A central question for any social entrepreneur with a proven, effective innovation is how to scale its impact. For many organizations and funders, the answer to this question is elusive. There are many pathways to scale beyond simply amplifying an organization’s own direct action. At the Skoll Foundation, we’ve been carefully documenting and analyzing the work of the organizations in our portfolio, and this has helped us spot notable trends, such as how an organization scales an innovation that works. We’ve also noticed that a number of organizations have expanded into consulting and advisory services as a means of scaling through other actors. By taking on an advising role, an organization can scale a core innovation with less demand on its resources than would be required through scaling its direct action.
The experiences of three organizations in the Skoll portfolio—Water and Sanitation for the Urban Poor, Health Leads, and EcoPeace Middle East—can perhaps offer some valuable lessons to other organizations that may be considering a strategic shift into advisory services in order to scale their work for the greatest impact.
Water and Sanitation for the Urban Poor (WSUP)
Zambia’s capital, Lusaka, has more than two million people and is one of the fastest-growing cities in Africa. Yet its groundwater has become deadly due to poor sanitation infrastructure, with a recent cholera outbreak affecting more than 4,000 people. In partnership with the Lusaka Water and Sewerage Company (LWSC), the UK-based NGO Water and Sanitation for the Urban Poor (WSUP) is helping implement a major sanitation overhaul funded by the World Bank and other international investors. WSUP has advised LWSC on community-based, economical, and environmentally sustainable businesses practices that enables water supply networks to reach low-income communities. This advisory work has the potential to enable more than a million low-income residents to benefit from improved sanitation in Zambia, up from the nearly 100,000 WSUP has already reached.
As this example demonstrates, WSUP supports the development of financially sustainable business models in partnership with public and private service providers, enabling these providers to develop services, build infrastructure, and attract funding. WSUP, which was founded in 2005, also shares its evidence and learning as widely as possible, while supporting organizational and sectoral change, so that financially viable services can reach those who need it most.
But WSUP wanted to do more. “We [were] seeing a growing interest in tackling water and sanitation for low-income areas in cities as a result of Sustainable Development Goal 6,” says WSUP Advisory Managing Director Yaver Abidi. So, in addition to its ongoing work in countries like Bangladesh and Mozambique, WSUP developed a for-profit advisory arm in 2015 to improve the technical, business, and operational capabilities of urban water and sanitation service providers. “WSUP Advisory now provides technical assistance in strategy and planning—helping governments develop national policy and regulation, service providers to develop business plans and build institutional capacity, and funders to develop strategies for addressing the complex challenges of service provision in cities,” says Abidi—thus giving it the ability to scale far beyond its own footprint.
WSUP’s for-profit advisory arm enables the organization to leverage its experience and learning for the benefit of the sector, further build its credibility, and work in new contexts and geographies. WSUP Advisory also provides an avenue for WSUP to influence national plans in a way that it could not through its core country programming alone. Finally, funds generated through this for-profit consultancy provide a revenue stream for WSUP’s nonprofit activities.
For its first 18 years, Health Leads, a US-based nonprofit focused on the integration of social needs as an important component of quality healthcare, offered services within clinics that enabled doctors to “prescribe” social and economic services like food stamps, fuel assistance, and emergency shelter. Health Leads staff also helped patients “fill” prescriptions by identifying appropriate community resources and addressing barriers to accessing them.
Health Leads’ approach has proven effective in connecting patients to critical resources and improving clinical outcomes, which in turn can lead to reduced health care costs. And while Health Leads continues this direct work, its scaling strategy has shifted to advising other actors, namely health care providers and policy experts, on best practices for incorporating social determinants into the care setting. In 2015, Health Leads launched a learning network—a platform for education, support, and best practices—to provide institutions with personalized coaching, peer learning, and access to its “Reach” technology, which supports and tracks patient connections to resources. “The shift has augmented our earned revenue stream by expanding our addressable market beyond areas where have a physical footprint, creating financial flexibility as we continue to scale our approach,” says Bill Brodnitzki, Health Leads’ managing principal.
Health Leads’ credibility through its direct work and emerging advisory support also positioned it to serve as an advisor during the 2016-17 development of two new national health care pilots under the Center for Medicare and Medicaid Services that will explicitly test and promote models for integrating social needs into healthcare delivery, providing a national platform for scaling approaches similar to Health Leads’.
“This advisory work enabled us to influence the healthcare sector at a level we could not have accomplished through direct service alone,” Brodnitzki adds.
EcoPeace Middle East
EcoPeace Middle East encourages Jordanians, Palestinians, and Israelis to work together to address water crises and protect shared natural resources. In doing so, it aims to bring about sustainable development and the conditions necessary for lasting peace in the region. EcoPeace operates through “bottom up” grassroots activities targeting youth and adults in local communities, including its flagship Good Water Neighbors program, as well as “top down” advocacy and research to promote cooperation by influencing decision-makers at the regional and international levels.