Achieving Lasting Impact at Scale - Bill & Melinda Gates Foundation

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Introduction
Two days is not a lot of time, but perhaps 200 “conversation-days” is.
When 100 people – each an expert in his
or her field – gathered together for two
days in Seattle on November 1-2, 2011,
they were contributing to a conversation
that was several years old and will
continue for several more. It was about
how to achieve lasting impact on family
health at scale.
Much has been said, and much remains
to be said, so it is too early to draw
conclusions. But the product of these
discussions has the potential to radically
change approaches to family health, and
to greatly reduce preventable maternal
and child deaths.
But before I begin to explain why I am so
excited about the possibilities, let me say
a little about how we got to Seattle and
how I came to be synthesizing what we
have learned so far.
It is not necessary to be super smart to
recognize that money alone is insufficient
to solve the world’s great problems, such
as the millions of children who die
needlessly each year. The Bill & Melinda
Gates Foundation can bring a lot of
resources to bear on any challenge – but it
also knows that progress depends on
exploiting the best available knowledge.
So, in 2008, when the Foundation began
in earnest to think about how it might
play its part in meeting the United
Nations’ Millennium Goals Four and
| Achieving Lasting Impact at Scale
Five – to reduce child and maternal
mortality and to achieve universal access
to reproductive health – it began with the
evidence base. The Family Health team at
the Foundation rapidly uncovered more
than 700 relevant papers from microeconomics,
political science, sociology,
psychology and other disciplines. They
read the papers and began to invite some
of the authors to come to Seattle to
discuss their ideas.
A lot was learned. But the knowledge
tended to be over-complicated. It often
focused on the things that interest
academics, which are not always the most
relevant for practice. It generally drew on
experiences in economically advantaged
contexts.
These first explorations prompted a more
systematic review of the literature.
Several studies were commissioned, two
of which got a good airing in Seattle. The
first sifted through what is known about
the social and behavioral changes that
will be necessary to deliver biomedical
interventions leading to sustainable
population-based improvements in family
health. The second examined what works
in scaling up evidence-based interventions
in low-income countries.
At the same time the Foundation was
testing its emerging ideas on what it
called “tracer innovations”: products,
practices, or platforms that had the
potential to improve family health at scale
and also to produce learning for future
investments. Such was the impetus for the
Bill & Melinda Gates Foundation’s
support for the project Alive and Thrive,
which promotes breastfeeding and child
nutrition in Bangladesh, Ethiopia, and
Vietnam, and its funding of other major
initiatives to improve reproductive health
and save newborn lives in Bihar, Ghana,
Mexico, and Central America.
By this stage, the Foundation was
involved in a lot of transactions – with the
experts, with the international aid
community, with the governments of
countries testing the tracer innovations,
and with the grantees implementing or
evaluating them.
But more could be learned from a
conversation among these communities
than from a series of bilateral exchanges.
When Jeff Raikes became the
Foundation’s CEO, he brought with him
a lot of ideas with fancy names (like
“solution leverage”) that had helped him
and Bill Gates make Microsoft one of the
biggest scale-up successes in history.
These are ideas I will explore in more
depth later in this synthesis.
For now, all that needs to be said is that
the Bill & Melinda Gates Foundation
came to realize that its progress depended
on bringing together a diverse group of
Introduction