Pilotitis

Pilotitis is a term used in public health and development to describe a pattern in which numerous pilot projects are launched but few are scaled or integrated into policy and practice. The phenomenon leads to a proliferation of isolated pilots that do not translate into sustainable, system-wide improvements, leaving donors and governments with fragmented interventions and limited long-term impact.

The term arose within global health and development circles to critique the tendency to fund short-term pilots to demonstrate effectiveness without ensuring scalability, local ownership, or alignment with national strategies. It highlights gaps between testing ideas and implementing them at scale within real-world health systems or programs.

Causes include donor-driven funding cycles that reward new pilots over expansion; demand for quick results; limited capacity to scale successful pilots; fragmentation and weak coordination across ministries and implementing partners; lack of robust monitoring, evaluation, and knowledge management to translate lessons; and uncertain policy or financing environments that hinder scale-up.

Consequences involve wasted resources, duplication of efforts, and the creation of parallel or unsustainable programs. When pilots remain isolated, health systems miss opportunities to learn from broader implementation experiences, integrate innovations into routine practice, and achieve lasting impact.

Mitigation strategies focus on designing with scale in mind: require scale-out plans and exit strategies from the outset; align pilots with national strategies and financing; build local capacity and governance; integrate data systems for cross-program learning; and establish coordinated knowledge management to guide decision-making and policy adoption.

See also: implementation science; scale-up; program evaluation; health systems strengthening.