Five requirements, review criteria and eighteen red flags for every call for proposals that funds a health innovation intended to reach scale. Free to copy, adapt and put into your own instrument.
Take it with you. The whole Standard as a PDF, ready to bring to a design meeting or send to a review panel.
Download the PDF →Licence: CC BY-NC-SA 4.0. Cite, quote and adapt freely for non-commercial use with attribution.
The funding environment that built the last twenty years of global health programming is closing.
The Gates Foundation has announced it will spend down and complete its work on 31 December 2045. Official development assistance is contracting at the same time, and faster than the announcements suggest. Aid from DAC members fell 23.1 per cent in real terms in 2025, the largest annual contraction on record and a second consecutive year of decline. United States assistance fell 56.9 per cent (OECD, preliminary 2025 data, April 2026). Whatever replaces that architecture, it will not be a larger version of it.
This has a consequence that has not yet reached most calls for proposals. Any health programme designed today will outlive the funding environment that starts it. A five-year investment beginning in 2027 will end in a world with materially less external money in it than the world it was designed in.
That turns institutionalisation from good practice into the only exit.
For most of the past two decades a project could close, be judged on its results, and leave the question of what happens next to a sustainability annex written in the final quarter. That option is being withdrawn. The question of who owns the work and who pays for it is moving from the end of the project to the beginning, and into the funding decision itself.
This Standard exists so that the move can be made deliberately, and so that funders, applicants and reviewers work from the same list.
Scaling is now widely understood to be a government function. The 2026 WHO guidance, Scaling innovations in public health systems, is explicit that government’s job is to steward the move from promising pilots to system-wide adoption. It sets out seven government roles and states that to the extent roles go unfilled, the overall impact of the innovation is harmed.
The gap is not in the framework. It is in the funding instrument.
Calls for proposals continue to ask applicants to describe sustainability, and continue to award on the strength of implementation capability. They rarely ask who in government will own the work, whether that person has been spoken to, which budget line will carry the cost, what that line gives up to make room, or when the first fully government-funded year begins.
The result is a programme designed with a seat at the table that nobody is sitting in. That is the vacant seat problem. It is not that government is absent from the documents. It is that government appears as a stakeholder to be engaged rather than as the party that will eventually own, staff and pay for the thing.
The five requirements below fill that seat at the point where it is cheapest to fill: proposal stage.
Funders and programme officers. Insert the five requirements into the call. Each carries a review criterion, so they can be scored rather than admired. The wording is free to copy.
Applicants. Treat the five as design constraints rather than narrative sections. Four of the five are impossible to answer honestly in the final week before submission, which is the point.
Reviewers. Use the red flags. Each names a specific thing a proposal says when a requirement has been decorated rather than met.
Three free instruments support the Standard: a Government Scaling Role Check, a Readiness Check and a Scalability Check for proposals. They are diagnostic, not certification. Nothing here requires anyone’s approval, and nothing here is for sale.
The requirement. The proposal names the government body that will eventually own the intervention, evidences that it participated in designing what is being proposed, and states what changed in the design as a result. That second clause is the requirement. Participation that changes nothing is attendance.
Review criterion. Does the proposal contain dated evidence of government participation in design, and can a reviewer point to a specific design decision that is different because of it? Participation after the design was fixed does not meet the requirement.
Red flags. - A letter of support with no evidence of involvement in the design. - “Consultations will be held with the State Ministry of Health,” in the future tense. - Government named as a beneficiary or stakeholder, but never as a designer.
The requirement. A specific post, held by a specific person, accountable for the innovation inside government, with the seniority to move a budget line, who has read the proposal. And because postings change, the proposal names the instrument that carries the accountability when that person moves. That instrument is a signed terms of reference, a standing committee with the innovation on its agenda, a line in an annual operational plan, or a curriculum a training institution now owns.
Review criterion. Is a post named, is its occupant named, is there evidence they have seen the proposal and accepted the role, and would anything still hold if that person were redeployed tomorrow? A directorate is not a champion, and a champion without an instrument is a relationship.
Red flags. - The champion is an office rather than a person. - The named person is a technical officer without budget authority. - No evidence the person knows they have been named. - The whole accountability rests on one person, with no instrument named.
Individual capacity and goodwill can outperform government systems, which is why a well-connected champion can move things a system cannot. That is also the danger. A programme built on an exceptional post-holder is a programme with the lifespan of their posting. The instrument is what converts a relationship into an institutionalisation.
The requirement. The proposal identifies the government budget line expected to absorb each recurrent cost, states whether that line already exists or must be created, and names the first budget cycle in which it carries the cost. It also states what that line currently funds that will be reduced, deferred or discontinued to make room.
Review criterion. Are there four specifics: a line, a cost, a cycle, and a named trade-off? A stated intention to advocate for a budget line meets the requirement only if it names all four.
Red flags. - “Sustainability will be ensured through government ownership,” with no line named. - A budget line named, with no distinction between approved and released. - A budget line named with no displacement named. - The word “advocacy” doing the work of a plan. - A budget line named with nothing said about protecting it from reallocation.
A budget line approved is not money received. An approved line can be diverted to another sector’s priority. And a funded plan that displaces nothing is not funded either, because a budget line named without a displacement named is an arithmetic answer to a political question.
Evidence from Nigeria in 2026 shows the gap at state level. One state’s programme sat inside an approved health sector plan and an approved annual operational plan, and the gap it ranked first, in its own words, was the “delayed and incomplete budget release by government”.
The federal record shows the same thing at national scale. Appearing before the House of Representatives Committee on Healthcare Services to defend the 2026 budget, the Minister of Health stated that ₦218 billion had been appropriated in 2025 for capital projects at the Ministry headquarters, and that ₦36 million had been released against it. Seventeen thousandths of one per cent. The personnel budget was released in full and fully spent. The reasons given were the bottom-up cash planning system operated by the Office of the Accountant-General of the Federation, and an inability to access certain counterpart funds owing to delays in counterpart contributions.
A ministry that pays every salary and releases one naira in every six thousand of its capital line is not short of money. It is short of a release pathway.
There is one further reason to ask where the money travels. Donor funding routinely reaches an intervention through implementing organisations rather than through government systems, so a programme can be co-designed with government and still build no absorption capacity, because the money never once moves through the machinery that would have to carry it later.
The requirement is therefore about the pathway to release, not about the existence of an allocation.
The requirement. The results framework distinguishes metrics that measure delivery from metrics that measure institutional absorption, and includes at least one of the latter from the first reporting period.
Review criterion. Can a reviewer identify, in the framework as submitted, a measure that would change if government took over more of the work? Coverage and output counts do not qualify.
Red flags. - Every indicator is a count of activity the project itself performs. - Absorption indicators appear only in the final year. - The information system cannot disaggregate the innovation from routine service delivery, so no absorption measure is possible.
The requirement. The workplan contains dated transition milestones in every year of the investment, each with a named owner on the government side.
Review criterion. Does year one contain a transition milestone? Does each milestone name a government owner rather than a project post?
Red flags. - A transition or exit plan scheduled as a deliverable in the final year. - Milestones owned by the implementing partner throughout. - A handover workshop as the transition strategy.
It does not replace a scaling framework. It assumes one.
The requirements rest on the ExpandNet/WHO systematic scale-up framework, which established the analysis this Standard applies to funding instruments. Two propositions carry it. A pilot must be designed for scale from the outset rather than reviewed for it afterwards. And scaling up is an open system of five interacting elements, the innovation, the user organisation, the environment, the resource team and the scaling-up strategy, whose states interact, so that a change in one affects the others. The Standard is written against three of those elements, the ones a funder can see at proposal stage.
The 2026 WHO guidance carries the same analysis into government stewardship. This Standard adds one thing only: the point of application. Frameworks tell designers what to build. A call for proposals decides what gets built.
It is also not a certification. There is no assessor, no register and no fee. A standard nobody can be excluded from is harder to ignore than one that has to be bought.
v1.0, 9 September 2026. First publication. Five requirements, review criteria and eighteen red flags.
Comment, disagreement and field testing are all welcome, and will be reflected in v1.1 with attribution. The instrument improves by being used against real calls for proposals, which is the only test that matters.
Femi Quaitey is a Nigerian public-health scale-up consultant and ExpandNet affiliate. This Standard is his own work, published under his own name. It is not a product of any employer, grantee or funder.
Quaitey, F. (2026). The Vacant Seat Standard v1.0: five requirements every call for proposals should carry. https://femi-quaitey.org/standard.html