Africa is increasingly recognised for its energy, creativity and entrepreneurial momentum, but outsiders often focus on issues of reliable power supply or gaps in logistics, connectivity and capital. The work of entrepreneurs and organisations rebuilding health systems across the continent, however, reveals a different picture - one defined by creativity, speed and a willingness to design solutions that work precisely because they were developed within complex, resource-constrained environments.

In short, Africa’s infrastructure gaps persist, but they are not insurmountable. While these gaps constrain scale and equitable impact, they force clarity, encourage lean testing and enable leapfrogging over legacy models that slow change elsewhere.

For Isabelle Ugochukwu (GEMBA’24), founder of MedTech Solutions (MTS), building in Africa is both a personal commitment and  a desire to help improve digital healthcare infastructure. “Building MTS was never just a business decision,” she explains. “Having been born and raised on the continent, I saw firsthand how many decisions were being made in the dark.” In many health systems, public actors, payers (insurers and other financial entities) and providers operate without reliable, real-time data. “We cannot manage what we cannot see,” she says. “Our mission is to change that.”

The MTS data platform was designed for Africa from the outset. It is built for intermittent connectivity, limited bandwidth and unreliable power. The platform features offline-first functionality, resilience to power outages and data that synchronizes automatically when networks become available. By engineering systems that function reliably with slow data flows and fragmented information, MTS meets the realities of African operating contexts and also delivers a robust, adaptable platform that strengthens digital infrastructure.

Alex Wang (MBA’17J), who leads direct‑to‑consumer telehealth venture, Get Tested, in South Africa, adopted a similar philosophy. “Most solutions are developed for first-world nations and then adapted to retrofit our context,” he says. “We believe that such thinking is flawed.” 

His company spent years seeking integration with major laboratories, but APIs (Application Programming Interfaces) were unavailable or tightly controlled. Instead of waiting, they built workarounds that allowed services to scale immediately. “The trade-off is to move ahead rather than get dragged into multi‑year integrations that amount to very little.”

Rethinking primary care 

Two organisations emblematic of Africa’s healthcare innovation and which are INSEAD partners through the INSEAD Master Strategist Day, Access Afya in Kenya and Unjani Clinics NPC in South Africa are redesigning healthcare from the ground up. They are driving innovative business and operating models for primary healthcare in Africa at scale.

Daphne Ngunjiri, CEO of Access Afya, describes Kenya as “a pivotal and timely opportunity for primary healthcare transformation”. Public health budgets are under pressure, out-of-pocket spending remains high and preventable mortality persists. Yet Ngunjiri sees not only gaps but potential. “Africa may lack legacy systems, but this can be a strategic advantage. We can design from first principles,” she says.

Access Afya integrates bricks-and-mortar clinics, digital infrastructure and community-based delivery into a single, scalable primary healthcare system. Digital tools are usable even in low‑connectivity environments. AI-supported triage is available in local languages. Community health workers conduct screenings at markets, factories and churches, bringing care to where people are.

To operate effectively in Kenya’s complex operating ecosystem, Access Afya adopted a blended finance strategy that aligns capital, payers and delivery at scale. Equity capital supports core operating systems, technology development and overall business growth.  Philanthropic and global health funding underwrites population-level public-health programmes. 

In parallel, Access Afya partners with insurers and other payers to co-design affordable coverage and payment models, enabling access to high-quality primary care with lower premiums and predictable reimbursement.

Unjani Clinics offers a different, but equally innovative and scalable model. Its network of nurse‑led clinics, housed in refurbished shipping containers and located in communities with the greatest need, serves the “missing middle”: employed but uninsured patients with limited access to quality primary care. The model is designed to become financially self-sustaining over time, with clinics that eventually cover their own operating costs.

Building and operating Unjani Clinics has meant adapting to fuel-price shocks, container shortages, electricity blackouts, crime and unreliable water supply. CEO Lynda Toussaint describes responding with practical adjustments: designing modular alternatives when containers became scarce, introducing hybrid solar systems to ensure reliable power, shifting towards card-based payments to reduce crime risks, and equipping each clinic with a back-up 2,500 litre water tank.

Today, Unjani Clinic operates 280 care settings, in collaboration with over 200 nurse‑entrepreneurs, and has delivered more than 7.2 million consultations – all through innovative organisational design that meets both local adaptiveness and scale. Rather than coping with infrastructure gaps, Unjani Clinic has overcome them by building a unique blended for-profit and non-profit primary care platform that is community‑anchored, scalable and sustainable.

Building in a high‑complexity and resource-constrained environment

Although their approaches differ, all the founders interviewed operate in “high‑complexity environments”, under considerable resource constraints and institutional uncertainty:  infrastructure is uneven, regulation takes time to evolve and human resources are stretched. Yet their stories reveal a common thread in how they navigate these challenges.

For Alon Lits (MBA’12D), founder of October Health, a South-African based mental health and well-being technology company,  the starting point is the magnitude of need. “Across Africa, there are fewer than two mental-health professionals per 100,000 people,” he explains. Technology, he argues, can dramatically expand access if built with a mindset that “necessity breeds innovation, and done is better than perfect.”

His experience scaling operations as Director at Uber (Sub-Saharan Africa) taught him how to embed global platforms locally and respond to regulatory uncertainty. At October Health, this translates into tools that enhance, not replace, human expertise. These tools include: AI companions, live audio sessions facilitated by experts, AI coaching, AI dieticians and health-related content. These tools can scale impact to thousands of individuals in a way that is not possible with traditional care.

For all these healthcare entrepreneurs in Africa, trust and the human dimension of infrastructure emerge as critical themes. Ugochukwu notes that “technology alone doesn’t shift systems. Local champions, training and co‑designed workflows are critical to adoption.” Digital innovation in Africa succeeds when communities see clear value and feel ownership over the systems being built.

Perspectives for global leaders

Progress across African healthcare ventures shows that constraint can spark innovation. Offline‑first systems, modular infrastructure and community‑based delivery models – once local solutions – provide lessons for resilient healthcare worldwide. Cross-sector partnerships, NGOs, insurers, governments and communities demonstrate how collaboration can substitute for missing infrastructure and enable coordinated scale.

Local leadership remains key. Systems led by those closest to the challenges, from nurse‑entrepreneurs to clinicians, are inherently more effective. Solutions designed for resilience under power outages, regulatory shifts or connectivity gaps are naturally adaptable to complex, global health contexts.

Although these ventures are rooted in African contexts, their strategic insights extend globally. As Ugochukwu notes, if you can design interoperable, data‑driven solutions that work within Africa’s multi-layered complexity, “you’re ultimately building models that can inform global health, not just African health.”