to address other needs that 
were relevant to their growth stages. As an example of these partnerships, program partners connected a SL@B 
grantee with a researcher from a HIC, who helped the grantee design a risk assessment tool that was a critical 
component of their mHealth platform for maternal health. The tool helped the grantee secure additional funding 
based on its current and future potential to triage and treat at-risk pregnant women. Additionally, grantees consider 
the SL@B peer-review process that their innovation goes through as an important mechanism for vetting by potential 
collaborators which opens doors for them to engage with future partners and funders.
Transformative Partnerships Established by SL@B innovators
In the key informant interviews, SL@B innovators highlighted the critical junctures at which the 
partnerships they established with SL@B support made a significant difference to help their innovation 
advance to the next stage of growth. Based on interview data with the sample of SL@B innovators, Table 8 highlights 
illustrative key partnerships that SL@B innovators formed, which subsequently became turning points for the 
trajectories of their innovations.
The ESL@B team also examined the acceleration trajectory of five SL@B innovators who were key informants to the 
partnerships analysis based on their responses to the online survey. Of note, findings suggest that SL@B innovators 
with key partnerships established such as those described above spent fewer months in each IDIA growth stage 
relative to the average number of months spent by all innovators who responded to the survey.
Innovators who did not form partnerships at DevX also highly valued their 
participation in DevX and noted that it helped them network and engage 
with mentors, funders, and technical experts. The exposure through DevX 
to business models, marketing, and pitch decks, combined with targeted 
capacity building efforts, helped innovators talk to potential collaborators and 
funders as well as think more clearly about the partnerships that would be 
needed to roll out their interventions for scale up. It also provided them the 
opportunity to refine their pitch, showcase their innovation, describe progress 
made, and seek out collaborators for specific needs at particular stages. 
2.
3.
“Getting an award from SL@B is a rigorous peer 
reviewed and competitive process, and the fact that by 
the time we met [device manufacturer], we had gotten 
a seed award from SL@B already that we successfully 
implemented, and we were auditioning for a validation 
grant which they saw us ‘Win’ at that meeting, was very 
powerful. I think it helped some of them believe in the 
technology more because of all these people and peer 
review process that the technology was going through.” 
- SL@B innovator (device)
“What has come up was more getting 
to meet technical experts who’ve 
been able to help us find solutions 
to the whole process of rolling out 
the intervention. So, getting to know 
people who come to DevXs, there are 
people we know who mentored us 
through this process, to get us to where 
we are.” - SL@B innovator (device) 
“What I came to learn was that [device manufacturer] had reached out 
to [SL@B Funder] to look into their portfolio of innovations and see 
which ones may be ready for private investment and partners from 
that. So when [SL@B Funder] learned that we were in talks with [device 
manufacturer], that was positive, and also when [device manufacturer] 
knew that [SL@B Funder] was supporting us through SL@B, that was 
another thing that I think facilitated the growth of this relationship, 
because then we had [SL@B Funder] that trusted us, [SL@B Funder] 
that trusted [device manufacturer] and [device manufacturer], which 
cultivated this growing relationship.”- SL@B innovator (device) 
“When you look at the SL@B community, you’ve got this whole ecosystem of innovators, all of whom might well have very different 
technologies that they’re developing but a lot of going through exactly the same challenges and how to learn to implement a product in 
these situations. So, that’s been a great source of connection, discussion, and good information.” 
- SL@B innovator (drug) 
41
Table 8. Illustrative Key Partnerships Formed by SL@B Innovators
KEY 
PARTNERSHIPS 
PARTNER 
SECTOR
SL@B INNOVATORS’ 
REASONS FOR 
PARTNERSHIP
SL@B INNOVATORS’ 
PARTNERS’ REASONS FOR 
PARTNERSHIP
SL@B SUPPORT TOWARDS 
PARTNERSHIP 
Development 
partnership
Private (academic, 
for-profit)
Developer provides cost￾effective solution to address 
critical needs in innovator’s 
region or focus area
Leverage innovator’s local, 
on-the-ground networks and 
connections
- Initiation of partnership dialogue 
at DevX
- Endorsement of innovation by 
SL@B program
Manufacturing 
partnership
Private (for-profit, 
NGO)
Manufacturer obtains 
technology (open or restricted 
license) from innovator to 
commercialize innovation at 
scale
Leverage innovator’s focused 
research and clinical expertise
- Initiation of partnership dialogue 
at DevX
- Direct matchmaking between 
innovator and manufacturer
- Endorsement of innovation by 
SL@B program
Government 
partnership Public 
- MoH provides regulatory 
approval to roll out innovation 
in country
- MoH identifies districts to 
roll out innovation
- Trust in innovator’s expertise 
- Evidence of innovation’s 
effectiveness 
- Alignment with MoH priorities
Endorsement of innovation by 
SL@B program
Distribution 
partnership
Private (NGO and 
for-profit) and 
Public
Distributor brings supply 
chain efficiencies in country of 
implementation
Innovator provides clinically 
validated solution to address 
MNH challenges in country
Initiation of partnership dialogue 
at DevX between SL@B innovator 
and International NGO
Source: Key informant interviews with sample of SL@B innovators conducted by the ESL@B team.
Findings from Innovator Survey
Highlights from the innovator survey validate the findings from the key informant interviews that, unlike most 
funders, a key programmatic element of SL@B that grantees value is the facilitation of connections for its 
grantees. Of the innovators who responded to the survey, 56% (n=34) reported that SL@B facilitated connections 
with potential funders, 28% (n=17) reported that SL@B facilitated connections with public sector partners, and 23% 
(n=14) reported that SL@B facilitated connections with private sector partners. The survey also asked respondents 
to indicate whether the partnerships support they received from SL@B (if applicable), was sufficient or insufficient 
among other elements of technical assistance. Data indicating whether innovators felt that SL@B support in facili￾tating connections with various stakeholders was sufficient or insufficient is shown in Figure 13.
Figure 13: SL@B Partnerships Support, by Percent of Innovators Reporting it as Sufficient or Insufficient 
Source: SL@B innovator survey developed and administered by ESL@B team.
Note: Total number of survey respondents is 61. The number of innovators who reported SL@B-facilitated connections is noted in parentheses. Bars show the 
percent of innovators who ranked the helpfulness of each type of SL@B-facilitated connection as sufficient or insufficient.
42
Figure 13 above demonstrates that the support towards forming partnerships provided by SL@B program staff has 
been valuable to innovators to make connections with different stakeholders including potential funders, public 
sector partners, and other partners. However, the figure also shows areas where the program could more directly 
address innovator needs, particularly in facilitating connections with private sector partners.
OPPORTUNITIES TO FACILITATE STRONGER PARTNERSHIPS IN THE ECOSYSTEM
Innovators consider the SL@B program as more than a funding partner. They expressed that the program has 
been an important point of call to connect them with other innovators as well as with key stakeholders to learn, 
discuss, and grow. 
While innovators appreciated the training sessions and the opportunity to make connections at events, they felt 
that SL@B and similar funders in the ecosystem can play an even greater role in the support they provide to help 
innovators make targeted connections. Interviews with SL@B innovators revealed that while they highly value 
SL@B’s efforts in facilitating connections for them, they note that these connections are not consistently available 
for all promising SL@B innovations. 
Findings from the innovator interviews are consistent with the responses to the online survey about the extent 
to which SL@B support in facilitating connections with potential funders, partners, public and private sectors was 
helpful and sufficient. Data from interviews and innovators’ milestone reports also shed more detail on the kinds of 
connections innovators are seeking and what they perceive would be valuable in moving their innovations forward. 
Private Sector and Funding Partners. Innovators expressed that they needed significant additional funding, 
particularly after they have proven that their innovation is effective and their SL@B funding has ended to 
support their adoption, integration, and scaling efforts. SL@B and other programs could be more intentional and 
proactive in addressing this funding gap after SL@B’s exit from an innovation and provide targeted connections 
to funding and implementing partners at later stages of 
development to help take the promising innovations to the 
next stage on their scaling pathway.
Public Sector. Several innovators reported that they have 
a critical need for connections with the public sector in 
different countries to adopt and scale their innovation. In 
particular, innovators with little prior history of engaging 
with government stakeholders could significantly benefit 
from the additional boost from large funders to make the 
right connections with national health authorities as well as 
national and sub-national governments.
These engagements are complex because of the different levels of public sector partnerships as well as the variability 
across countries. Additionally, in some countries such as India, there is considerable heterogeneity between states in 
terms of priorities and ease of operations. While it is crucial to 
get regulatory approval from the central government in India, 
state governments ultimately lead efforts to adopt and scale an 
innovation. 
In some cases, gaining a foothold in larger countries through 
the public sector can open doors in other countries for roll out 
and adoption. According to one KI, having regulatory approval 
from Ghana, for example, is often an access point to reach other 
countries in West Africa, while approval from Kenya opens doors 
to other countries in East Africa.
The case study of JSI’s chlorhexidine project (below) illustrates 
how one SL@B grantee found collaboration with a local 
government crucial to scale their innovation. 
“We are still seeking other donor partners to allow us 
to expand and fill in some of the financial gaps. Part 
of that is that we would have liked to see a greater 
proportion go to [developing partner] so that they could 
continue to do more of the technology development. 
But we really needed the majority of the [SL@B] grant 
just for the implementation piece. So, there is a little bit 
of a financial gap there.” - SL@B innovator (diagnostic)
“There is another category of partners that in my mind 
is critical and those partners are partners that will be 
able to adopt and deploy. This could be ministries of 
health or health multinationals/ organizations, and 
that kind of partnership is what is not very strong 
right now. [SL@B funder] can write to ministries 
expressing their enthusiasm in the technologies that 
show promise and ask ministries how they [ministries] 
can further help innovators; request innovators to 
co-apply with ministries if the innovation has reached 
some degree of maturity requiring implementation 
studies. This could bring greater ministry involvement 
but will require innovators to engage ministries more.” 
– SL@B innovator (device)
43
With a mission to improve the health of underserved people and communities, JSI Research & Training 
Institute, Inc. (JSI) is a non-profit organization that has implemented more than 2,500 projects in 107 countries 
across the world, since its establishment in 1978.37 One of the projects that JSI led was the SL@B funded 
Chlorhexidine Navi (Cord) Care Program (CNCP) to address newborn sepsis/infection in Nepal. 
Infection accounted for almost 70% of newborn deaths in Nepal, mainly due to unclean practices during 
home births, where the umbilical cord is cut with sharp non-disinfected household objects and then covered 
with turmeric, mustard oil paste, or other traditional practices.*,38
In 2006, research conducted by Johns Hopkins University in Nepal showed Chlorhexidine’s (CHX) efficacy in 
reducing infections caused by bacterial contamination of the umbilical cord stump.39 JSI conducted pilot studies 
and collaborated closely with the Nepali government and a local pharmaceutical company to create a standard 
antiseptic gel formulation of the product and a sustainable method of distribution, primarily through Female 
Community Health Volunteers.*
 Based on promising results from the pilot studies, the government standardized 
CHX use as part of the national essential newborn care guidelines.40 In 2011, JSI received the SL@B TTS award
to support the government’s plan of scaling up CHX across Nepal.
41, 42
JSI, in partnership with the government, successfully achieved nationwide coverage in Nepal by the end 
of the SL@B funding period, in 2017.40 A total of 2.1 million newborns have received CHX umbilical care, 
resulting in an estimated 9600 newborn deaths averted during the SL@B funding period.41 JSI’s program 
activities to achieve scale included incorporating CHX into the Nepal government’s MNH policy, integrating 
CHX within existing government MNH programs, coordinating with the government and private sector to 
secure continuous product supply, and appending CHX guidelines in the Nepal medical professionals’ training 
curriculum.†
 Despite CHX’s wide coverage, the Nepal national compliance survey (household and homebirths) 
revealed a 59% usage rate which indicates continued room for improvement.40
SL@B’s funding and technical assistance were pivotal 
in JSI’s CHX scale up in Nepal. JSI indicated that they 
received “highly helpful” support from SL@B in a number of 
areas, particularly through DevX, facilitation of connections 
to potential partners for scale (non-funding), support for 
publication in open access journal, highlighting CHX in 
communications pieces (blogs, briefs, social media) and 
promoting through media channels), and nominating 
and/or connecting innovators for speaking/ conference 
opportunities (e.g. Grand Challenges meeting, Unite for 
Sight, and others).‡
In 2013, WHO added CHX to the Essential Medicine List for 
Children (EMLc), largely based on JSI’s research findings 
from Nepal.43 As a result, Nepal has served as a model for 
others countries interested in scaling up CHX and emulating 
JSI’s CHX implementation strategy. During the SL@B period,
JSI provided technical assistance, coordinated with the Global Chlorhexidine Working Group, and led 
study tours and learning visits for more than 200 visitors from 20 countries; Bangladesh, Ethiopia, 
and Nigeria to name a few.†
 Furthermore, JSI made its program data, monitoring and evaluation, training 
and advocacy tools publicly available to support CHX-adopting countries. In recognition of its global advocacy 
efforts, the program received the USAID Global Science and Technology Pioneer Prize in 2013.44
CASE STUDY 3: JSI Research & Training Institute, Inc. (JSI) -- Chlorhexidine
* JSI SL@B Work Plan, 2011
† JSI SL@B Final Report, 2017 
‡ Evaluating SL@B Quantitative Survey completed by JSI, 2019
JSI’s scale up success can primarily be 
attributed to its close partnership with 
the Nepali Ministry of Health, building on 
existing systems using Female Community 
Health Volunteers, and reliable in-country 
production of CHX ensured sustainability.
Photo credit: https://www.jsi.com/project/chlorhexidine-na￾vi-cord-care-program/
44
Local Expertise. 
A significant proportion of SL@B innovators originate 
from HICs, thus it can be difficult for them to make local 
connections and identify strong organizations with the 
right capabilities and expertise to adopt and implement the 
project in target LMIC markets. Innovators need on-the￾ground support with organizations who have the capabilities 
to provide implementation support, as well as deep 
networks among the public sector, health care providers, 
and community of users. This is particularly helpful for key 
milestones such as getting regulatory approval, testing 
user acceptability, creating advocacy platforms, providing 
training support, and distributing their innovation. 
International Organizations. 
For both LMIC and HIC innovators, introductions and endorsements from their funders to major global health 
organizations can foster collaboration to address shared goals. Innovators expressed strong interest in being 
connected to global bodies such as the WHO, UNAIDS, and UNICEF, but do not have the opportunity to form 
these connections. 
The goals for connections with global organizations are three-fold:
1. Regulatory approval and/or inclusion in standards or guidelines issued by such organizations is usually well￾recognized around the world. 
2. The capacity of PIOs to serve as global conveners for procurement of innovations could ensure that needed 
innovations are produced at scale.
3. Global organizations are well positioned to navigate political challenges and instability, helping local actors, 
particularly in the public sector, take responsibility for implementing and scaling. 
“If you rely purely on government to implement 
something like this, the chance of success is very 
low. For them to take up a new idea and implement 
it, it is very, very hard. So, if you have somebody 
like [large local implementing partner] coming to 
the government and saying – look, we will help 
you introduce the product, we will provide backup 
support. So, the importance of having a nonprofit 
organization, the need for a non-governmental or a 
voluntary organization to work hand in hand with 
the government at the national level is also critical 
in my opinion, based on my experience.”
-SL@B innovator (nutrient)
“If you take for example Global Fund, Global Fund is deeply working with 
political authority in countries and have them set up what they call a 
country coordination mechanism, but at a political level, it is very high. 
The requirement from donor is very high for the government to be more 
involved. But you know how governments are in Africa, political instability 
and also, if it is coming from one partner, one to three NGOs, they take 
their time but if they have this type of support coming from the top level 
with big donors, I feel like this Saving Lives at Birth partnership, I think that 
could help us to accelerate the process.” -SL@B innovator (mHealth/practice)
“If I go to any country and I speak to health 
ministries, and I propose something, their first 
question is – do you have WHO recommendations 
of this, and if WHO recommendations are there, 
they will accept it as a very good valid validation 
and they’re much more confident to move. 
Otherwise, if you come up with some idea for 
which there is no WHO opinion, they are less 
keen to take/ adopt it.” -SL@B innovator (nutrient)
Multi-stakeholder partnerships (private, public, and PIO) are crucial for innovators as they go through a 
scaling pathway. While SL@B recognized the need to foster a supportive community for innovators, key 
stakeholders in the MNH innovation ecosystem would need to address this gap as well, in providing targeted 
support to innovators consistently (e.g. with funding partners, commercial manufacturers, national and sub￾national authorities, exit strategies, PIO endorsements).
45
KEY RECOMMENDATIONS FOR MNH INNOVATION AND FUNDING COMMUNITY
1.
3.
2.
Implement tailored strategies for innovators to facilitate targeted partnership connections, 
including with funders. The funding community should develop and refine the strategy used by 
SL@B to make targeted and proactive connections for innovators more consistently. In particular, DevX 
emerged as a valuable platform to convene public and private sector stakeholders and for innovators 
to network and form connections. In that vein, other funders in this space could consider holding 
similar convenings in LMICs where it is easier to engage and form meaningful connections with key 
local stakeholders. The funding community also needs to proactively coordinate engagement between 
innovators and other innovation funders to make targeted connections at different growth stages based 
on the profile and need of innovators. There are a number of funders that provide stage-specific funding; 
early-stage funders such as SL@B could use its position to convene funders of later-stage innovations 
and develop a coordinated pipeline of funders to scale innovations. 
Engage with procurement platforms to support procurement for validated innovations. MNH 
innovation funders are aptly poised to facilitate introductions to global platforms for procurement of 
innovations across different countries (e.g., UNICEF), and inclusion of validated innovations in the WHO 
list. Given the fragmented nature of several of the key causes of mortality across geographies, even 
when a clinically validated solution is available and is backed by a commercial scale manufacturer, 
it is not often possible to manufacture at scale if the intended market is only within one country. A 
program like SL@B can ensure stable production by facilitating global procurement of innovations into 
countries where they are needed.
Proactively engage LMIC national and sub-national stakeholders early, jointly determine 
priorities, and curate validated innovations that can be scaled in different countries based on need and 
demand. Engagement with local public and private sector stakeholders, particularly in priority LMICs 
should be intentional and strategic elements in funders’ program design. Suggested ways for funders to 
incorporate this include:
a. Engage ministries and key local stakeholders in an advisory function prior to sourcing to ensure that 
innovations meet the needs and priorities of stakeholders in target countries.
b. Invite LMIC public and private sector stakeholders to attend forums like DevX and the Grand 
Challenges Annual Meetings (GCAM), held in LMICs, to meet innovators, learn about innovations, 
and assess potential collaboration opportunities. 
c. Convene an integrated marketplace for innovations at the country or regional level with country 
stewardship and ownership of the platform. A national or regional marketplace would provide an 
opportunity for countries to select the most impactful innovations for their context, and to integrate 
scaling efforts with local health and financing systems. Similar efforts currently exist, such as the 
EWEC Innovation Marketplace, which closely collaborated with SL@B; but these efforts need to be 
strengthened and extended to the MNH funding community more broadly.
We draw on interviews and survey data to highlight three data-driven recommendations applicable not only to the 
SL@B program, but also to the broader funding community and innovation ecosystem.
46
QUANTIFYING THE IMPACT OF SL@B 
(lives saved, cost, and equity)
In addressing the fourth evaluation question, “What is the potential impact of SL@B-funded innovations on 
MNH mortality and in the MNH ecosystem?”, the ESL@B team determined that this question was really about the 
effectiveness of an innovation (lives saved), whether it is or would be affordable per person (cost), and whether the 
innovation was reaching those at greatest risk of poor health outcomes (equity). These three issues can largely be 
answered at the innovation level per a rigorous CEA. For reasons discussed below, we were able to conduct CEAs for 
a subset of SL@B innovations to help illustrate this important aspect of SL@B’s impact.
Selection Process
To conduct a CEA, we needed to identify and select innovations that were advanced in their pathway to scale. 
These innovations fell under the TTS category, and were in a position to provide the data needed to complete a 
CEA – historical cost data along with cost projections for scaling until 2030. This required cost data was provided 
by innovators via an Excel-based costing tool developed by the ESL@B team as part of the evaluation.2 The other 
data source needed to complete a CEA was the lives-saved estimate from individual impact models originally 
developed by one of the SL@B partners, GCC, and validated by the ESL@B team. The ESL@B team has also 
created a new innovation modeling checklist to assist with these validation efforts (see Appendix IV). The checklist 
includes standardized elements and assumptions that needed to be included or addressed in an impact model, 
similar to other methods’ standard checklists such as COREQ for qualitative data and CONSORT for randomized 
controlled trials.46, 47
To select the innovations for CEA, our team looked into 19 out of the total 26 TTS innovations funded, and selected 
four innovations to conduct a CEA. The rest of the 14 innovations were not pursued due to the following reasons: 
innovators were not interested (and we needed their participation for cost data), the innovations did not have an impact 
model yet, and/or the innovators had already conducted their own economic analyses including published CEAs. 
Significance of CEA
The CEAs produced through this evaluation are not included in this report but are standalone documents on each of 
the four chosen innovations. They provide quantitative evidence on the associated cost of scaling a certain innovation 
as well as determining if an innovation is deemed cost-effective based on the WHO thresholds for measuring cost￾effectiveness. This information can be used by funders, program implementers, governments or other stakeholders 
to make informed decision regarding funding/scaling an innovation. However, it is important to note that CEA is only 
one type of economic analysis that could inform program/funding decisions, and it may not represent a holistic view 
of every economic element around the innovation. Increasingly around the world, CEAs and efficiency considerations 
5
• SL@B has sourced and scaled some cost-effective innovations (e.g. Bempu TempWatch); however, impact 
estimates for most grantees are premature given their earlier stage of growth (and evidence level) in the 
scaling pathway.*
 Longer timeframes are needed to assess mortality impact for the lifecycle of the SL@B￾funded innovations. 
• SL@B TTS grantees are very interested in having CEA of their innovations in order to leverage funding for 
scale. We suggest either providing technical assistance within the SL@B program to conduct CEAs for all TTS 
grantees or link grantees with outside partners who can help them complete a CEA.
• A number of SL@B innovations have modeled positive health impact and calculated attractive economic 
parameters such as cost-effectiveness, which shows the future promise of the portfolio.45
KEY FINDINGS
47
Key Takeaways from CEA Process 
During our collaborative CEA process, the ESL@B team learned that most innovators had not planned and/or 
thought much about the expenses that would be incurred during the expansion of their project, which is vital for 
conducting a CEA and assessing the feasibility of scaling. However, gathering and documenting historical costs was 
feasible, albeit time-consuming, for most innovators. We recommend that donors encourage innovators to document 
their structure of costs in relation to the number of beneficiaries, think about future expenses, and consider doing CEAs 
when applicable. We also learned that CEAs could be a necessary next step for many innovators as they seek more 
funding or progress through their pathway to scale. CEA is an important analysis and a building block for evidence￾based decision making that innovators could leverage as they interact with government, funders, and other 
decision-making stakeholders in different settings and countries. 
Having said that, CEA is not the only way to determine whether an innovation is having an impact or not. Other tools 
such as the publically available EquityTool could be used to assess the reach and impact of an innovation.18 Even 
if an innovation is not yet deemed cost-effective, proving that it is reaching the most vulnerable could be another 
way of quantifying impact. During our evaluation process, we were able to do an EquityTool analysis for one 
innovation which the innovator found helpful to understand the wealth quintiles of their current beneficiaries. By 
way of doing that, we also learned that many innovations do not have a data-based system of monitoring economic 
status of their beneficiaries, a proxy for those most vulnerable to poor health outcomes. We recommend that donors 
encourage innovators to document their reach by known wealth quintiles (or other socio-economic status indicators) to 
ensure they are reaching beneficiaries who could most benefit from their innovation. 
* Dixit S, Fernholz F, Ogbuoji O, et al. Cost Effectiveness Analysis: Bempu TempWatch. Durham: Evaluating Saving Lives at Births (E-SL@B) Program; 2020.
are combined with social, political and administrative parameters, making them one of the main pillars for resource 
allocation and decision making. Therefore, it is vital to understand how the cost of implementing an innovation in a 
county or a region fits in overall public health expenditure of that area. This might impact the feasibility of scaling up 
an innovation in a region even if the innovation is cost-effective according to the WHO thresholds.
Furthermore, CEAs are a snapshot in time, and, therefore are subject to change if conditions for the innovator 
change down the line (e.g. if the innovator receives more funding or is not showing the expected impact). To this 
end, CEAs are best positioned to provide evidence on a particular innovation at a certain point in time, and not 
much insight on a portfolio level. The CEAs for the four SL@B innovations that are being conducted capture the 
impact of an innovation based on the current availability of data. If a certain innovator scales more than the current 
assumptions, and achieves higher impact, then the CEAs results will improve further. To model some of the future 
changes and uncertainties in innovators’ expansion plans, the CEAs include sensitivity analysis of cost and impact 
variables using methods such as Monte Carlo simulation (a method that was used to determine the range of 
variability in an innovation’s outcome for all variables/assumptions involved.)
48
CONCLUSION
Results from this evaluation of SL@B from 2011 to 2020 show that as a multi-donor partnership seeking to grow 
and scale innovations, the program has helped to address critical gaps in the MNH landscape by funding early￾stage innovations that aim to address common causes of maternal and neonatal mortality, sourcing from a 
variety of fields to address key MNH needs, and building the capacity of innovators through a range of non￾financial support activities. For a recap of key findings and recommendations, please see the Executive Summary.
DISCUSSION
Throughout this report, we present findings and proposed recommendations linked directly to the data, research 
methods, and analyses undertaken in this evaluation program. In this section, we further expand upon our 
recommendations by leveraging the team’s broader expertise and experience in MNH, global health innovation, 
health economics, and evaluation methods. Thus, the recommendations in this discussion section represent only 
the views of the authors for further consideration by the SL@B program partners. They generally build from the key 
recommendations in each section and provide more specific guidance for future priorities and action. 
As a pioneering model for co-investment and explicit open innovation approaches to address critical challenges in 
MNH, the SL@B program should be commended for its forward-looking and inclusive design. The learnings and 
partnerships formed through SL@B have also supported and been incorporated into additional Grand Challenges 
for Development, including for Zika and Ebola. A vibrant Grand Challenges community now exists that includes and 
is made stronger by the SL@B community of innovators, funders, private sector partners, and other supporting 
organizations. The community that SL@B has brought together is critical to the future of MNH and is a 
valuable asset that has been cultivated and nurtured over eight years. Regardless of the future of SL@B, there 
should be a commitment to keeping the MNH innovation community actively engaged and growing over time. 
To maximize its impact and build on its differentiated strengths and capabilities in the future within the rapidly 
evolving global health innovation landscape, SL@B could be re-designed with a mandate to serve as a 
comprehensive MNH innovation platform, not primarily or predominantly as a more narrow grant funding 
mechanism with some add-on non-financial support. Such an innovation platform would include many of the 
components and approaches described below. 
Deep focus on “problem sourcing,” applying the principles of human-centered design to effectively 
describe, analyze, contextualize, and prioritize MNH challenges for innovations and innovators 
to target; this should be done in close partnership with and co-led by LMIC based organizations such 
as Grand Challenges Africa, African Academy of Sciences, regional bodies such as West African Health 
Organization (WAHO), and national policy-shaping entities such as Ministries of Health and Ministries of 
Science and Technology, NITI-Aayog (India), and Biotechnology Industry Research Assistance Council (BIRAC, Grand 
Challenges India). This curation and prioritization of MNH challenges suited for innovation, with strong local voices 
and context, would itself be an important service from SL@B for the broader MNH community, helping innovators and 
other key stakeholders make better decisions and more effectively target their potential solutions. 
We also see a significant opportunity to more effectively link SL@B-supported innovations, and SL@B 
as an innovator platform, into the broader efforts in MNH funding and implementation of SL@B 
funding partners. This could include operational models such as incorporating SL@B innovators directly 
into MNH implementation programs, creating specific funding priorities within implementation programs 
to integrate SL@B supported innovations, leveraging implementation partners to highlight and bring 
more visibility to SL@B-supported innovations, and holding local and regional LMIC-based innovation marketplaces 
(leveraging local and regional offices and missions of SL@B funding partners) linked to implementation projects that 
highlight responsive and promising SL@B innovations. 
1.
2.
6
49
In addition to LMIC public sector partners, SL@B could deploy a network-of-networks organizing model 
to better engage the growing RMNCH community, and more precisely and effectively describe its primary 
role and value-add in the context of other groups, including the Partnership for Maternal, Newborn and 
Child Health (PMNCH), the Global Financing Facility (GFF), and Every Woman Every Child (EWEC). SL@B 
can especially ensure that the voices and perspectives of innovators and the MNH innovation community are fully 
represented in other networks, and make coordination and handoffs more effective over time. 
Furthermore, SL@B could strongly consider and target the inclusion of additional private sector partners, and 
donor country offices for future iterations. A stronger and more inclusive partnership would enable more successful 
identification, support, and scaling of innovations in MNH. It will enable SL@B to more effectively focus on integration 
and adaptation of successful point innovations to support more comprehensive solutions for complex health 
challenges. As the MNH field matures and the investment into innovation grows, SL@B has a significant opportunity 
to serve as the central coordinating platform for MNH innovation, bringing together public and private sector 
partners to more effectively communicate, collaborate, and accelerate impact. 
There are clear tensions internal to SL@B funding partners, and development organizations in general, about 
the right levels of investment between innovation and implementation of current best practices. Stronger 
and more proactive internal governance and communications efforts would potentially alleviate those 
tensions and highlight the potential synergies across the innovation to implementation spectrum.
Explicit portfolio management approach for SL@B with multiple tracks. Building upon the key 
recommendations set out in this report for more clear and transparent targets for risk tolerance and 
expected success factors at different stages and tracks of innovation, we also propose that SL@B consider 
additional flexible opportunities for add-on funding, more integrated access to private sector funding, and 
explicit expected success rates for each tier. Key considerations for such a portfolio management approach include:
a. Distinct tracks within the SL@B program (separate to the current breakdown by stages of development) would 
require different evaluation criteria and support mechanisms, and may include:
i. innovations addressing the most intractable problems in the hardest places to reach and/or among the most 
vulnerable populations, where innovation is certainly needed but it is unlikely to lead to market-based, 
sustainable solutions; 
ii. curation and scaling of promising market-based solutions in target LMICs where conditions could support 
financial sustainability for such private-sector solutions; and
iii. later-stage scaling of proven innovations, where there is a gap within SL@B but also across other MNH funding 
sources; larger scale funding and different types of non-financial support are needed for this stage of 
scaling, and the new Innovation-to-Scale initiative supported by the GFF in partnership with Laerdal Global 
Health is one example that could be built upon. 
b. Another aspect of portfolio management that is important to consider is to publicly acknowledge and quantify 
the expectation that not all investments will or should be successful. A traditional grant-making and global 
development aid approach attempts to support all grantees equally and expects incremental progress from 
each, while a more explicit venture philanthropy management approach across the portfolio might set targets 
for success and failure at various stages of financing and growth, and see the accelerated shut-down of 
unsuccessful ideas as a key marker of success rather than failure. While there is a lack of existing benchmarks 
for expected success rates for global health innovations, one can infer appropriate principles from other 
literature, including the venture capital and pharmaceutical industries. 
A common approach to examining startup failure is to examine 1) failure to raise the next round of capital 
(which for SL@B innovators could include philanthropy, donor aid, and/or private investment), or 2) failure 
to exit (which for SL@B innovators could include acquisition, licensing, and/or handoff of the innovation to 
an implementing partner or government).48 Data on startups in the US tracked from 2008 to 2010 show that 
nearly two-thirds of startups stagnate in the venture capital funnel as they fail to exit or raise the next round of 
funding.49 While the rate of failure to exit decreases as a startup progresses through financing stages, the rate 
of failure to raise the next round of financing is highest at the earliest (seed to Series A, 79.4% failure rate) and 
the final stages (Series G to Series H, 82.6% failure rate).48 At each round, there are fewer startups making it to 
3.
4.
5.
50
the subsequent round for more capital.49 
Similarly, the pharmaceutical industry has strong data on success rates that firms utilize to manage risk. In 
a study of clinical drug development success rates from 2006-2015, overall success from Phase I to approval 
was approximately 10%. Significant variability exists between the phases, with success rates varying from 
63.2%, 30.7%. 58.1% and 85.3% from transitions between Phase I to II, Phase II to III, Phase III to New Drug 
Application/Biologic License Application (NDA/BLA) and NDA/BLA to approval respectively.50
Building from these and other appropriate industry data, the SL@B program can set initial benchmarks for 
expected success rates by stage and track, and measure performance over time, through which it can adapt 
targets for its portfolio. This approach also holds strong promise to be deployed across the Grand Challenges 
and global health innovation communities.
c. To strengthen its operating approach as a venture philanthropy program, SL@B could consider adding more 
investment professionals, especially those with LMIC venture capital experience, to the SL@B design and 
implementation team including the formal investment committee. 
Finally, we note the lack of comprehensive and high-quality data and evidence to inform the 
development and scale-up of global health innovations, including in MNH. While SL@B has undertaken 
program-level external reviews, it has the opportunity to lead the global health innovation field by 
significantly strengthening its approach to data, evaluation, and evidence.This will require setting clear 
indicators and metrics of success at project, portfolio and program levels, and for the investment; and commitment 
to prospective evaluation, evidence generation, and transparent sharing of results. We note that while SL@B 
currently has a retroactively developed TOC, in our formal and informal engagement with teams across the SL@B 
partnership, we found that there is little reference to this TOC in decision-making and priority-setting, and a lack of 
clarity in how the TOC guides internal project and portfolio evaluations.1 SL@B has an opportunity to demonstrate 
world-leading commitment to evaluation and evidence and incorporation of continuous improvement principles 
and systems of a learning organization within and across the program. Much as it led the way as an early Grand 
Challenge for Development, SL@B can again lead the way for evidence generation and use in driving innovation, 
maximizing and accelerating impact while ensuring strong stewardship of scarce resources. 
6.
“For any good program to be successful, you need to have the courage to pause and course correct as you go along. This is 
very important for an ambitious and wonderful program such as SL@B. One key question to ask in this pause mode is the 
question “Why are we doing this?” or “Who are we doing this for?” Is it for the innovators, for the industry or is it for the 
mums and babies around the neediest places in the world? If the answer to this question is mums and babies, then SL@B 
must pause and redirect their efforts to ensure that there is an innovative business model to scale the innovations to the 
mothers and children that need it most. This is not business as usual and to assume that just because there is seed funding 
for an innovation (not underestimating the importance of that) there will be an automatic deployment of the technology.”
– HIC MNH industry investor
51
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framework and prioritised metrics. Global Health. 2018;14:13. doi:10.1186/s12992-018-0327-z
2. Dixit, S, F Fernholz, O Ogbuoji, A Finnegan, B Biru, K Udayakumar, and J Baumgartner. “Costing Tool for Health 
Innovators.” Durham: Evaluating Saving Lives at Births (E-SL@B) Program: Duke Global Health Institute Evidence 
Lab & Global Health Innovation Center at Duke University, 2019.
3. Arregoces L, Daly F, Pitt C, et al. Countdown to 2015: changes in official development assistance to reproductive, 
maternal, newborn, and child health, and assessment of progress between 2003 and 2012. Lancet Glob Heal. 
2015;3(7):e410-e421. doi:10.1016/S2214-109X(15)00057-1
4. Dingle A, Schäferhoff M, Borghi J, et al. Estimates of aid for reproductive, maternal, newborn, and child health: 
findings from application of the Muskoka2 method, 2002–17. Lancet Glob Heal. 2020;8(3):e374-e386. doi:https://
doi.org/10.1016/S2214-109X(20)30005-X
5. Grand Challenges Canada. Saving Lives at Birth. https://www.grandchallenges.ca/programs/saving-lives-at-birth/. 
Published 2019.
6. Canada GCCD. The Grand Challenges Approach. 2011.
7. WHO, UNICEF, UNFPA, Group WB, Division UNP. Trends in maternal mortality: 1990 to 2015: estimates by WHO, 
UNICEF, UNFPA, World Bank Group and the United Nations Population Division. 2015.
8. World Health Organization. Maternal Mortality Factsheet.
9. WHO. Newborns: reducing mortality. https://www.who.int/news-room/fact-sheets/detail/newborns-reducing￾mortality. Published 2019. Accessed June 8, 2020.
10. World Health Organization. Stillbirths. https://www.who.int/reproductivehealth/topics/maternal_perinatal/
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53
AUTHORS’ ROLES AND CONTRIBUTIONS
Note on Authorship:
As joint principal investigators of the Evaluating Saving Lives at Birth program, Joy Noel Baumgartner and Krishna 
Udayakumar share joint senior authorship by providing strategic and detailed guidance to inform the evaluation. 
Blen Biru, Sowmya Rajan, and Andrea Taylor are joint first authors, contributing to multiple aspects of study 
design, data collection, analysis and writing of the report.
*Disclosures: 
Krishna Udayakumar is the Co-PI of Evaluating SL@B (ESL@B) as well as PI of Accelerating SL@B (ASL@B), a 
program that has provided accelerator support and technical assistance for select SL@B innovations offered 
through another team at Duke Global Health Innovation Center from January 2018 to May 2020. ASL@B has also 
managed the DevelopmentXChange (Devx) in 2018 and 2019. To offset potential bias, Joy Noel Baumgartner led 
all efforts on data collection, analysis, interpretation, and writing involving the non-financial support provided by 
SL@B (including the Xcelerator and DevX), while both PIs (Krishna Udayakumar and Joy Noel Baumgartner) co-led 
all other aspects of the evaluation.
The following organizations have provided research and operational support (funding and/or in-kind) through 
Duke Global Health Innovation Center or Duke-affiliated non-profit, Duke Global Health Institute Evidence Lab, 
and Innovations in Healthcare, in the past three years (2018-2020): Amgen, Asia Pacific Medical Technology 
Association, AstraZeneca, Bayer, Bill and Melinda Gates Foundation, Cardinal Health, Catholic Relief Services, 
Colorado Hospital Association, Commonwealth Fund, Duke Corporate Education, FHI 360, Grand Challenges 
Canada, GlaxoSmithKline, LifeNet International, McKinsey & Company, Medtronic, National Institutes of Health, 
Novartis Foundation, Pfizer, Pfizer Foundation, Takeda, United States Agency for International Development, 
Vynamic, and World Economic Forum. 
AUTHOR CONTRIBUTION 
Blen Biru, MSc
Duke Global Health Institute Evidence Lab Overall study design, data collection, analysis, writing, editing
Sowmya Rajan, PhD
Duke Global Health Innovation Center Overall study design, data collection, analysis, writing, editing
Andrea Taylor, MSW
Duke Global Health Innovation Center Overall study design, data collection, analysis, writing, editing
Kate Crissman, MPH
Duke Global Health Innovation Center Overall analysis and writing and editing
Siddharth Dixit, MIDP
Duke Global Health Institute Evidence Lab CEA-related data collection, analysis, writing
Pratik Doshi, MS
Duke Global Health Innovation Center Analysis and writing
Minahil Shahid, MPP
Duke Global Health Institute Evidence Lab CEA-related data collection, analysis, writing, and analysis of online survey
Joy Noel Baumgartner, MSSW, PhD
Duke Global Health Institute Evidence Lab
Principal Investigator, overseeing all aspects of research design, data collection, 
analysis, writing, and interpretation of findings 
Krishna Udayakumar, MD, MBA,* 
Duke Global Health Innovation Center
Principal Investigator, overseeing all aspects of research design, data collection, 
analysis, writing, and interpretation of findings 
54
ABOUT THE CENTERS
Duke Global Health Innovation Center
The Duke Global Health Innovation Center’s (GHIC) mission is to study and support the scaling and adaptation 
of innovations, and related policy reforms, to address critical health challenges worldwide. The GHIC strives to 
have an impact on healthcare and health through scaling of health innovations, promoting policy and regulatory 
changes, and implementation projects in health systems. The GHIC links global health, health policy, and health 
innovation efforts across Duke University.
Duke Global Health Institute Evidence Lab 
The Duke Global Health Institute (DGHI) Evidence Lab blends theory and practice and draws upon the research 
and policy expertise across Duke University to inform our evaluations and to disseminate new evidence to 
policymakers, donors and diverse stakeholders to inform decision-making. With deep, on-the-ground knowledge 
and experience with a wide range of global health projects, our team offers research and practice-based 
understandings of regional health challenges. A core principle of the DGHI Evidence Lab is to strengthen the 
evaluation capacity of local project counterparts on collaborative projects.
Duke Center for International Development
The Duke Center for International Development (DCID), a unit within Duke University’s Sanford School of Public 
Policy, advances international development policy and practice through interdisciplinary approaches to post￾graduate education, mid-career training, international advising and research. DCID faculty and staff continuously
strive to create programs that meet the specific needs of each client and student.
Additional Contributors
AUTHOR CONTRIBUTION 
Fernando Fernholz, MSCE, MPA, PhD
Duke Center for International Development Co-lead on CEA, data collection, analysis, and writing
Osondu Ogbuoji, MBBS, MPH, ScD
Duke Global Health Institute, Center for Policy Impact 
in Global Health
Co-lead on CEA, data collection, analysis, and writing
Amy Finnegan, PhD
Duke Global Health Institute Evidence Lab Overall study design, data collection, analysis, and writing of first draft
Stacey Dixson, Ed.M
Duke Global Health Institute Evidence Lab First draft of writing
55
APPENDIX I
SL@B’S THEORY OF CHANGE 
Source: Lalli M, Ruysen H, Blencowe H, et al. Saving Lives at Birth; development of a retrospective theory of change, impact framework and prioritized metrics. Glob Health. 
2018;14(1). doi:10.1186/s12992-018-0327-z 
56
Key outputs sought by SL@B funding partners organized into thematic impact areas. 
APPENDIX II
SL@B’S IMPACT AREA FRAMEWORK 
Source: SL@B Impact Framework listing Key Dimensions of Interest, shared by USAID via email communication in Powerpoint, with ESL@B team in January 2019.
IMPACT AREA DESCRIPTION
Lives Saved / Improved Current number of lives saved or DALY’s or QALY’s improved by fielded innovations
Acceleration to Market Future impact of bringing innovations to scale faster (reducing the time to scale), further (broader reach 
or level of scale), or more equitably (including marginalized populations)
Pipeline development and 
new partnerships
Bringing different expertise and unconventional partners (e.g., car mechanics) to tackle MCH challenges 
and the resulting innovations (e.g., Odon device)
Market Shaping
Improving efficiency of relevant markets for these innovations to increase LMIC access by:
1) Reducing transaction costs
2) Increasing market information
3) Balancing supplier and buyer risks*
Capacity Development
Development of innovators’ capacity across core skill sets (i.e., business model, manufacturing or supply 
chain knowledge) and how that is translated into broader learnings for the field (i.e., accelerators or 
shared knowledge products, etc.)
Increased awareness of 
MNH issues:
1. Media Attention
2. Funding Leveraged
3. Enabling Environments
Awareness defines as:
1. Mainstream media attention, such as newspapers/blogs
2. Funding leveraged, including incremental funds to current donors’ MNH budgets and attracting new 
funders
3. Capacity building amongst enablers of innovation, including intended policymakers/regulators (i.e., 
LMIC MoH’s), universities, innovation accelerators, etc. 
Platforms that drive 
acceleration
Establishing practices that help MNH donors efficiently support a new way of doing business around 
driving innovation, supporting innovators, and bringing successful innovations to scale
57
APPENDIX III
SL@B’S NON-FINANCIAL SUPPORT 
The SL@B innovator survey, conducted by Duke University in 2019, asked innovators about a variety of non￾financial support areas (this list was determined in consultation with SL@B funding partners). The survey asked 
respondents how helpful (low, medium, and high) and how sufficient (sufficient or insufficient) each type of 
support from SL@B had been. 
Figures 1 through 10 below present a summary of how helpful and sufficient the following areas of SL@B’s 
non-financial support was for innovators: grants management, market entry, public relations, accelerator, and 
networking. The figures also note the number of respondents who reported receiving each type of support. 
Figure 1.Grants management support provided by SL@B 
SL@B Support Found Helpful
SL@B Support Found Sufficient 
Figure 2: Grants management support provided by SL@B Number of respondents Number of respondents
25
20
15
10
5
0
40
35
30
25
20
15
10
5
0
Low
High
Low
High
4
11%
3
8%
17
46%
32
86%
6
46%
5
38%
5
39%
6
46%
Grants Management
(n=37)
Grants Management
(n=37)
USAID Intern
(n=13)
USAID Intern
(n=13)
58
Figure 3: Market entry support provided by SL@B
Figure 4: Market entry support provided by SL@B Number of respondents Number of respondents
25
20
15
10
5
0
35
30
25
20
15
10
5
0
Low
High
Low
High
6
19%
4
12%
2
10%
14
44%
14
44%
8
30%
6
22%
11
55%
15
75%
11
44%
16
64%
10
53%
7
37%
12
44%
20
74%
5
25%
5
20%
5
20%
3 - 16%
9
47%
Market 
Understanding 
(n=32)
Market 
Understanding 
(n=32)
Development 
Impact Frameworks
(n=27)
Development 
Impact Frameworks
(n=27)
Market 
Identification
(n=25)
Market 
Identification
(n=25)
SL@B Proposal 
Support
(n=20)
SL@B Proposal 
Support
(n=20)
TA by USAID 
Missions 
(n=19)
TA by USAID 
Missions 
(n=19)
SL@B Support Found Helpful
SL@B Support Found Sufficient 
59
Figure 5: Public relations support provided by SL@B
Figure 6: Public relations support provided by SL@B Number of respondents Number of respondents
30
25
20
15
10
5
0
35
30
25
20
15
10
5
0
Low
High
Low
High
9
27%
10
30%
17
52%
21
64%
6
26%
8
33%
6
35%
11
65%
6
35%
6
35%
5
50%
4 - 40%
7
29&
16
70%
7
70%
11
48%
15
62%
9
38%
6
26%
Communications 
Support
(n=33)
Communications 
Support
(n=33)
Speaking 
Opportunities
(n=23)
Speaking 
Opportunities
(n=23)
Media Promotion
(n=24)
Media Promotion
(n=24)
Journal Publication 
Support
(n=17)
Journal Publication 
Support
(n=17)
Manuscript
Editing
(n=10)
Manuscript
Editing
(n=10)
SL@B Support Found Helpful
SL@B Support Found Sufficient 
60
Figure 7: Accelerator support provided by SL@B
Figure 8: Accelerator support provided by SL@B Number of respondents Number of respondents
30
25
20
15
10
5
0
35
30
25
20
15
10
5
0
Low
High
Low
High
7
22%
3 - 9 %
19
59%
29
85%
5
15%
5
16%
9
43%
16
76%
5
24% 8
50%
4
25%
3 - 19%
10
62%
12
50%
17
71%
21
62%
25
78%
4
17%
5
21%
Pitch Support
(n=32)
Pitch Support
(n=32)
VentureWell 
Accelerator
(n=34)
VentureWell 
Accelerator
(n=34)
Other Accelerator 
Support
(n=24)
Other Accelerator 
Support
(n=24)
Business Plan 
Development
(n=21)
Business Plan 
Development
(n=21)
High-touch 
Consulting
(n=16)
High-touch 
Consulting
(n=16)
3 - 14%
SL@B Support Found Helpful 
SL@B Support Found Sufficient 
61
Figure 9: Networking support provided by SL@B
Figure 10: Networking support provided by SL@B Number of respondents Number of respondents
35
30
25
20
15
10
5
0
50
45
40
35
30
25
20
15
10
5
0
Low
High
Low
High
5
11%
4 - 9%
28
60%
41
87%
12
35%
11
32%
8
42%
12
71%
4
24%
7
50%
11
79%
9
53%
6
43%
2 - 14%
10
59%
9
35%
18
69%
7
41%
12
63%
10
29%
21
62%
8
31%
6
23%
8
31%
5
26% 5
26%
DevX
(n=47)
DevX
(n=47)
Facilitate 
Connections 
to Funders
(n=34)
Facilitate 
Connections 
to Funders
(n=34)
Facilitate 
Connections to 
Non-financial 
Partners to Scale
(n=26)
Facilitate 
Connections to 
Non-financial 
Partners to Scale
(n=26)
Facilitate 
Connections to 
Public Sector 
for Scale
(n=17)
Facilitate 
Connections to 
Public Sector 
for Scale
(n=17)
Support 
Developing 
Proposals 
for Follow￾on funding
(n=14)
Support 
Developing 
Proposals 
for Follow￾on funding
(n=14)
Letters of 
Support
(n=17)
Letters of 
Support
(n=17)
Facilitate 
Connections to 
Private Sector 
for Scale
(n=14)
Facilitate 
Connections to 
Private Sector 
for Scale
(n=14)
6
32%
4 - 24%
SL@B Support Found Helpful 
SL@B Support Found Sufficient 
62
APPENDIX IV
IMPACT MODELING CHECKLIST, WORKING DRAFT 
Section/Topic Checklist item 
Parameters 
Included
Sensitivity 
Assessed
Y/N/NA Describe Y/N/NA Describe
Model description 
Theory of Change Describe the innovation's Theory of Change (TOC) or logic model.
Study perspective
Describe the perspective of the study and relate this to the impacts being 
evaluated. Options include: innovator perspective, societal perspective, 
health/epidemiological perspective.
Time horizon State the time horizon(s) over which impact is being evaluated and 
describe why appropriate. 
Target population Describe the target population.
Assumptions
Demographic factors 
Disease burden 
Does the model include assumptions for how the at-risk population 
will change over time without the intervention? Describe whether the 
assumption is based on a level or trend change or both. For example, 
fertility trends, neonatal and maternal mortality trends etc. Describe the 
source of information used.
Efficacy & Fidelity 
Efficacy 
Does the model account for the efficacy of the innovation with typical use 
and perfect use compared to some counterfactual? Describe the source 
of information used. State the rigor of the evidence base for efficacy 
measurements. Options include: pilot, RCT, observational study (case￾control), anecdotal evidence. Describe the sample size, p-value, effect size, 
level/tier of health system included in evidence, etc. Describe the source of 
information used.
Fidelity to treatment 
protocol (intermediary) 
Does the model include a parameter for quality of service delivery by 
intermediaries (e.g. health workers, manufacturing)? Describe the source 
of information used.
Fidelity to treatment 
protocol (beneficiary) 
Does the model include a parameter for fidelity to treatment protocol by 
the beneficiary (e.g. improper use, sub-optimal use)? Describe the source 
of information used.
Health system factors 
Equitable access 
Does the model include a parameter for equitable access to services? For 
example, does access to service vary across rural vs. urban populations, 
across vulnerable populations etc.? Describe the source of information 
used.
Stock outs 
Does the model account for stock outs? Describe how the model takes this 
into consideration and if not, why not. Describe the source of information 
used.
Referrals 
Does the model account for referral of severe cases? For example, what 
proportion of cases will be referred and once referred what proportion will 
actually reach care. Describe how the model takes this into consideration 
and if not, why not. Describe the source of information used.
Attrition of 
intermediaries 
Does the model include attrition and replacement of CHWs, nurses, etc.? 
Describe how the model takes this into consideration and if not, why not. 
Describe the source of information used.
Scenarios
Innovator scale-up Does the model include innovator reported scale up as a scenario? 
Describe the scenario.
Universal health 
coverage
Does the model include universal health coverage as a scenario? Describe 
the scenario.
Note. Developed by Evidence Lab at the Duke Global Health Institute (DGHI).
CONTACT
Krishna Udayakumar, MD, MBA 
Co-Principal Investigator
Director, Duke Global Health Innovation Center, 
Duke Global Health Institute
Associate Professor of Global Health and Medicine
ku@duke.edu
Joy Noel Baumgartner, PhD, MSSW
Co-Principal Investigator
Director, DGHI Evidence Lab,
Duke Global Health Institute
Associate Research Professor of Global Health
joy.baumgartner@duke.edu 
This draft report was produced for review by Grand Challenges Canada and the United States Agency for International Development. 
It was prepared by the Duke Global Health Innovation Center and the Duke Global Health Institute Evidence Lab at Duke University, 
and was authored by:
Blen Biru, MSc, Duke Global Health Institute Evidence Lab
Sowmya Rajan, PhD, Duke Global Health Innovation Center
Andrea Taylor, MSW, Duke Global Health Innovation Center
Kate Crissman, MPH, Duke Global Health Innovation Center
Siddharth Dixit, MIDP, Duke Global Health Institute Evidence Lab
Pratik Doshi, MS, Duke Global Health Innovation Center
Minahil Shahid, MPP, Duke Global Health Institute Evidence Lab
Joy Noel Baumgartner, MSSW, PhD, Duke Global Health Institute Evidence Lab
Krishna Udayakumar, MD, MBA, Duke Global Health Innovation Center
With significant contributions from: 
Fernando Fernholz, MSCE, MPA, PhD, Duke Center for International Development
Osondu Ogbuoji, MBBS, MPH, ScD, Duke Global Health Institute, Center for Policy Impact in Global Health
Amy Finnegan, PhD, Duke Global Health Institute Evidence Lab
Stacey Dixson, EdM, Duke Global Health Institute Evidence Lab
DISCLAIMER: This product is made possible through the generous support of the Saving Lives at Birth partners: the United States 
Agency for International Development (USAID), Grand Challenges Canada (GCC) (with funding from the Government of Canada), 
Norwegian Agency for Development Cooperation (NORAD), the Bill & Melinda Gates Foundation (BMGF), the UK Department for 
International Development (DFID), and the Korea International Cooperation Agency (KOICA). The contents of this report are the 
sole responsibility of the Duke Global Health Innovation Center and the Duke Global Health Institute Evidence Lab, and do not 
necessarily reflect the views of Saving Lives at Birth partners.