Medical & Healthcare Intrapreneurship — From Ward Problems to Sustainable Digital Health Solutions (Kenya & Africa case study)

Levi Cheptora

Tue, 21 Oct 2025

Executive summary

Public sector intrapreneurship in healthcare means frontline staff (clinicians, nurses, health managers) using entrepreneurial practice inside government systems to design, test, and scale durable digital health solutions. This article gives an international audience a practical, step-by-step playbook using Kenya and wider African health-system realities as the primary case study lens. It covers problem identification, rapid validation, co-design, prototyping, pilot evaluation, scale pathways, procurement/regulatory realities, financing and sustainability, and monitoring & evaluation — all with templates and concrete recommendations for public sector settings.

1. Why intrapreneurship matters in public health

• Frontline staff see recurring inefficiencies (drug stockouts, late referrals, triage delays, documentation burden). These problems are innovation opportunities.

• Intrapreneurship enables low-cost, contextually appropriate solutions that large vendors often miss.

• Public systems can adopt innovations legally and at scale when intrapreneurship is linked to procurement, regulatory compliance, and sustainable finance.

2. Definitions (short)

• Intrapreneurship: entrepreneurial activity inside an existing organization to create new products, services, or ways of working (Pinchot, 1985).

• Digital health product/service: software, device, workflow or integrated service using digital technologies to improve health outcomes (WHO, 2019).

3. The context: Kenya & Sub-Saharan Africa (why this lens)

• Health systems in Kenya and many African contexts are resource-constrained, highly innovative at the front line, and have strong mobile penetration — a fertile ground for clinically relevant digital solutions.

• Public sector adoption requires alignment with national eHealth strategies, procurement rules, and data governance.

4. High-level intrapreneurship framework (6 phases)

1. Spot & frame the problem — write a concise problem statement (see template).

2. Rapid evidence & stakeholder mapping — who’s affected, who decides, what rules govern adoption.

3. Co-design & low-fidelity prototyping — paper mockups, workflow diagrams, simple SMS scripts.

4. Pilot & iterate — short timeboxed pilots with clear outcomes.

5. Evaluate & build the business case — cost, impact, sustainability, procurement path.

6. Scale & integrate — align with procurement, interoperability, training, and maintenance.

5. How to identify high-value ward problems (practical)

Look for problems that are:

• Frequent and repeatable (e.g., daily drug stock checks).

• Have measurable outcomes (time saved, errors avoided).

• Low-to-medium technical complexity to prototype (SMS, simple mobile app, dashboard).

• Potential to save money or lives if solved at scale.

Example (illustrative vignette): In a county hospital, nurses spend 45 minutes per shift reconciling medication charts across paper and a separate pharmacy log. That time and mismatch cause delays and dosing errors — a good candidate.

6. Problem statement template (one-line + evidence)

• One-line problem: [Who] experiences [what] resulting in [harm/waste/outcome].

• Evidence: log of X incidents in Y days; time motion study; patient complaint summary.

• Outcome metric: reduce medication reconciliation time per shift by 60% within 3 months.

7. Rapid validation methods (no-regret checks)

• 48-hour shadowing and time-motion notes.

• Short questionnaire (5 items) for staff.

• Quick cost estimate (staff time × salary/hour).

• Small n pilot (5–10 patients/shifts) for feasibility.

8. Co-design and prototyping (practical steps)

• Convene a 1–2 hour co-design workshop with clinicians, IT staff, and procurement rep. Use simple tools (paper, whiteboard).

• Produce a “happy path” workflow and one alternative failure path.

• Build a low-fidelity prototype: paper mockups, Excel dashboard, SMS script, or a simple web form.

• Test with real users for a single shift, record feedback, iterate.

9. Minimum viable product (MVP) checklist for wards

• Solves the core problem (no extra features).

• Integrates with at least one existing process (e.g., uses existing nurse handover time).

• Data captured in a way that allows evaluation (timestamped log, counts).

• Minimal training required (<30 minutes).

• Low maintenance plan (who will host, update, and back up).

10. Ethics, data governance & patient safety (must-do)

• Obtain local clinical governance sign-off before testing.

• Follow national data-protection rules; anonymize PHI where possible.

• Implement clinical safety checks (e.g., alerts to clinicians for abnormal values).

• Document informed consent if patient data are used beyond routine care.

11. Regulatory & procurement realities (public sector specifics)

• Early engage with procurement & legal units — innovations often fail on procurement grounds, not technical grounds.

• Map procurement pathways: internal budget reallocation, innovation funds, pilot exceptions, or partnership via a memorandum of understanding (MOU).

• If the product meets the definition of a medical device/software as a medical device (SaMD), confirm whether it needs regulatory approval in your country.

• Build a simple total cost of ownership (TCO) model: development, hosting, training, support, maintenance, and replacement.

12. Financing models (practical possibilities)

• Internal reallocation: small innovation line items in facility budgets.

• County/national innovation funds or challenge prizes.

• Development partner grants (short term, conditional).

• Public–private partnerships (PPP) with clear contracts on IP, maintenance, and data.

• Social enterprise spin-out if permitted and aligned with public interest.

13. Scaling pathways

• Horizontal scale: replicate to other wards/facilities with same workflow.

• Vertical scale: integrate into county/national systems (requires interoperability standards).

• Procurement scale: handover to official procurement with specification and vendor list.
  Key requirement: prepare a “handover pack” (technical spec, training materials, M&E plan, maintenance plan).

14. Monitoring, evaluation & learning (KPIs & methods)

Core KPIs (choose 3–5):

• Clinical outcome(s) (e.g., medication errors per 1,000 doses).

• Process outcome(s) (time spent on task per shift).

• Adoption (percentage of staff using MVP per shift).

• Cost savings (staff time saved × wage rate).
  Methods: routine data extraction, short surveys, direct observation, and change-audit.

15. Common barriers and mitigations

• Resistance to change — mitigation: involve champions and early adopters, use credible micro-pilots.

• Procurement blockers — mitigation: involve procurement early, prepare costed business case, offer multiple procurement routes.

• Technical sustainability — mitigation: prefer open standards, low-maintenance stacks, and local hosting agreements.

• Data privacy concerns — mitigation: minimal data collection, anonymization, and clear governance.

16. Practical templates (short & copyable)

Pitch elevator (30 seconds)
Problem — Who — Impact now. Proposed solution — quick benefits (time saved/lives saved). Ask — what you need (pilot fund, procurement waiver, IT support).
Example: “Nurses in ward X spend 45 minutes reconciling medication records each shift, causing delays and errors. A simple interoperable mobile checklist that syncs with the pharmacy log could cut reconciliation time by 60% and reduce missed doses. We need a KES X pilot fund for 3 months and IT help to connect to the pharmacy log.”

Business case skeleton (one page)

1. Problem & evidence

2. Proposed solution (MVP)

3. Outcomes & KPIs

4. Costs (pilot & scale)

5. Procurement & approval path

6. Risk & mitigation

7. Ask

Simple M&E dashboard fields
Date | Facility | Ward | # Shifts using tool | Time per reconciliation (min) | # Discrepancies detected | Notes

17. Illustrative Kenya/Africa case vignettes (not real project names — illustrative only)

• SMS triage for maternal referrals (vignette): A county hospital used an SMS form to standardize referral details from peripheral clinics. Result: faster ambulance dispatch and fewer lost referrals during a 3-month pilot. (Hypothetical vignette to show approach.)

• Nurse medication reconciliation app (vignette): A simple tablet app shortened handover and produced a printable list for pharmacy; adoption grew when ward managers trained peers. (Illustrative only.)

These vignettes are intentionally descriptive examples of how intrapreneurial projects are commonly shaped in Kenya/Africa; they are not claims about specific programmes.

18. Checklist before you pilot (quick)

• Problem statement & KPIs ✔

• Clinical governance approval ✔

• IT & data governance sign-off ✔

• Procurement alignment or pilot exemption ✔

• Budget (pilot) secured ✔

• Training & user guides ready ✔

• Monitoring plan ready ✔

19. What success looks like (practical definition)

• Measurable improvement in at least one clinical or process KPI during pilot.

• Local users endorse the solution and request scale.

• Clear pathway to finance and procurement for scale (budget line, PPP, donor or county adoption).

• Technical handover documents and an identified owner for maintenance.

20. Recommended next steps for a public sector intrapreneur team

1. Pick a single, high-value problem and write the problem statement.

2. Run a 2-week rapid validation (observe, interview, quantify).

3. Convene a co-design session to produce an MVP flow.

4. Run a 4–8 week pilot with clear KPIs.

5. Document results and engage procurement + county/national leadership early if pilot succeeds.

21. Recommended partners & resources (types)

• National eHealth authority / Ministry of Health (policy & interoperability).

• County health management teams (implementation & budgets).

• Local universities or tech hubs (prototyping).

• Development partners (seed funding).

• Procurement/legal units (contracts & scale).

22. References (APA)

(Selected reading to support the approach — core, stable sources and classic works.)

Pinchot, G. (1985). Intrapreneuring: Why you don’t have to leave the corporation to become an entrepreneur. Harper & Row.

Rogers, E. M. (2003). Diffusion of innovations (5th ed.). Free Press.

World Health Organization. (2019). WHO guideline: recommendations on digital interventions for health system strengthening. World Health Organization.

World Health Organization. (2020). Global strategy on digital health 2020–2025. World Health Organization.

Ministry of Health, Kenya. (2017). Kenya National eHealth Strategy 2017–2030. [Policy document].

Kruk, M. E., Gage, A. D., Joseph, N. T., Danaei, G., García-Saisó, S., & Salomon, J. A. (2018). Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries. The Lancet, 392(10160), 2203–2212. https://doi.org/10.1016/S0140-6736(18)31668-4