Government as Your First Customer: Building Public-Private Partnerships That Actually Work

Hamza Asumah, MD, MBA, MPH

The mathematics of African healthcare are unforgiving: governments control 70-90% of health systems across East Africa. For healthtech founders dreaming of scale, this isn’t just a statistic—it’s your reality. You can build the most elegant digital health platform or revolutionary diagnostic tool, but without government partnership, you’re fighting for scraps in the remaining 10-30% of the market.

Yet somewhere between that first promising meeting with a Ministry of Health official and actually seeing a purchase order, most founders lose hope. The sales cycle stretches from months to years. Procurement processes feel deliberately opaque. Budget cycles seem designed to crush startup runway. And then there’s the ultimate frustration: watching your solution work brilliantly in pilots, only to see it languish without the political will to scale.

But some companies crack the code. Maisha Meds, for instance, partnered with three Kenyan county governments to strengthen medical supply chains. They didn’t stumble into these partnerships—they engineered them through strategic patience, relentless evidence generation, and deep understanding of how government actually works.

Understanding the Government Customer

Government isn’t monolithic. The permanent secretary thinking about health system transformation has different priorities than the procurement officer worried about audit compliance, who has entirely different concerns than the county health director managing daily emergencies with insufficient resources.

Your first task is mapping the ecosystem. In Kenya’s devolved system, county governments control health budgets ranging from $8 million to $45 million annually. Tanzania’s regional medical officers manage facility networks serving hundreds of thousands. Uganda’s district health officers juggle HIV programs, maternal health initiatives, and chronic disease management—often with fewer resources than a small startup burns through in a quarter.

Each of these officials faces immense pressure. They answer to politicians who face voters, national ministries demanding reports, and communities desperate for services. They’ve seen countless “innovative solutions” pitched by enthusiastic entrepreneurs who disappear when implementation gets difficult. They’ve attended workshops promising transformation that delivered only PowerPoint decks.

Your challenge is proving you’re different. Not through slides, but through evidence.

The Evidence Imperative

When Maisha Meds approached county governments, they didn’t lead with technology. They led with stockout data. They demonstrated that 30-40% of health facilities experienced essential medicine shortages at any given time, costing governments millions in wasted clinical capacity and emergency procurement.

Then they showed how their system reduced stockouts by 65% in pilot facilities, generated real-time inventory visibility, and actually saved money through better forecasting. The technology was almost incidental—the value proposition was undeniable.

Build your evidence engine from day one. If you’re piloting in five facilities, instrument everything. Track clinical outcomes, operational efficiency, cost savings, staff satisfaction, and patient experience. Compare your intervention facilities against matched controls. Calculate return on investment in terms government officials actually use: cost per patient served, reduction in referrals, improvement in quality indicators.

Budget $15,000 to $30,000 for proper monitoring and evaluation, even at pilot stage. This might feel extravagant when you’re operating on accelerator funding, but it’s the cheapest business development investment you’ll make. A rigorous evaluation report is worth more than a hundred pitch meetings.

Partner with local universities or research institutions. A study co-authored with Makerere University or the University of Nairobi carries weight that your internal data never will. Budget $8,000 to $20,000 for academic partnerships that include publication potential. When your pilot results appear in African Health Sciences or BMJ Global Health, you’re no longer a vendor—you’re a validated intervention.

Navigating Procurement: The Long Game

Government procurement isn’t broken—it’s designed for different priorities than startup speed. It prioritizes fairness, transparency, audit compliance, and political accountability. Understanding this reframes frustration into strategy.

The typical government health procurement follows this timeline:

Months 1-3: Budget Planning Season This is when next year’s budgets are drafted. If your solution isn’t in the budget, it won’t get procured—period. In Kenya, county budget preparation runs from January to March. Miss this window, and you’re waiting another year.

Your move: Get your solution into county integrated development plans (CIDPs) and annual work plans during this window. This requires relationships built months earlier.

Months 4-6: Budget Approval County assemblies or parliaments review and approve budgets. Your allies in the health department are now defending their entire budget against competing priorities: roads, education, agriculture.

Your move: Provide ammunition. Brief notes showing health impact per dollar spent, comparisons to alternative interventions, and alignment with national health strategies give your champions data to fight with.

Months 7-9: Procurement Initiation This is when tender notices appear. By now, the specific budget line exists and specifications are drafted. If you’re seeing the tender notice for the first time, you’re already too late—specifications were likely written with incumbent providers in mind.

Your move: Years earlier, you’ve been capacity building. You’ve trained government staff on your system. You’ve provided technical input on what good specifications look like. When the tender emerges, your solution is the obvious fit because you’ve shaped the requirement.

Months 10-12: Evaluation and Award Technical and financial evaluation, approval committees, final sign-offs. This phase is largely out of your hands.

Months 13-15: Contract Negotiation Yes, negotiation starts this far in. Government legal departments review every clause. Procurement oversight boards scrutinize politically sensitive contracts.

Months 16-18: First Payment If you’re lucky. Many governments run payment arrears. Your contract might be worth $200,000, but cash flow looks nothing like that number suggests.

This 18-month cycle is why most startups fail at government sales. Your six-month runway meets reality at month three, when you realize the procurement hasn’t started. Your Series A metrics require revenue by month twelve, but the contract isn’t signed until month fifteen.

Financial Survival Strategies

Successful government partnerships require financial engineering:

1. Anchor with Grant Funding Foundations and development agencies love supporting government partnerships. A $150,000 grant from Grand Challenges Canada or USAID Development Innovation Ventures can fund your first government partnership, proving the model before government budgets kick in.

Structure it correctly: the grant covers implementation costs while government provides in-kind support (staff time, facility access, data). After twelve months of proven results, transition to government funding. You’ve de-risked the partnership and built champions who’ll fight for budget allocation.

2. Accept Long Payment Terms Government payment terms run 60 to 90 days—officially. Realistically, expect 90 to 180 days. Budget for this. If your monthly burn rate is $25,000 and you’re booking $200,000 in government contracts, you still need $75,000 to $150,000 in working capital to bridge payment delays.

Invoice immediately upon milestone completion. Follow up religiously. Understand the payment process: invoices route through program managers, then finance, then county treasuries or national payment systems. Each stage can add weeks. Having contacts at each level helps you identify blockages.

3. Diversify Revenue Streams Pure government dependence is dangerous. Smart operators build hybrid models:

• Core government partnership for primary healthcare facilities (your volume play)
• Private facility contracts for immediate cash flow (paying 30-day terms)
• Development partner projects for innovation funding (supporting new product development)
• Training and capacity building for professional services revenue (high margin, quick payment)

Aim for government revenue comprising 40-60% of total by year three, never 100%.

Building Political Intelligence

Government partnerships succeed or fail based on relationships—not in the transactional sense, but in genuinely understanding and supporting government priorities.

Invest in political intelligence. Who are the rising stars in the Ministry of Health? Which county health directors are innovators versus caretakers? Who’s positioning for the next cabinet reshuffle? This isn’t gossip—it’s essential market intelligence.

Attend every conference, workshop, and technical working group. The $150 registration fee for the East African Health Summit is negligible compared to the relationship value. When you’re sitting in working groups on supply chain strengthening or digital health standards, you’re building credibility and understanding priorities before they become procurement requirements.

Join industry associations. The Kenya Healthcare Federation, Healthcare Federation of Nigeria, or similar bodies provide collective advocacy and insider knowledge. Membership typically costs $500 to $2,000 annually—cheap insurance.

Secondments build deep relationships. Offer to place your technical staff in government offices for three to six months. Yes, you’re essentially donating $15,000 to $30,000 in salary costs, but the knowledge transfer and relationship building is invaluable. Your staff member returns understanding how government actually operates, and government officials see you as partners, not vendors.

Contract Templates and Negotiation Points

When you finally reach contract negotiation, be prepared. Government contracts contain provisions that can kill startups:

Dangerous Clauses to Negotiate:

Unlimited Liability: Many government templates include unlimited liability for system failures. This is existential risk for a startup. Negotiate caps at contract value or obtain appropriate insurance (expect $5,000 to $15,000 annually for $1 million in coverage).

IP Ownership: Some contracts claim government owns all intellectual property developed during the contract. This destroys your business model if your core platform is involved. Negotiate background IP (what you brought) versus foreground IP (what’s developed), ensuring you retain ownership of core systems.

Performance Guarantees: 100% uptime guarantees are impossible. Negotiate realistic SLAs (99.5% uptime is achievable; 99.9% requires infrastructure investment that’s unjustifiable at early stage). Define force majeure clearly—internet outages beyond your control shouldn’t trigger penalties.

Payment Terms: Push for milestone-based payments rather than completion-based. For a twelve-month implementation, structure payments: 30% upon contract signing, 40% at six-month milestone, 30% upon completion. This aligns incentives and maintains cash flow.

Change Order Process: Governments frequently request scope changes mid-contract. Ensure the contract includes clear change order processes with associated timeline and budget adjustments. Without this, you’re funding scope creep from your margin.

The Trust-Building Marathon

Ultimately, government partnerships are trust-building exercises stretched over years. You’re asking cash-strapped ministries to bet scarce resources on your unproven solution. You’re asking career civil servants to champion something that might fail publicly, damaging their reputations.

Earn that trust through radical transparency. When things break—and they will—own it immediately. When promised timelines slip, communicate early. When results underperform expectations, present data honestly and propose solutions.

Share knowledge generously. Publish your learnings. Present at government forums. Train government staff beyond contractual obligations. When you’re known as the team that strengthens government capacity rather than extracting profit, doors open.

Celebrate government wins publicly. When a county health director presents your joint results at a national forum, ensure they receive full credit. When a procurement officer navigates complex approval processes to get your contract through, acknowledge their skill. Government officials rarely receive recognition—your genuine appreciation builds loyalty.

Think in election cycles and political timelines. New governments often review existing contracts. Transitions create vulnerability but also opportunity. By maintaining relationships across political divides and focusing on technical results rather than political patronage, you position yourself as the safe, proven option regardless of who’s in power.

The Patience Paradox

The cruel irony is that government partnerships require patience precisely when startups have none. You’re burning through runway while waiting for budget cycles. Your investors expect growth while you’re capacity building. Your team wants to move fast while government processes move slowly.

But there’s no alternative route to scale. The private market in most African countries simply isn’t large enough to sustain significant health enterprises. Those 70-90% government-controlled health systems aren’t changing. The only path to impact at scale runs through government.

The companies that succeed are those that internalize this reality early, build their financial models around it, and play the long game strategically. They secure grant funding to survive the first partnership. They build evidence obsessively. They invest in relationships before needing them. They structure contracts carefully. They deliver excellence consistently.

And eventually—sometimes after three years, sometimes after five—they reach the promised land. They’re in the government budget. They’re specified in procurement requirements. They’re the proven solution that new counties want to replicate. They’ve transitioned from vendor to partner to essential infrastructure.

That’s when government partnership transforms from painful necessity to competitive moat. Because now all those barriers that frustrated you—the slow procurement cycles, the relationship requirements, the evidence demands—they’re keeping competitors out. Your patience has become your defensibility. The government isn’t just your customer. Done right, it becomes your distribution channel, your validation engine, and your path to sustainable scale in African healthcare.