First Person

Go Big or Go Home

By Kevin Starr

Stanford Social Innovation Review

Fall 2008

Copyright 2008 by Leland Stanford Jr. University

All Rights Reserved

Stanford Social Innovation Review

518 Memorial Way, Stanford, CA 94305-5015
Ph: 650-725-5399. Fax: 650-723-0516
Email: info@ssireview.com, www.ssireview.com

Ideas First Person

Go Big or Go Home

One foundations approach to maximum impact

Illustration by Brian Stauffer

Pascaline Dupas had a cool idea. She would offer free insecticide-treated mosquito bed nets to pregnant women in western Kenya who signed up for prenatal care at government clinics.
Not only would their children get to sleep under a bed net, but
once in prenatal care they would also get malaria prophylaxis and,
if needed, treatment to prevent fetal transmission of HIV. An
economist affiliated with the Abdul Latif Jameel Poverty Action
Lab in Cambridge, Mass., Dupas maintained a healthy skepticism
as to impact, and made sure to collect the data that would show
any change in child mortality.
Her idea worked. Sign-up for prenatal care skyrocketed, and
Dupass direct observation showed that 85 percent of the womens children slept under nets. Several randomized trials in Kenya
had shown that sleeping under a net reduces child mortality by 20
percent, so Dupas could make a persuasive case that the cost per
childs life saved was about $600 (the cost of the intervention divided by the additional number of children sleeping under nets,
divided by 0.2 children saved per net). She had kept Kenyas Ministry of Health in the loop, and as a result of her lobbying efforts,
clinics in western Kenya will soon distribute free nets.
Dupass work is a prime example of a scalable solutionan idea
that can grow to make a big dent in a big problem. At the Mulago
Foundation we make philanthropic investments in scalable solutions for health, development, and conservation in the Third World,
and we invested in Dupass work when she was a Rainer Arnhold
Fellow in the foundations program to help social entrepreneurs
turn good ideas into lasting change that will go big.
Why did we think her idea could go big? Or more generally,
how can you tell whether an idea is scalable? Were a small shop,
so we had to find a simple way to screen for scalability. A while
back, our friend Martin Fisher put forward the idea that scalable
solutions have four critical characteristics: They must have real
impact, and must be cost-effective, sustainable, and replicable.
Fisher used his idea to build KickStart, an iconic organization that
has pulled thousands of African farmers out of poverty, and we
adapted his criteria to guide our philanthropic investments.

real impact
If an intervention cant demonstrate real impact, it shouldnt be
scaled upperiod. We dont invest in organizations that dont measure their impact: Theyre flying blind, and we would be, too.
We dont want a flood of data, either. We just want the right
data. To ascertain your organizations real impact, you need to
measure the right thing, measure it adequately, and make the case

B y Kevin Starr

that change was in fact due to your efforts.

Start with knowing your real mission. If youre distributing
mosquito nets, for instance, what matters is not how many nets
you get out the door, but whether malaria rates and mortality
drop. If youre making microloans, what matters is not whether
people pay you back, but whether they make more money. Impact
isnt the activities you completed, the services you delivered, the
attitudes or even the behavior you changed; its the result of all of
that. And it isnt vague terms like lives affected, or a kitchensink compendium of all the possible benefits you can think of; its
focused indicators that capture the real mission.
Dupass real mission was to save kids lives in Kenya. She used
proven survey methods, rigorous before-and-after data attributable
to her intervention, and a big enough sample size. Because randomized trials had made the connection, she
could use a verified behaviorkids sleeping
KEVIN STARR directs
the Mulago Foundation
under netsto make an accurate estimate
and the Rainer Arnhold
of impact. Better yet, we know her estimate
Fellows Program. He also
is a conservative one, since she didnt even
practices rural emergencount the lives saved by the prenatal care.
cy medicine part time.
Fall 2008 Stanford Social Innovation Review

29

Ideas First Person

Not everyone needs to do a randomized trial. But you do need a
way to show the change that you effected. Sometimes you can get
away with matched controls, or even simple before-and-after data.
Dupas could prove the increase in bed net use, but she also needed
data from randomized trials, because there are many other causes
of child mortality.
Not all of our start-up organizations have proven and attributed
impact yet, but all have identified what to measure and have a process in place to measure it. In fact, when theyre needed, we like to
pay for formal impact studies.

drive important behaviors. Are they adequate and will they last?
Our experience is that coerced behavior is the least stable (we
locked people out of the forest); self-reinforcing behavior is the
most stable (we helped them make money from a healthy forest); and compensated behavior is somewhere in the middle
(we paid them to take care of the forest). The crucial behavior
in Dupass project was sleeping under a netabout as selfreinforcing as youre going to get.
As for exit strategies, there are only three kinds. First, you can
hand your intervention over to the government to deliver. Dupas,
for instance, designed her intervention so that government clinics
cost-effective
would take it up, and she brought the relevant decision makers into
Even with real impact, a solution still wont scale if it costs too
the process to make sure it would happen.
much. Dupass intervention was cheap: $600 per life saved is
Second, you can embed the intervention in the market. Kickabout half the cost of some of the best interventions out there.
Start uses donor funds to market its affordable moneymaking technologies, leaving profitable businesses and
supply chains in place to continue generating new impact.
Impact isnt vague terms like lives affected, or a kitchenThird, you can create a self-perpetuating
sink compendium of all the benefits you can think of; its mechanism for behavior change that allows
focused indicators that capture the real mission.
you to move on. World Relief has an intervention called mothers care groups
Its a solid, conservative number that gives us a meaningful sense
wherein peer-to-peer teaching of high-impact household health beof value in light of the real mission.
haviors creates durable new social norms like exclusive breast-feedWe really want a number. It doesnt tell you if something is
ing and oral rehydration that continue to save lives when a project
worth doing, just what it costs to do. Cost per impact is our social
is over. (True self-perpetuating interventions are rare, however.)
return on investment (SROI), the single most important number to
Like everyone else, we like to invest in the start-up costs of
guide our decisions and the best indicator of our own impact.
organizations that can eventually expand into new settings withNo two settings are the same, so we have to evaluate each numout subsidies. Despite a lot of hoopla, however, few can do that
ber in context, but sometimes we can use it to make meaningful,
while meeting the needs of the very poor. In the settings where
albeit rough, comparisons. For example, we benchmark nongovern- we work, government and market failures must be overcome, and
mental organizations working to get one-acre farmers out of pover- even organizations that no longer need a subsidy in one setting
tyVipani, One Acre Fund, KickStart, and IDE, for instanceby
often need philanthropic capital to innovate and extend into new
calculating the ratio of average three-year increase in farmer insettings. When the impact return on that capital is high, were
come to donor cost per farmer.
happy to put in our money.
With a mature organization like KickStart, or a fully completed
replicable
project like Dupass, the SROI calculation can be pretty simple: DiDupass intervention passes our replicability test, too: It is fovide the total amount expended by the total impact. For newer orcused by a clear central idea, simple and systematic enough that
ganizations, that calculation doesnt really work because of high
research and development and start-up costs. In that case, what we others can do it, and broadly adaptable to a wide range of settings,
and it can leverage something big to drive growthin this case,
ask for are projections that can at least stand up to scrutiny.
When we emphasize SROI, we dont have to care about organi- government health systems. To be fair, her intervention is on the
really-simple end of the simple-enough spectrum. But innovazations percentage of overhead or whether they sometimes fly
tions such as micro-franchising have allowed the efficient packaging
business class. As long as we have a credible number that we like,
of what might otherwise be too complicated.
we know we have good value and can let them decide how money
We wont pretend that scalable solutions are easy to find, but
is best spent.
in our experience they arent that hard to screen for. Suffice it to
sustainable
say that we look for organizations that listen to the customer,
What a sadly abused and weirdly indispensable word! For Mulago, track their own performance and impact, and have leaders who
sustainable means that impacts last and continue to grow once
will use that information to take corrective action and innovate
the primary intervention is complete; in other words, a solution
when necessary.
passes the walk-away test. We look for two interrelated things:
The better we all get at channeling money to those who really
the behavior that drives impact lasts, and there is an exit strategy
know how to create change at scale, the more well hasten the day
for donor subsidies.
when philanthropy starts to operate as an efficient market for imThe first is about systematically looking at the incentives that
pact. And when that day comes, we might just save the world. n
30

Stanford Social Innovation Review Fall 2008