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Unlock Aid Solutions: Health Innovator Intake

What is the name of your organization?

What is the name of the person filling out this form?

What is a good email address to contact you?

If you have previously filled out our initial Solutions Index intake form, would you like us:

If you have previously filled out our initial Solutions Index intake form, would you like us:
A
B
C
Organizational Data

1. Are you a nonprofit, for profit, or something else?

1. Are you a nonprofit, for profit, or something else?
A
B
C

2. Please select all countries where you presently operate (as of December 2025):

2. Please select all countries where you presently operate (as of December 2025):

3. Please select all countries where you could potentially operate within 12 months from today (with sufficient resources):

3. Please select all countries where you could potentially operate within 12 months from today (with sufficient resources):

4. Please check which category best describes your primary business activity (we understand organizations may perform more than one function, please select which category best describes your primary business category):

4. Please check which category best describes your primary business activity (we understand organizations may perform more than one function, please select which category best describes your primary business category):

5. What does your organization do? (Note: If selected for inclusion in the Solutions Index, we will use this text to describe you. Maximum 300 characters, approx. 50 words)

Organizational Alignment with Health Goals

6. What is your strategy for reaching your intended users or population segments? (Please list 3-4 bullets, Maximum 300 characters, approx. 50 words)

7. Impact assessment: What are your 1-2 key metrics? How do you collect data and/or monitor your impact? (Please list 3-4 bullets, Maximum 300 characters, approx. 50 words)

8. Are there credible indicators that your approach can achieve these sustained results at scale? (Maximum 300 characters, approx. 50 words)

9. What evidence do you have of your innovation's effectiveness? (Check all that apply)

9. What evidence do you have of your innovation's effectiveness? (Check all that apply)

10. How is your approach innovative or technology-enabled in a way that enhances efficiency and/or reach? (Maximum 300 characters, approx. 50 words)

Organizational Maturity

11. Please describe your organization’s team leadership and their relevant experience leading sustainable businesses/organizations in low- and middle-income settings. (Please list 3-4 bullets, Maximum 300 characters, approx. 50 words)

12. For any specific innovation or solution you sell/build (e.g. software, hardware, product), do you hold the intellectual property and/or licenses/rights to operate?

12. For any specific innovation or solution you sell/build (e.g. software, hardware, product), do you hold the intellectual property and/or licenses/rights to operate?
A
B
C

13. What systems, processes, and partnerships do you have that would enable you to scale to additional geographies/use cases within 2–3 years? (Please list 3-4 bullets, Maximum 300 characters, approx. 50 words)

14. Please indicate your approximate total budget in 2024?

14. Please indicate your approximate total budget in 2024?
A
B
C
D
E
F
Business Model Financial Sustainability

15. Who are your top 3 funders/investors right now? Would receiving additional funds unlock any other investment? (Maximum 300 characters, approx. 50 words)

16. How does your unit cost change at scale? If your solution has historically relied in part or in full on donor or philanthropic funding, in what way can a donor provide one-time catalytic funding to make your solution more accessible to country governments or local markets (e.g. up-front investments enable you to bring down costs over time, expand access to new markets that can sustain solution, etc.)? (Maximum 300 characters, approx. 50 words)

17. If your solution can be sustained over the long-term from non-donor sources of revenue, please explain how. For example, you may operate a direct-to-consumer business model, have partnerships with local commercial partners, or may be included within national/local health budgets. (Maximum 300 characters, approx. 50 words)

18. What are your primary sources of revenue (check all that apply)?

18. What are your primary sources of revenue (check all that apply)?

19. Approximately what percentage of your budget comes from earned revenue or contracts with local governments/markets (versus philanthropic grants/donations/donor funding)?

Local Endorsement / Local Buy-In

20. What local and/or commercial partnerships do you currently have in place? For example, please explain any credible distribution or scaling partnership that are ready to go with a commitment from a ministry of health, memoranda of understanding with local actors, large company that wants to partner, a local distributor with regional reach, etc.
(Maximum 300 characters, approx. 50 words)

21. To what extent is your model aligned, or included in national or regional health frameworks? Please explain or write N/A if not applicable. (Maximum 300 characters, approx. 50 words)

Population Safety

22. If you are developing or distributing a product, what regulatory clearance do you have? If you are pre-market what is your regulatory pathway and strategy? Please explain or write N/A if not applicable. (Maximum 300 characters, approx. 50 words)

23. Does your organization have the following? (Check all that apply)

23. Does your organization have the following? (Check all that apply)