How many promising digital health pilots have you seen celebrated at conferences for addressing mental health, only to disappear into the graveyard of good intentions? The sector’s obsession with perfect pilots is killing scalable solutions.
The real challenge isn’t proving your intervention works. It is designing something the government can actually operationalize within existing budget constraints and administrative capacity.
That is what Wysa found when looking at how to scale mental health systems with the Government of India. As they shared in a recent webinar, the Tele MANAS mental health system in India receives 3,500 calls per day, because the government designed it differently from day one.
The Pilot Trap Is Real
Every district wants its own unique mental health intervention. Every state demands context-specific customization. While this sounds reasonable, too many organizations get trapped in an endless cycle of bespoke pilots that never translate to sustainable programs.
The District Mental Health Programme (DMHP) now covers more than 90% of India’s revenue districts, but integration with digital solutions remains fragmented precisely because implementers keep designing for perfection rather than procurement.
The truth is more complex than most development practitioners want to admit. Government systems aren’t broken. They’re optimized for different outcomes than startup-style innovation. Understanding this fundamental mismatch is where real scaling begins.
Five Ways to Move Pilots to Programs
1. Design for Procurement From Day One
The most successful digital health implementations started by understanding procurement realities, not user needs. This sounds backwards until you realize that India’s digital health market is expected to reach $47.8 billion by 2033, but procurement processes remain the primary bottleneck.
Smart implementers reverse-engineer their solutions from existing budget lines. Can your intervention fit within National Health Mission allocations? Does it align with Ayushman Bharat Digital Mission infrastructure? If you’re creating parallel systems that require new budget categories, you’re essentially asking states to redesign their financial architecture around your pilot.
2. Build Cross-Sectional Political Support
Mental health’s greatest advantage is also its biggest challenge. It’s genuinely cross-sectoral. Chatbot interventions successfully scale when they are positioned as education technology for socio-emotional learning, gender programming for adolescent girls, or skill-building tools for employment readiness.
The key insight is that mental wellbeing outcomes can legitimately serve multiple ministerial priorities simultaneously. Rather than competing for limited mental health budgets, successful implementers approach education ministries, women and child development departments, and skill development agencies with the same core technology adapted to their specific mandates.
3. Co-Create With the Full Ecosystem
The most sustainable digital mental health programs emerge from genuine co-creation involving frontline workers, community health volunteers, teachers, and beneficiaries from the design phase. This isn’t consultation—it’s shared ownership of problem identification and solution architecture.
Implementation has consistently fallen short, primarily due to a shortage of professionals and volunteers, uneven access to technology, and technical glitches. The programs that avoid these pitfalls embed feedback loops and adaptation mechanisms from day one, treating implementation as iterative learning rather than execution of a fixed plan.
4. Prove Multi-State Validation
Regulatory approval requires different evidence than user acceptance. I’ve observed that single-state pilots, while sufficient for technical validation, consistently fail to convince policy makers of broader applicability. The most successful implementations conduct multi-state validation studies that demonstrate both effectiveness across diverse contexts and adaptation mechanisms for local customization.
The sophisticated implementers treat this validation phase as business model testing. Can the intervention work in high smartphone penetration areas and in states where only half the population has device access? How does the cost-per-beneficiary calculation change across different delivery modalities?
5. Show Long-Term Sustainability at the Start
States consistently ask the same question about every promising pilot: what happens when external funding ends? The programs that successfully transition to government ownership present detailed convergence plans during initial discussions, not as afterthoughts.
This means designing interventions that can operate within existing health worker time allocation, integrate with current reporting systems, and align with established capacity building frameworks. The government collaborated with the iGOT-Diksha platform to train healthcare professionals, frontline workers, and community health volunteers precisely because it leveraged existing digital learning infrastructure rather than creating parallel training systems.
The Path Forward Requires Strategic Patience
India’s National Mental Health Policy 2017 acknowledged mental health as a national health priority, creating unprecedented opportunities for digital solutions. But capturing these opportunities requires thinking like government partners, not disruptive innovators.
The organizations succeeding at scale understand that sustainable implementation means designing for the system as it exists, not as we wish it existed. This doesn’t mean compromising on impact—it means getting sophisticated about how impact scales within real government constraints.
The future belongs to implementers who can navigate procurement complexities while maintaining clinical validity, who can build cross-sectoral coalitions while delivering sector-specific outcomes, and who can demonstrate evidence-based effectiveness while remaining cost-effective enough for state budgets.
That’s the real magic sauce: not better technology, but better systems thinking.
