By the Health Innovation Exchange

For more than a decade, femtech’s scale gap has been treated as a funding problem.  What if that diagnosis is incomplete?

Despite growing attention, women founders still receive just 2 per cent of global venture funding, and years of advocacy have failed to shift the needle.

This persistence is no longer just a concern; it signals a deeper structural failure.

This is not just a funding gap.  It is a system failure.

As Pradeep Kakkitill, founder and CEO of the Health Innovation Exchange (HIEx), argues, the sector continues to operate on a flawed assumption.

The belief that better support to founders alone will unlock scale overlooks the deeper structural constraints that determine whether the innovation is adopted at all.

Barriers That Go Beyond Capital

These insights are not theoretical. Global research reinforces that these challenges are not isolated, highlighting structural, financial and systemic barriers that shape how women-led and under-represented ventures access funding, markets and pathways to scale.

Importantly, these findings are not draw from research alone, but from the lived experiences of women and under-represented founders themselves.

Across HIEx-led interviews and focus group discussions conducted as part of the Reckitt Catalyst Programme, founders repeatedly described the same challenges:  fragmented financing, unclear adoption pathways, repeated cycles of proof, and systems that lacked clear routes from validation to procurement and scale.

These experiences suggest that the  barriers facing women-led innovation are not simply financial.  They are structural.

Many high-potential ventures are not failing because funding is absent.

They are failing because the systems that determine scale, including public procurement, regulation and financing, are not built to move proven solutions beyond pilots into widespread adoption.

This is not a founder problem. It is a system design failure.

Beneath these structural constraints sits a more persistent challenge.  Entrenched attitudes shaped by unconscious bias continue to influence decision making.

Across investment and public-sector systems, innovation led by women and underrepresented founders is still frequently perceived as higher risk.

These perceptions shape how opportunities are evaluated, increase the burden of proof placed on founders, and slow decision making.   In practice, this results in systematically higher barriers to both funding and adoption.

Systems Unable to Absorb Innovation

Dr. Abas Hassen, lead executive officer for health innovation and quality at Ethiopia’s Ministry of Health, underscores this point.

The primary constraints are not about innovation quality, but about the systems that determine adoption and scale, including procurement, regulation, financing and delivery.

He identifies three persistent challenges:  institutional resistance to change, “pilot purgatory” where solutions are repeatedly tested but not integrated into public systems, and a disconnect between what external funders support and what governments can sustain.

Ethiopia’s response reflects a broader shift.  Innovation is no longer treated as isolated pilots, but as a structured component of system design.

The country’s system-led innovation model combines regulatory pathways, prioritisation frameworks and structured testing environments to embed innovation directly within the health system.

The implication is clear.

Scaling innovation is not only about accelerating individual ventures alone.  It is about strengthening the systems that determine whether innovation is adopted at scale.

The Missing Middle:  From Pilot to Procurement

In many low- and middle-income countries, public systems remain the largest market for health and WASH solutions, accounting for the majority of service delivery and procurement.

Yet capital is deployed through models that do not reflect this reality, as scaling depends on public-sector adoption, long procurement cycles and regulatory integration rather than rapid returns.

This creates a misalignment within the financial ecosystem, where capital is structured for faster high returns, while impact depends on long-term system integration.

At its core, the challenge is the absence of clear adoption pathways.

Without structured routes from validation to procurement and system-wide use, even effective solutions struggle to move beyond pilots.

This is the “missing middle”, the gap between early validation and large-scale adoption.

The consequences of this “missing middle” are perhaps best illustrated by the founders trying to navigate it.

Temie Giwa-Tubosun, founder and CEO of LifeBank, describes her decade-old company as an “orphan” within existing financial structures, too commercial for impact investors and too impact driven for venture capital.

Businesses operating within health systems often fall between funding models that were not designed for them.

Thato Schermer, co-founder of Zoie Health, describes a similar challenge.

Even companies with strong revenue and clear demand struggle to secure funding at the right stage, as they are assessed through frameworks that do not reflect the healthcare markets.

Across interviews and focus group discussions, these patterns were consistent.

Founders described fragmented financing, unclear adoption pathways, and repeated cycles of proof, where they are asked to keep proving their solutions without a clear route to scale.

These are not isolated challenges.  They reflect how innovation is funded, evaluated and integrated across the system.

The barrier to scale is not a lack of viable solutions.  It is about the systems and models that are not designed to support them.

Reducing Risk Through System Design

From an HIEx perspective, a different approach is emerging, one that focuses not on fixing founders, but on designing how systems manage risk and adopt innovation.

Rather than avoiding risk, Ethiopia is working to manage it through structured processes.

The system is “risk-aware, not risk-averse.”  It uses innovation sandboxes, structured testing environments within public systems that allow new solutions to be evaluated under controlled conditions.

These mechanisms, generate decision-grade evidence while limiting system-wide exposure, creating clearer pathways from validation to adoption.

When innovations are tested within public systems, they gain institutional legitimacy.  This reduces perceived risk for both governments and investors and enables more confident decision making.

From Fragmentation to Coordination

Within this context, initiatives such as Reckitt Catalyst, a multi-partner platform supporting women-led health and WASH innovation to scale, play a critical bridging role.

By connecting entrepreneurs with governments, investors and technical partners, and aligning solutions with national priorities, the programme helps to create clearer pathways from pilot to procurement and scale.

But alignment alone is not enough.

As Pradeep Kakkattil notes, the climate movement offers a useful parallel.  Climate progress was not driven by evidence alone. It accelerated when investors, governments, and institutions began treating inaction as the greater risk.

Sustained pressure exposed the cost of doing nothing, redefined how risk was assessed and ultimately reshaped capital allocation and policy decisions.

Women’s health and WASH innovation is now at a similar inflection point.

Despite years of evidence and advocacy, outcomes such as women receiving a fraction of global funding persist.

This is not due to a lack of solutions. It is because the systems governing investment, adoption and scale have not been sufficiently challenged.

What is required is not incremental progress.

It is a shift in what the system tolerates – how risk is defined, how capital is allocated, and how accountability is enforced.

A System at an Inflection Point

The implications are clear.

Investors must move beyond rigid funding models and deploy capital aligned to how health systems scale.  Governments must build clearer pathways for testing, procurement and adoption.

Ecosystem actors must shift from supporting individual ventures, to enabling system-level integration.

The persistent funding gap is not a result of slow progress; it reflects a system operating exactly as designed. Incremental change will not shift outcomes.

What is required is a fundamental reset of how femtech is financed and scaled:  from passive investment to active market-shaping, where capital, policy, and procurement work together to create real pathways to adoption.

Until that shift happens, the sector will continue to produce innovation that the market is not structured to absorb.

The Women’s Health Innovation Summit (WHIS) has announced that submissions are  open for the 2026 Innovation Showcase, giving early and growth-stage start-ups the  chance to present their solutions to the most influential audience in women’s health.

Taking place October 13–15 at Encore Boston Harbor in Everett, Massachusetts, WHIS  brings together more than 1,000 decision-makers from across the women’s health  ecosystem — investors, payers, health systems, pharma leaders, and employers — all  under one roof.

Selected companies will pitch live on stage to an audience with the funding, expertise,  and connections to accelerate their growth.

Past participants have walked away with  investor introductions, commercial partnerships, and clinical collaborations that  moved from conversation to contract.

WHIS is where the women’s health ecosystem comes together to get deals done,” said Sarah Rowlands, marketing director.

“The Innovation Showcase puts promising start ups directly in front of the people who can take them to the next level.”

The showcase sits at the heart of a three-day programme spanning digital health,  therapeutics, diagnostics, and consumer health.

Previous attendees have included  representatives from Mayo Clinic, CVS Health, Eli Lilly, Brigham and Women’s Hospital,  Alumni Ventures, Muse Capital, and Maverick Ventures, among hundreds of others.

Applications are open now. Start-ups can submit at

www.whisusa.com/attend/start-ups

About WHIS

Now in its eighth year, the Women’s Health Innovation Summit is the largest global  gathering of senior leaders shaping the future of women’s health.

Organised by Kisaco  Research, WHIS unites providers, health plans, employers, regulators, pharma,  investors, and innovators to increase deal flow, expand reimbursement, improve  access, and deliver better health outcomes for women at every stage of life.

WHIS 2026 takes place October 13–15 at Encore Boston Harbor, Everett, MA.

Learn more at www.whisusa.com