Thinking scale from the start
So you’ve spotted a social problem you’re determined to solve. Perhaps you start by spending time with people really getting to understand the issue. You come up with a great idea for a solution and get some pilot funding to start delivering. It seems to work and you want to reach more people, so you come up with a business model and work out how you’ll fund the costs of scaling up.
At this point, things unravel a bit. You’d hoped local public services would commission your project but they think it’s too expensive, or simply haven’t got the budget at present. You reconsider your business model, looking for other sources of income. Perhaps you even reconsider your service, looking at cheaper ways to deliver the same results. Maybe you pivot completely, aiming your work at a different target group or trying to solve a slightly different problem.
This type of story is quite common amongst the social innovators that we come across at Nesta. For example, when we called out for innovations looking to scale social action projects with the Centre for Social Action Innovation Fund we came across many really great innovations, but not all had interventions or business models that could scale. Some interventions were quite costly, making it difficult to see who would pay for them; others had not identified any routes to scale or would need to create a large infrastructure which could prove hard to sustain. In other cases, it was difficult to see how the interventions they had designed could be delivered at scale.
But what if you took a different starting point? When BRAC came to Nesta to talk about scaling in February 2015, it laid down a challenge:
What type of solution would you design if you could ONLY work with existing systems and resources?
BRAC is the poster child for scale, reaching an estimated 135 million people each year. And it takes a pretty rigorous approach to scalability. 'We do throw out ideas that are too cost-intensive, or try to cover too many bases, even if they look good', explains Ishtiaque Hussain of BRAC’s Social Innovation Lab, emphasising that for BRAC, scale needs to be built in from the start.
BRAC’s tuberculosis programme gives a good example of this approach. The programme looked to tackle the specific problem of ‘compliance’ with TB drugs - at the time, people being treated had to take the drugs for two years, and would often stop after the first couple of months, when they started to feel better. To solve the problem, BRAC looked to use the resources it already had: community health workers, usually women, based in rural villages. It trained the women to spot symptoms and diagnose TB, and to administer and monitor treatment. To further increase compliance, it introduced a bond system, in which a patient pays the equivalent of a week’s wages upfront, returnable (minus a small payment to the community health worker) on completion of treatment. Last year, BRAC treated over 90,000 cases, with a 90% success rate.
Maria A May, senior program manager at BRAC Social Innovation Lab, argues that the intervention was successful because it started from existing resources - 'we didn’t try to build hospitals or employ doctors' - and because BRAC knew its limitations. To go to scale, BRAC worked closely with the Bangladeshi government, as links with existing health infrastructure were crucial in, for example, getting access to labs and purchasing TB medication.
This approach requires focus - not trying to solve too many problems at once. It suggests incremental, rather than system-wide change. But on the other hand, as this BRAC example shows, it gives the opportunity for genuine impact at scale.
So would this work in the UK? Could we set ourselves the challenge of designing solutions that work only with existing resources? Do we sometimes fail to build in scale earlier enough into our thinking? What could be gained - or lost - by taking a sharper focus on scale?
For more learning from BRAC's work on scaling up, see the report 'What does it take to scale social impact?'
Photo credit: BRAC/Shehzad Noorani.