Over the last 12 years Grand Challenges Canada’s Saving Brains program has invested $70M CAD in more than 140 social innovations to foster early childhood development in the Global South. We have taken a portfolio approach—not every program reaches scale effectively—but taken together our innovators have now reached more than six million people in 39 countries. In most successful scaling cases, our innovators have played an intermediary role in their work with regional or national systems, such as public health systems. The value of an intermediary in public sector scaling is familiar, but what have we learned about challenges and success factors from the experience of innovators playing this role for early childhood programs?
Early childhood programs are typically more complex than, say, a vaccination campaign. We tend to see positive outcomes for families only when frontline service providers—such as nurses, community health workers and home visitors —build hiqh-quality relationships with families. Yet large public systems rely on repeatable, mandatory protocols for scaled delivery, whereas the most impactful work emerges when families are seen as active partners in the change process, where individual dignity and agency is honored. Our team began to notice common elements in innovators who successfully met this challenge at scale. We’ve come to call this category of social innovator “System Catalysts”.
Below, we’ll describe what we’ve learned about the System Catalyst role in the early childhood context in two ways: first, by offering a concrete example, the work of the Community Empowerment Lab to help mothers and newborn babies; and second, by sketching some common aspects of the working approach of the Systems Catalysts we have observed.
Helping newborns and mothers: The Community Empowerment Lab
Community Empowerment Lab (CEL) is a community-based health research and innovation organization in Uttar Pradesh (UP), India, a state of over 240 million people. CEL formed a remarkable partnership with the public hospital system, and together with diverse stakeholders achieved systemic buy-in for improving infant survival.
In 2003, CEL began working with villages in the rural Shivgarh area where high infant mortality was an acute challenge. They used a collaborative approach to improve neonatal survival. Together with partners, CEL implemented a package of measures, including improved birth hygiene and skin-to-skin newborn care. These interventions cut infant death rates in half, according to a randomized evaluation.
To expand this success from the village-level to hospital and clinic settings, CEL focused on improving uptake of skin-to-skin “Kangaroo Mother Care” (KMC) for low-birthweight babies. KMC was a WHO approved evidence-based policy already in use in UP, but adoption in hospital settings has proven challenging. Over a 10-year period, CEL engaged with government administrators, hospital administrators, obstetricians, paediatricians, nurses, and families to develop a collaborative, scalable approach to implementing KMC. The approach included creating, at low cost, a special hospital room furnished and equipped in a way that respected the dignity of mothers, babies and families and the KMC nurses who served them. CEL also provided wrap-around 24-hour support to facility managers to build ownership and support continuous improvement. By respecting the needs of all stakeholders, the approach saw accelerated uptake by state and district administrations, making Uttar Pradesh the only state in India to successfully scale KMC.
We view organizations like CEL as System Catalysts because they knew that Kangaroo Mother Care was more than just a medical intervention that needed to be scaled. They understood that a culture change around postnatal care was required and that it had to be endorsed by existing health systems and embedded within hospitals. They also recognized that collaboration was paramount to gain the trust of mothers and their families and to secure endorsement from nurses and physicians. They also built in monitoring and evaluation, including a phoneapp-based feedback system, to course correct during implementation.
Community Empowerment Lab’s success as a System Catalyst increased the use of KMC for low-birthweight babies from 8% to 92%. Today, hospitals in more than 90% of UP’s districts have adopted KMC. Stakeholders at all levels have provided positive feedback on the value of CEL’s role in supporting the health system.
Feedback from stakeholders at all levels illustrates the way CEL collaborates across the health system. A staff nurse said, “The CEL team is just wonderful. Whenever we have a problem, we can approach them directly, even at 2 am, and they are there to support.” Similarly, a senior pediatrician said, “The CEL team has put across all the technical details in-depth, it’s wonderful. It’s been of great help, and we’re trying—as far as possible—that our people, mothers and attendants get the best out of KMC, and our infant mortality and morbidity rates reduce significantly….” A Chief Development Officer said CEL “have passion for transforming impossible to possible, which at times is missing in the government setup…. CEL is aptly named as it really empowers to deliver results which were not even thought of. It was an empowering relationship.”
Ingredients to success
Here are some common aspects of the approaches we have seen System Catalysts like CEL use to shift underlying structures, policies and mindsets:
- They connect within the system and across stakeholders: they work sufficiently inside the system so they are trusted, knowledgeable and superbly connected at multiple levels, including with community leaders and senior officials. They also remain sufficiently outside the system to stay independent, keep questioning, and stay well connected to all stakeholders.
- They articulate and work toward shared goals: they work with leaders, system participants and all stakeholders, including communities and families, to identify a specific challenge that everyone wants to address. They stick at it over time, guided by a shared commitment to the outcome being sought. They are not tied to any one way to get there. They let the system own the goal, as well as the credit for successes along the way.
- They respect families and communities: they have direct experience with the issue and understand community perspectives. They approach families as active participants in solutions. They ground their work in respect for the dignity of everyone being served and everyone delivering the service. In this way, they tap into the creativity and latent energy of people and communities.
- They upgrade and energize system performance: they’re not simply trying to ‘sell’ their solution to the system for replication and scaling. They partner with the system to co-create and build its capacity to deliver. They use data for both rigorous evaluation and continuous improvement to help the system learn to do better. They embrace the system, including its faults, and resist the temptation to set up parallel delivery systems.
- They innovate with stakeholders for better delivery: they work creatively with large systems to find practical new approaches to overcome implementation challenges. They tap into the distinctive motivations of each stakeholder, so that everyone benefits directly from serving the shared goal.
We hope innovators seeking to transform large systems will find value in the experiences sketched here. Likewise, we hope philanthropists seeking impact at scale will find and fund System Catalysts to develop human-centered system partnerships that can be sustained over time.
We have found that you can spot a System Catalyst by their approach, relationships, and attitudes. They need to be given flexible funding to nudge change in the larger system, or to invest their own time in networking, communication and collaboration with stakeholders. For philanthropists who want to effect long-term change to improve the lives of women, children and families, investing in System Catalysts will yield high returns for everyone.
Please contact us if you are interested in sharing your experience of working with System Catalysts or if you wish to explore how innovators, philanthropists, policymakers and other stakeholders can work together to catalyze system change.
Author Bios
James Radner is Assistant Professor at the Munk School of Global Affairs & Public Policy at the University of Toronto, Senior Fellow at the Center on the Developing Child at Harvard University, and Research Director of the TruePoint Center for Higher Ambition Leadership. James was an early initiator of the Saving Brains Learning Platform, a high-quality platform providing technical support to a broad community of innovators transitioning their ideas from proof-of-concept to scale.
Andrew Bollington, Managing Director of viaEd, provides strategic and management consulting services to foundations and organisations aiming to better the world through education. He has been a long term member of the Saving Brains community of experts and innovators.
Sanjana Janardhanan is the Saving Brains Portfolio Manager, managing an active and vibrant portfolio of innovations in early childhood development at Grand Challenges Canada, and supporting them in their transition-to-scale journeys.
