Eight Vehicles for Reaching Scale
by Abid Mallick
Having spent a quarter of a century in international development, one of the issues that strikes me is the plethora of pilots, models and initiatives for sustainable development that have benefitted people in limited geography and numbers but unable to reach scale. Achieving impact at scale is one of the major challenges in global pursuit of Sustainable Development Goals (SDGs).
Covid-19 has underscored the need for international assistance to make ‘achieving scale’ central to its efforts. According to the 2020 Goalkeepers Report of Bill and Melinda Gates Foundation, the pandemic has stalled 20 years of progress on global goals and adversely affected nearly every indicator. The Report refers to an estimated 7 percent increase in extreme poverty in the aftermath of the pandemic and vaccination coverage dropping to levels last seen in 1990s, with marginalised communities bearing the brunt.
Reversing this would require development initiatives to reach scale which is challenging but not impossible. There are numerous examples of products, services, initiatives and practices that have impacted millions of people. Learning from these and carefully applying or adapting some of the lessons can help. Scanning few examples - which are by no means exhaustive - from private, public and civil society sectors, I have attempted to highlight some basic characteristics of scaling up and identified eight vehicles that are instrumental in achieving development impact at scale.
I have four goals in writing this. First is a call to international assistance community to think hard about and focus efforts on creating sustainable impact at scale. Second is a reminder that it is possible. Third is to point out some of the most successful vehicles to help us get there. And fourth is to spark conversations to enrich our understanding on the topic.
The Business World
Despite a high failure rate, the business world offers many examples of products and services reaching millions even billions of people. The spread of internet and the phenomenal uptake of digital technology-based products and services such as cellular phone, M-pesa, Facebook, Google and Uber are unprecedented. M-pesa, a mobile money transfer service, developed as a pilot by Vodafone/Safaricom in 2007 in Kenya under a UK-Aid grant, scaled up rapidly as it provided the cheapest, fastest and safest channel for workers to send money to their families in remote rural areas. This product changed the landscape of financial services across the developing world in the next five years.
Impact at Scale by Public Sector
There are similar examples within public sector through policy changes and the delivery of new or improved services that have benefitted many. Programa Bolsa Familia (PDF), the conditional cash transfer program started by the Brazilian government under President Lula da Silva in 2003 and managed by local government, reached 11 million poor families (or 46 million people) and helped reduce the population living below the international poverty line from 13 percent to 3 percent by 2015. In China, despite its huge, widely dispersed population, the government succeeded in reducing illiteracy significantly within a span of three decades - from 80 percent in 1948 to 23 percent by 1978. The global initiatives against polio, TB, malaria and HIV/AIDs, supported by international development agencies, in which national governments and NGOs are implementing large scale prevention programs, have contributed to near- elimination of polio and a remarkable reduction in the spread of HIV/AIDs and malaria over the last three decades. Shifts in public sector policies have also contributed to large-scale impact as witnessed after the East African governments – notably Kenya and Tanzania – eliminated primary school fees in early 2000s. This policy resulted in rapid increase in primary school enrolment, especially girls’ enrolment, though it adversely affected the quality of education.
Civil Society-led impact at scale
But private and public sector are not the only ones to achieve scale and contribute to transformative change. Civil society, including NGOs, social movements, academia and professional bodies, have contributed to transformative change for large segments of population. In Bangladesh, non-governmental institutions such as the Grameen Bank and BRAC helped improve the lives of millions of poor Bangladeshi families through microfinance, education and livelihood programs. The impact of political or social movements such as the anti-apartheid movement in South Africa, and movements for civil rights, gay rights, women’s rights, Black rights (most recently Black Lives Matter), and environmental sustainability are unprecedented in scale and impact. On the other side of the spectrum, civil society organisations and movements such as the Ku Klux Klan, National Rifles Association, Al-Qaida, Boko Haram and many others have also garnered sizeable followings while influencing regressive behavior and practices at a scale.
Professional bodies that develop industry standards for products, practices or operations in a given field wield enormous influence, often at a global level. Private and public sector bodies develop guidelines and standards for food safety, road safety, schooling, clinical practice and the nursing profession, for example. These have impact at national level, when effectively implemented.
Finding commonalities
Each of the examples achieved scale through a complex interplay of multiple factors and approaches which researchers have documented. While plenty of research is available on approaches to scaling up health interventions [see www.Expandnet.net] for example, my focus is not on analysing how scale is reached but rather to identify common vehicles businesses, governments and civil society rely on to reach scale. A close look reveals eight vehicles (shown in the box below). Before discussing these, it is important to clarify that merely using these vehicles is not sufficient to achieve scale. Any product, service, message or practice that is intended for mass uptake must have appeal, acceptance, and provide a degree of satisfaction or utility – real or perceived - to the user. Whether it is the uptake of the internet, m-pesa, smart phones, Coca-Cola or the ideas germinated by anti-apartheid or Black Lives Matter movements or safety net program launched by Brazilian government, each one of these resonated with large segments of population, addressed a particular problem or need, satisfied the intended users and/or offered some utility. Without that, the likelihood of reaching scale is almost non-existent. It is however possible that the appeal and utility may not be obvious in the beginning but gains traction over time through awareness raising.
Most research on this subject points to several other common characteristics of successful scale up, including a smart plan, effective execution of the plan and adequate resources. But let me come back to the eight vehicles. I will introduce them briefly though each warrants a separate paper to elaborate how and for what purposes it is more amenable for use as a conduit to create impact at scale.
1. Systems: Introducing systemic change or working through and strengthening existing systems such as public health, elementary schooling, local government or a banking system provide opportunity to reach many and create impact at scale. The social safety net that reached millions of families in Brazil, education initiatives that massively reduced illiteracy in China, and the preventive health programs supported by global initiatives were largely implemented through strengthening and/or leveraging government structures and systems.
2. Partnership: Leveraging strengths of multiple institutions in a purpose driven partnership is another vehicle to create impact at scale. Global initiatives on polio, malaria, TB, HIV/AIDS and reduction of iodine deficiency are examples of national governments, civil society institutions, private sector, and international development agencies coming together in partnership to eradicate these diseases at scale. In the current context, partnerships that are forging to develop a Covid vaccine and hopefully to ensure that the vaccine is made available to everyone in need, offer promise to bring an end to this pandemic.
3. Policy: Influencing policies and laws at international, national and sub-national levels have a multiplier effect as it can create large distributional impact. For example, changes in European Union’s trade policy under its Economic Partnership Agreements (EPAs) with African countries can have huge positive or negative impact in Africa depending on how compatible EPAs are with development objectives. At the national level, policy shifts by governments in developing countries on the provision of free elementary education, integrating family planning services within health sector, and the setting of minimum wage for workers are examples that have had impact on a large scale.
4. Standards: Setting standards in a field or industry are important multipliers as they help make progress in that industry, field and society at large. There is strong evidence that improved road safety standards and policies have contributed to significant reductions in road traffic deaths in 18 high-income OECD countries. In the health sector, global standards for essential maternal and newborn (MNH) care developed by international agencies have informed the development and adaptation of MNH service delivery standards, guidelines and training packages in many developing countries thus opening up possibilities to improve quality of care for millions of women and newborn.
5. Digital Technology: Digital technology is one of the most powerful vehicles to reach large segments of population with information or products and services as we have seen from the remarkable uptake of M-pesa, Facebook, Google and Uber.
6. Mass media: Social, electronic and print media provide excellent platforms to raise awareness on critical issues, influence behavior and practices, mobilise support for a cause or market a product to large segments of the population. By creatively using television as a medium, Sesame Street has helped millions of pre-school children learn and laugh. A study on Use of Mass Media Campaign to Change Health Behaviors concludes that mass media campaigns can produce positive changes or prevent negative changes across large population on health-related behaviours such as tobacco use, birth rate reduction, intake of nutritious food, use of condoms for HIV prevention, and road safety. The authors explain that these behavior change outcomes were achieved through the combination of targeted media campaign and the concurrent availability of required services and products, community-based programmes, and policies that support behaviour change.
7. Influencers: Leveraging the influence and following of celebrities and political, social and religious leaders can also help reach key institutions and large segments of the population. We are well aware of how fashion industry engages famous personalities from entertainment and sports to market their brands globally. In the social and political sector, the role of Princess Dianna in addressing stigmatisation of HIV/AIDs in the 1980s and banning of landmines was groundbreaking.
8. Social Movement: Social movements have been one of the strongest vehicles for changing social norms and introducing policy reforms. They have contributed to attitudinal change as well as policy reforms for the rights of workers, women, LGBTQ, minorities and Indigenous people. Social movements have been instrumental in raising awareness and mobilising support for issues such as climate change, restoration of democracy, and freedom of speech. But there is no simple formula for their success. In her book, How Change Happens: Why Some Social Movements Succeed While Others Don't , Leslie Crutchfield and her research team at Georgetown University identified six patterns that distinguish successful social movements. These include “a focus on grassroots; a recognition of the importance of state and local efforts; a commitment to changing norms and attitudes as well as policy; a willingness to reckon with adversarial allies; acceptance of the fact that business is not always the enemy and often can be a key ally; and being leaderfull, meaning harnessing the energy of many”.
Critical Mass or Tipping Point: I will not classify critical mass or tipping point as a vehicle for scale but consider it as an interesting concept to appreciate in the context of reaching scale. Few organisations that have taken a ‘horizontal replication’ approach by expanding a service to more people through investing more resources (human and financial) reached a tipping point when it became viral. The microfinance product that Grameen Bank started in Bangladesh over time became so successful that the model was picked up and taken to scale by a number of other organisations within the country and abroad. According to the originator of M-pesa service, it went viral after it reached 1.2 million customers.
Malcom Gladwell in his best-selling book The Tipping Point: How Little Things Can Make a Big Difference, analyses the tipping point as that moment when ideas, trends and social behavior cross a threshold, tip and spread like wildfire. He found three distinguishing characteristics of tipping point phenomena – “that it comes through contagious behavior, often with little changes leading to big effects, and the dramatic rise or fall in a very short spell of time”. He uses the analogy of ‘epidemics’ to explain how certain ideas, products, messages and behaviors spread like viruses do. Gladwell identified three lessons on starting successful social ‘epidemics’ by closely analysing a number of cases including the sudden surge in popularity of Hush Puppies shoes in USA in late 1994, the dramatic fall in crime rate in New York City by early 1990s and the successful campaign by Georgia Sadler, a nurse, to increase knowledge and awareness on diabetes and breast cancer in the black community of San Diego: “concentrate resources on few key areas; reframe the way we think about the world; and have a bedrock belief that change is possible”.
Conclusion
Most development initiatives reach scale through leveraging some combination of the eight vehicles as global health programs that rely on systems, partnerships, policy, mass media and influencers have done. But reliance on one or more of these vehicles does not guarantee success as a host of factors contribute to success or failure in reaching scale in an increasingly complex world. While there is no simple recipe, these eight vehicles can be instrumental for creating sustainable development impact at scale.
Abid Mallick is a consultant with a focus on systems and institutional strengthening, evaluation and monitoring, and program design and management. He is founder and head of DevSYS Consulting, based in Ottawa. He can be reached at abid.mallick1@gmail.com
