The article hits on a few our favorite, and often repeated, maxims. For example, how difficult it is to go from piloting with NGO staff to scaling with government staff:
“When a program scales, it has to hire and train many new people — or in some cases transition to using government resources and civil servants. And that can change a program’s effectiveness. “You turn over a program from a highly motivated NGO…. to people who know less about it and are less driven to see it succeed — or informed about what it will take. A lot can be lost in transmission”[Mushfiq Mobarak – Yale’s Research Initiative on Innovation and Scale].
Another great point for practitioners to think about at the design phase (that isn’t often cited) is the equilibrium effect – for example, if you take a great worker training program to scale, you might actually drive down wages if there are now too many skilled workers available. While CARE is careful to consider the impact of our programs on markets, it can be difficult to accurately predict unintended consequences at scale. Being mindful of the equilibrium effect while designing for scale can help us set appropriate targets.
We’re excited to see new resources from the Bihar team!
A collaborative storytelling project from Bihar
Two short and powerful films document the Bihar Technical Support Program, a partnership between CARE the Bill & Melinda Gates Foundation, and the Government of Bihar to improve the quality of care and health system in Bihar, India. Through two films you will be inspired by the story of Manju Devi, a frontline health worker in Bihar, working to save lives by delivering maternal and child health care in her village; and in the second film you will be transported to Bihar to learn how CARE and the Government of Bihar are reducing rates of maternal, newborn, and child mortality and malnutrition, and improving reproductive health services statewide. Watch the films here: bihar.care.org
Innovation Briefs: Bihar Innovations
New briefs highlight five innovations being taken to scale in Bihar, India and beyond, Including Team-based Goals and Incentives. CARE has developed and implemented a package of evidence-based, quality innovations that seek to address the various issues which impede access to high-quality services in Bihar. The implementation of these innovations have resulted in successful outcomes and improvement in the health system – so significant that the Government of Bihar began to scale several of the innovations to all 38 districts in the state, and some of the innovations are scaling nationally. Find all five briefs at bihar.care.org.
“CARE’s theory of change posits that the empowerment of community members and frontline health
workers—where they feel comfortable advocating for their rights—plus the creation of space for power-holders, health workers, and community members to talk and interact in a safe, supportive, and equitable environment, leads to improved health outcomes. To test this, a research team conducted an evaluation in Malawi to analyze the effect of the CSC on a set of governance measures, including trust in health workers, power sharing, mutual responsibility, and collective efficacy.
The team found significant relationships between those who actively used the scorecard and perceptions of equity and quality of their discussions. They also found positive relationships with governance measures of actions resulting from the process, such as joint monitoring and transparency, collective action, and availability of community help.
“Active participation in the CSC ensures a safe, inclusive space to voice concerns and work together to improve health services and outcomes,” explained Sara Gullo, lead author of the article.
CARE Malawi’s Thumbiko Msiska agrees. “CSC enhances engagement of various stakeholders, especially rights-holders, and brings their perspectives into the conversations, clarifying expectations and promoting ownership.”
Read the full post by CARE staffer, April Houston here:
“Sometimes an innovation catches on, but we don’t actually know why or what is making it work,” said Whitney Pyles Adams, who runs the NGO CARE’s Scale X Design accelerator. “And if you don’t know what that secret sauce is, you really don’t have a chance of scaling it elsewhere.”
We’re excited to contribute to this series from Apolitical on designing for scale, our favorite topic! Check it out here:
The Chomoka team (Cohort 1) reached an important milestone this month with the onboarding of VSLA groups to start using the smartphone application for their weekly meetings. The team has been working diligently with the developers to test the application and fix bugs to create a stable version of the application that can be rolled out to a wider audience of groups. The team has 100 groups who have pre-registered for Chomoka in the Dar es Salaam area who will start using the application in the coming weeks and months. While the process has taken longer than the team hoped, they were determined to get the product right, using lean experimentation and human-centered design, so that customers have a positive first experience with Chomoka and word of mouth in communities drives demand. The team has 10 Chomoka Agents who have been trained and will be leading the on-boarding of the application with targeted VSLA groups from now into the new year. Check out how the app functions below! (The narration is in Swahili but the screen by screen navigation is in English!)