Positive and sustained changes resulting from social innovative approaches depend on interactions between the innovators and the environment, either within small local communities or in larger regional areas, and on community commitment and investment in such programmes. Although van Stam proposed a three-step community engagement process for social innovation, the duration for local adaptation of a given project or approach often depends on the specific intervention being delivered within a community setting. Initial sensitisation about a given health condition and awareness creation within communities, empowerment of local stakeholders, and subsequent skills development, community education and implementation, can be particularly complex for preventive efforts. In contrast, interventions related to logistics, such as improved mechanisms for drug distribution or the delivery of pathology results, may move faster. For example, the Riders for Health initiative, which began operating in Lesotho and extended to Liberia, Kenya, Zimbabwe, Zambia, Malawi, the Gambia and Nigeria, required government support but was not dependent on community engagement for operation and success (https://socialinnovationinhealth.org/case-studies/riders-for-health-2/). Accordingly in this case community engagement followed from the success of the intervention, rather than being essential to its introduction.