Transforming menstrual health from an overlooked issue into a national priority. Enabling 6.5 million health transactions for underserved communities. Newborn care practices that existed in policy for decades finally becoming routine in public hospitals.

These are the results of four organisations – Be Girl, Karma Healthcare, Community Empowerment Lab, and Healthy Entrepreneurs – that have achieved a level of impact that many aspire to.

Developed through a partnership between Spring Impact and GrandChallengesCanada, this case study series captures their scale breakthroughs and examines the strategic choices that made them possible.

Across different contexts and geographies, key lessons emerged:

• Engaging the right layer of government is critical. Organisations succeeded by focusing on the part of government that controls delivery infrastructure, not the one that sets policy.
• The most important evidence is that which answers the questions your next adopter is asking, rather than those of your current funders. When scaling with government, focus on generating implementation research for governments rather than abstract impact data.
• Every new thing you ask the system to build is a reason not to adopt. The most durable and scalable models shrink their own role over time, embedding into existing infrastructure, and not running alongside them.
• Adoption has to be the rational choice for the actors carrying the solution forward. Nobody adopts a solution just because it’s technically strong. They adopt one that reduces risk, and aligns with existing incentives.
• Affordability must be solved by the business model design. Financial sustainability in lower-income markets does not come from applying a standard commercial approach and hoping volume will compensate for low ability to pay.

These stories show what becomes possible when organisations start with scale in mind and are supported by patient, flexible funding that allows them to adapt, absorb risk, and align with how systems actually function.