Across Africa, a new wave of health tech startups is targeting one of the continent’s most persistent challenges: access to safe, adequate, and timely blood. From donor apps and delivery drones to digital inventory platforms, innovation is on the rise.

But most of these solutions never make it past the pilot phase. A few, like Zipline (Rwanda) [1] or Damu Sasa (Kenya) [2], achieve regional or national scale, the rest either slow down, lose momentum, or continue operating with limited alignment to national priorities, like Djooli(Mali), Swift Lab(Kenya) and Redbird(Ghana). The reasons are rarely about the technology itself, but about the systems in place.

Not a Startup Problem, a Systems Problem

The failure of blood tech startups is not rooted in a lack of innovation, but in the complex, underdeveloped systems within which they attempt to operate [3]. Blood, as a public good, is regulated, politically sensitive, and deeply embedded in government-run infrastructure, yet many innovators approach it as if it were part of a fast-moving, consumer-driven tech ecosystem. This fundamental mismatch between how blood systems function and how tech solutions are designed virtually guarantees failure. These challenges are not unique to one country or context; they appear consistently across the continent and point to a single, undeniable truth: Without integration into public systems, even the most promising innovations will never achieve scale.

The Common Pitfalls of Blood Tech Innovation

1. Lack of integration with National Health Systems

Many blood tech platforms are built in isolation, without connections to national blood transfusion services or Ministry of Health systems. Djooli launched in Mali with the aim of digitizing blood donation and supply coordination, supported by public awareness campaigns and partnerships with local facilities [4]. However, like many digital health pilots across Africa, its long-term integration into national blood systems has not been widely documented. This reflects a broader trend where promising innovations face challenges aligning with public health infrastructure, regulatory frameworks, and procurement systems

In contrast, Damu Sasa in Kenya has worked closely with government stakeholders from inception. It aligned with national reporting protocols, piloted in major public hospitals, and embedded itself into the blood supply chain [5].

Without formal integration, even the most promising tech ends up on the sidelines lacking legitimacy, funding, and staying power.

2. Weak or fragmented regulatory environments

Digital blood tools must navigate health, aviation, and ICT regulations. Most countries lack clear policies for how these tools should be evaluated, approved, or procured.

Swift Lab, a Kenyan startup using drones for blood delivery, was blocked by unclear aviation and health sector rules. It was unable to scale because it could not operate legally [6].

Meanwhile, Zipline succeeded in Rwanda by securing cross-sectoral government support and embedding itself into public logistics systems [7].

Without regulatory clarity and public sector backing, startups are left navigating grey zones until they run out of funding.

3. Mismatch between tech and on-ground capacity

Startups often assume hospitals are ready for digital tools. But many African facilities still use paper logs, phone calls, and manual stock tracking. Platforms designed for high-connectivity environments or automated processes do not land well in these contexts.

Redbird in Ghana, while focused more on diagnostics, struggled to expand beyond urban centres for this reason [8]. In the blood space, many platforms have failed because they ignored frontline conditions. No internet, no trained staff, no cold chain.

When tech adds complexity without solving immediate problems, it gets sidelined quickly.

4. Weak adoption incentives at facility level

Even when digital tools are technically sound, hospitals may still resist adopting them, often due to a combination of operational burdens and systemic mistrust. Common barriers include:

• Initially, extra work without compensation
• No technical support or training
• Tools do not improve reporting or supply reliability
• Mistrust of data-sharing with third parties

These challenges were especially evident with blood donor-matching applications in Uganda and Zambia, where hospital participation never materialized due to a lack of clear value to the hospital and therefore the apps missed institutional support from the hospitals. In contrast, Damu Sasa was able to succeed because it intentionally made hospital workflows more efficient, not more complicated, and provided comprehensive user training and ongoing support from the beginning [9]. Without tangible benefits and seamless integration into routine operations, digital tools no matter how well-designed, struggle to gain traction at the facility level.

5. Unsustainable business models

Many startups are built on “innovator” and incubation grants, prizes, or venture capital, expecting fast growth or mass-market returns. But blood systems do not work like consumer markets. They are publicly managed, slow to procure, and governed by complex rules.

To survive, blood tech platforms need sustainable pathways into government procurement systems, donor-backed programs, or Public-Private Partnerships (PPPs), not just innovation funding.

6. No access to real-time blood inventory data

Real-time data on blood stocks, usage, and demand is the backbone of any effective blood tech solution. But in most countries, that data is fragmented, paper-based, or restricted.

Startups that do not have official data access often build parallel systems which are either incomplete or ignored by hospitals. That is why many apps never move beyond pilot status.

Damu Sasa stands out because it could access official stock data and feed it back into hospital systems in real time. That level of integration is rare, but essential [2].

Shifting the System: What It Takes to Scale Blood Tech

If blood tech is to move beyond isolated pilots and become a reliable part of Africa’s health infrastructure, the approach must shift from standalone innovation to systemic integration. The failure of promising platforms is not a reflection of weak ideas, but of the lack of enabling conditions that allow those ideas to thrive within public systems. Scaling blood tech requires coordinated action from governments, donors, innovators, and implementers alike.

The following shifts are essential:

1. Governments to lead with clear policy frameworks

To enable sustainable scale, Ministries of Health and National Blood Services must lead with comprehensive policy frameworks that support the integration of digital health and blood systems. These frameworks should include:

• Regulatory pathways for evaluating digital tools

• Clear procurement guidelines for platforms and logistics services
• Integration of private tools into public data systems
• Digital blood strategies that align with broader health policies

Where strong leadership exists, like Rwanda’s partnership with Zipline-innovation is empowered with the structure and support it needs to thrive. In its absence, even the most promising solutions often fail to take root.

2. Innovation must align with public health realities

Startups must stop building parallel platforms and instead focus on developing tools that are grounded in the realities of African health systems and designed for long-term integration. These tools must:

• Strengthen existing workflows

• Function in low-resource, low-connectivity settings
• Use open data standards
• Plug into procurement and distribution systems

Achieving this requires more than a good design. It demands genuine co-development with health workers, facility managers, and public officials-those who understand the system from the inside out and are responsible for making it work every day. Building in a tech lab, detached from these actors, guarantees irrelevance.

3. Donors must fund infrastructure, not just apps

Many funding calls continue to prioritize digital solutions in isolation, without accounting for the foundational infrastructure and systems integration required to ensure those tools are usable and sustainable. To create real impact, donors should consider supporting:

• National blood inventory digitization
• Health worker training in digital tools
• Long-term infrastructure to host and manage platforms
• Integration of private platforms into public data systems

Digital applications alone cannot transform health systems; it is the underlying infrastructure that enables them to function at scale.

4. Public–Private Partnerships must be structured for scale

Startups cannot serve public health systems alone. Ministries must create clear PPP pathways that include:

• Procurement frameworks for digital services
• Shared and transparent funding models
• Defined performance and accountability metrics
• Long-term MoUs to guide implementation

The success of Zipline and Damu Sasa was not solely due to the strength of their technology, but because governments actively created the conditions for them to scale through formal partnerships and system integration. In contrast, where such partnerships are absent, startups often remain stuck in the “pilot trap”-perpetually testing without ever achieving national adoption or long-term sustainability.

It is Time to Build the System for Blood Tech to Thrive

Innovation thrives across Africa, but the systems required to support and sustain it at scale are often underdeveloped. For blood tech to move beyond pilots and deliver lasting impact, it must be treated as essential public infrastructure, not as a peripheral add-on. That means engaging regulators, aligning with national health strategies, integrating into clinical workflows, and designing for long-term resilience over short-term wins.

The way forward demands collective action. Governments must lead with enabling policies and procurement frameworks. Donors must invest in infrastructure, not just innovation. Startups must design for the realities of public health systems. And all actors must work together to shift from fragmentation to integration.

If we want blood tech to scale in Africa, we must stop working around the system and start building it.

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