NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

“Small is beautiful, but scale is critical,” was one of the key messages that emerged from the discussion with Ophelia Dahl, executive director of Partners in Health, at the opening plenary of the Skoll World Forum, being held Wednesday through today in Oxford, England.

On Thursday, Dr. Priya Agrawal, executive director of Merck for Mothers, kicked off a delegate-run discussion, “The Path from Innovation to Impact in Global Health,” with a reiteration of this message: If we have an ethical obligation to scale successful interventions, why have we failed in so many cases to expand beyond the pilot level?

With representatives from organizations ranging from Partners in Health to Novartis sitting around the table at Thursday’s discussion, we talked about the real-world challenges associated with taking an efficacious pilot project to national or global scale. One of the key barriers that participants emphasized was the lack of appropriate capital resources to support scale-up.

Currently, the largest global health funders focus on vertical programs, such as malaria or maternal health, with short time frames to demonstrate impact. Ken Himmelman from Partners in Health said that we are in great need for patient capital that can support the type of systems-level change that is needed in most countries. This type of change cuts across disease and program areas and requires a long-term outlook.

Dr. Ari Johnson, founder and CEO of MUSO, echoed the need to think more broadly about strengthening health systems. He illustrated the current challenges with an example from Mali where donor-funded antimalarial medicines had expired in the field because there was not support for strengthening the supply chain to get those medicines to patients.

Participants agreed that there was a need to demonstrate that alternative financing models, which support long-term, systems-level approaches, could have large payoffs.

While it may be difficult to move the giants of bilateral and multilateral funders toward these new models, we, as implementers, can start by reforming our own organizational approaches. Himmelmann pointed out that implementing organizations had become highly adapted to the current grant-based system, which has led to vertical program delivery.

If we are committed to changing the larger health care systems, we have to start with how we, as implementers, approach our own initiatives. This challenge will have to be met in order to achieve meaningful scale.

The Skoll World Forum is an annual gathering held in Oxford that brings together leaders from the social sector to discuss entrepreneurial approaches to addressing some of the world’s greatest challenges. Each year, about 1,000 delegates from around 65 different countries participate in the three-day event.

Nora Petty is a Skoll Scholar at the University of Oxford’s Saïd Business School.