Table 4 Enablers and barriers

Stage 1: Idea development & implementation

A facilitator overseeing the process—guidance, bricolage, linkages with the system [73]

External support—A social innovation process facilitated by professionals would be costly at scale [73]

A protective niche/environment—a safe setting for ideas to be developed and granting participants permission

Open information sharing between participants and stakeholders across different sectors and disciplines, including involving community or frontline voices [61, 71, 73]

Timing/Leveraging windows of opportunity—when resources and support is available. [70]

Context—history of innovation and enterprise in a specific people group, alignment with cultural values, existing organizations, active civic participation [80, 86]

Political context—a changing policy landscape and mandates [88]

Characteristics of the innovator—an insider (from local community, embedded and lived experience), access to different forms of capital (cultural, intellectual, political, social, financial) [65, 80]

Characteristics of implementers—lacking motivation and drive [88]

Community ownership—self-governance structures to place the community (beneficiaries) in charge of the innovation [64, 65]

Stage 2: Transfer/diffusion/scale

Alignment with existing regime and structures [74, 77]

Political culture—A lack of willingness of the existing system or government to make allowance for the integration of the innovation or for new actors to play a role [69, 70]

Partnerships with stakeholders & especially policy makers [65, 74]

Resource constraints—limitations in funding [65]

Digital formats e.g. applications, mobile phones, online networks [64, 66, 79]

Limited evidence on social innovation effectiveness and unintended consequences [83, 85]

Stage 3: Institutionalisation

Political context—encouraging civic engagement and participatory democracy through discussion and deliberation between civil society and state; history of community organizing and social movements; political capacity of government to bring about changes in healthcare [86]

Communication and advocacy—movement building by engaging a range of organizations to engage in the discussion/spread the message [77, 86]

Leveraging available infrastructure and competencies ( in contrast to creating new ones)—health facilities, health providers including traditional providers [77, 82, 86]

Political work—engaging existing institutions e.g., professional associations and forming new ones [77]

Educating work—developing training for new actors to become involved (medical professionals or volunteers) [77, 86]

Policing work—through certification of certain actors, quality is enforced and monitored [77]