Each year the Skoll Centre invites a small number of Oxford students to the annual Skoll World Forum on Social Entrepreneurship. Each year they share their unique perspectives of the sessions and events that unfold during this magical time in Oxford.
Achieving universal health care through collaboration between funders, social entrepreneurs, and government
Frustrating. Slow. Fundamental. Scale. These were the words that came to mind to attendees when Erin Worsham of the Center for the Advancement of Social Entrepreneurship asked them to describe working with government. The balance between the challenges of working with government, and the potential impact and scale that could be achieved through collaboration was immediately apparent.
In the next hour and a half, we heard candid conversations from two partnerships between social entrepreneurs and governments. One was between Last Mile Health and the Government of Liberia. The other was between Partners in Health and the Kingdom of Lesotho. Through these conversations, there were three themes that kept coming up:
Collaborative target setting and evaluation between social enterprises and governments
Demonstrating impact to inspire scale up
Funding for comprehensive primary health care, rather than particular diseases
Collaborative target setting and evaluation
Thabelo Ramatlapeng of the Kingdom of Lesotho kicked off this theme when she mentioned one of the major challenges for governments was working with organizations who brought their own missions, and their own objectives, and were inflexible about setting these objectives collaboratively. In both partnerships, there was a concerted effort made to understand the government’s priorities and ambitions, and design the work and evaluation according to these, rather than organizational agendas.
Lisha McCormick of Last Mile Health drove this home when she mentioned that in her experience, the Government of Liberia wasn’t concerned with RCTs, and evaluation; they had very practical questions- how do we implement, and how do we pay for it?
Demonstrating impact to inspire scale up
Another recurring theme was social enterprises demonstrating impact to government in smaller use cases, and government building on this momentum to scale up what is proven to work. Partners in Health by building seven comprehensive primary care clinics in the most isolated and difficult to reach areas of Lesotho, and Last Mile Health by implementing a community health worker model in three counties of Liberia. Each have now scaled rapidly in close collaboration with government, with comprehensive primary healthcare now reaching 40% of the population of Lesotho, and community health workers operating in 15 counties of Liberia.
This to me, seems like the ultimate theory of change around working with government. Innovators prove that work can be done differently and more effectively, and the value of government is in recognizing and scaling this innovation so that it has massive impact. The innovation would not have been recognized, however, if the respective teams hadn’t engaged government in setting the objectives and defining success at the very earliest stages.
Delivering comprehensive primary healthcare
There was a third stakeholder in the conversation between panelists that wasn’t a speaker, but whose presence was felt- the funders. A major challenge emphasized by Abera Leta of Partners in Health was that funding for health is often in verticals, designated to treat HIV vs. malaria vs. a vaccination, rather than funding that can be used for comprehensive care that treats communicable and noncommunicable diseases, and makes true universal healthcare access a reality.
Again, the importance of following the government’s lead was emphasized. In countries like Rwanda that insist on autonomy in how they use donor money to fund healthcare, comprehensive primary healthcare can be prioritized. Just like with social enterprises, when funding reinforces and enables the government agenda around comprehensive primary healthcare, rather than trying to force its own, the potential of this collaborative relationship is realized. Every speaker, from the government and the social enterprises, was unanimous in calling for funding that could be used to build the primary healthcare systems that countries need.
As we think about these themes, it’s important to keep the individuals at the center, who are the reason that all three players- governments, social entrepreneurs, and funders- do this work. S. Olasford Wiah of the Government of Liberia brought us back to these individuals when he shared what inspires him to work in community health. He shared the story of one of his former patients. A woman who had a healthy pregnancy, but experienced complications during the delivery. Her community came together to try and bring her to a health center, walking and carrying her for hours in a hammock, but by the time they reached the center, she had passed away.
This is the injustice experienced by the 50% of the world that doesn’t have access to essential health services. And addressing this injustice is what motivates us and demands that we collaborate to achieve a world with universal access to health care.
About the Author
Puja Balachander is a social impact designer following the lead of vulnerable communities to help solve their most intractable problems. Throughout her career so far, she has worked on designing sustainable, equilibrium-shifting solutions with end-users. Puja believes in working with end-users in their language and in their community, therefore she practices and teaches design in French, Hindi, and Tamil, and has worked all over the US, India, and Madagascar. Currently undertaking her MBA degree at Saïd Business School, she is also co-founding Devie, a social enterprise that aims to improve access to quality early childhood development.