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Scaling Health Solutions through Government Partnerships

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:

  1. Collaborative target setting and evaluation between social enterprises and governments
  2. Demonstrating impact to inspire scale up
  3. 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

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.

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My journey from an impact business in India to a world-class MBA

Daniela Gheorghe is one of our 2018-19 Skoll Scholars on the Oxford MBA. Natively from Romania, Daniela has lived and worked in India for the last seven years where she has helped numerous families gain access to affordable health and education. Here she describes her journey to Oxford.

It was 2008. I was on a plane to Germany. I just received an Erasmus scholarship to study at a German university for six months. I spent 30 minutes writing my application for the scholarship three months before. That’s how much it took me to accomplish this on my own: my first time flying, my first time out of Romania. There, while looking at the clouds, I understood that I could achieve anything I intend to achieve. If I set my mind on the goal, I can do anything (and fly anywhere)!

Above the clouds, in that minute, I understood my potential for the first time! I was 22.

But what if all children understand and realize their potential early? Imagine what that world would look like.

For the last four years, I have been serving poor parents’ aspiration. Families with a household income of less than $300 per month spend 13% of this income on education. What is their return on investment? Their return on primary education investment is very low as children spend five years in schools without being able to calculate, read or express themselves in the language of their books.

When aspirations meet willingness to pay, demand is defined and so, a market.

In 2014, I co-founded vChalk. At vChalk, we sell fun English learning activities on a mobile app to schools and parents for students to transition from learning English as a second language to being confident and expressive using it. Four years have passed; bootstrapping, improving the model, winning national and international competitions (we raised about $35,000 from different awards). We supported more than 80 teachers and 2500 students to catch up on foundation skills for learning. We tested a pricing model of less than $10 per year/child. We crossed a sales revenue of$12,000 in 2017. However, the business model was not ready for large scale.

This is a classroom in a resource-limited school in Bangalore India. Parents aspire for their children to speak English, get a good job and a good salary. Teachers struggle to teach in English and ensure that foundation learning happens.

Before my time at vChalk, I worked in political marketing and the non-profit sector in Romania. When I came to India in 2011 for an internship through AIESEC I thought it was just for a few months.

Little did I know I would spend more than seven years in India.

This is the place I discovered social entrepreneurship. I knew it was for me. But seven years later, I still feel I don’t know how to solve the world’s most challenging problems.

Daniela in Jaipur, Rajasthan, India. Picture is taken during her work at Jaipur Rugs, a company presented asa case by C.K. Prahalad in his book: The Fortune at the Bottom of the Pyramid.
Daniela’s room in 2011, in a women’s hostel in Jaipur, Rajas than, India while working at Jaipur Rugs. On the wall, spot the postcard depicting an aerial view of Oxford University. Jaipur Rugs connects more than 40,000 artisans with high quality markets in USA and Europe while creating timely handmade carpets.
Daniela in a village around Jorhat, Assam, India. Picture is taken during her work at ERC Eye Care, a social business offering affordable eye glasses and ophthalmological services to rural families in this “tribal” state of North-East India.
Daniela’s office in ERC Eye Care in Assam, India. Daniela supported the start-up to raise its first impact investment of $100,000.
Daniela on the field on a regular day in a waste management company in Telangana, India. As a Frontier Market Scout, Daniela worked to improve the operations of Waste Ventures, a for-profit impact business that transforms organic waste into soil conditioner and sells to farmers. More on Daniela’s journey in India, before she started her owned-tech company, here.

I am honored to be in Oxford. Honored and privileged. Just four months ago I couldn’t imagine that I would be here. It is so incredible how life turns around.

But why am I here?

Firstly, I’m here to take a step back. I’m here to try to understand what I can do better to positively impact more children. I’m here to learn about systems thinking and I understand that I can do so much more than being a start-up founder. I’m here to discover where I can place myself in my next role to see my work have long-term positive impact on low-income families.

On a personal level, I seek to be happy with my work every day. I want to be a doer and dedicate my hard work to something meaningful that empowers people. I need to grow myself as a person, to learn to pace my efforts, to become more diplomatic and wiser so that I learn from failures. This MBA will help me grow. It will hone my financial and business skills too.

Finally, Oxford adds weight to my voice. It gives me a chance to be heard in important decision-making forums for change at large scale. It gives me a chance to join some of the greatest minds out there to tackle the world’s most difficult problems.

I am here to reach my full potential. To build connections, gain learning and gather insights that will last a life-time.

Find Daniela on  TwitterInstagram, and LinkedIn.

Visit Daniela’s personal project on emotional intelligence here.

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A letter to my younger self

Mohsin Ali Mustafa is our 2018-19 Skoll Scholar on the Oxford MBA. Mohsin is also a Weidenfeld-Hoffman Scholar, co-founder and managing director of Clinic5 – an affordable health delivery service in Pakistan. 

I write this blog post as a letter to my younger self. We don’t have a time machine (yet) but what we do have is an ability to communicate ideas through our written word and I see my life as part of a larger continuum, so this blog is an effort to speak to that young man or woman who is brimming with enthusiasm to go out and “change the world.”

“Dear Mohsin,

Congratulations on graduating from medical school, I am proud to see the passion to serve in you is thriving to the point where you want to work as medic on the front lines of the war in Pakistan. I know right now you want to do a Che Guevara and change the world. I remember you mentioned that you wish to end the war that’s raging in your country by working as a Disaster Response Medic. I’d like to share a few things I learnt over the course of the last few years that might help you along the way. I am cautious as I write this since the words of age can strike as pessimism to the youth so take from this what makes sense to you.

First – patience, Rome wasn’t built in a day. Climate change did not start last year, the war that rages all over the world is not a product of inequities of the past few days. The big problems that you want to tackle are insidious and hence their solutions would also require time, patience and effort. This is a marathon and not a sprint pace yourself or you will burn yourself out. Keep your eyes on the prize, this will be your life’s work – take the long-term approach. Do not let small losses here or there dissuade you from the end goal.

Second, find a mentor; life at 24 seems impossible to navigate at times, a mentor who works in the space or inspires you with their professional and personal attributes can transform your worldview. I know I got direction from my mentor or else I might have ended up completely misdirected. A mentor encourages you and anchors you in life with their wisdom.

Third – balance, this world needs young people like you, but remember you’re not the only one in this. I know right now you can’t see it with everyone that you know taking the path that’s safe and comfortable but let me assure you there are thousands of troops fighting the same battle as you. It is important that in your struggle to change the world you don’t forget yourself. Remember the relationships that make who you are, spend time with them; remember the passion for trekking in the mountains, do it occasionally; remember your love for sushi, have it once in a while. Don’t blindside yourself in the effort to change the world and in the process forget what made you, you.

The last and the most important one, love. Don’t forget to love, you were driven on this path out of the love for a patient, a patient you lost on your watch in the ER, I know you shed tears that night and vowed to fix the systemic problems that caused it, don’t forget that passion. Protect that flame in your heart. Winds will blow to put it out, sometimes under the guise of practicality, other times in the guise of rewards.

Remember, your heart will harden to cope with all the sorrows you will experience, and it would seem like a wise thing to let it harden as that hurts less. That’s a cop out young man – don’t be weak and give in to that urge. A good way to judge this is by observing how you treat everyone closest to you. If you notice you’re becoming harsher with the people in your life, you’re doing something wrong. This one is the hardest to maintain and let me be honest with you, it’s still a constant struggle in my life despite the few years I have over you.

That’s enough for today, I know you’re a young man with a short attention span so I kept it short but trust the path you have taken, who knows this path might even lead you to the leading center of learning in the world where you would be sharing your experience with colleagues from all over the world. When that happens remember to treat that privilege with humility and purpose.

I have a hunch life will be a rewarding adventure on your chosen path and you will go places you did not even imagine you would.

Salute comrade,

Mohsin”

I am immensely grateful to the Skoll Centre and the Weidenfeld-Hoffman Trust for enabling my education at the Saïd Business School. I am cognizant of the privilege and will do my utmost to deliver on the promise.  I pledge to return to my organization Clinic5 at the end of this academic year to scale our work in healthcare in partnership with schools in Pakistan.

Mohsin Mustafa with young children from his clinic in a Pakistani classroom

Mohsin Mustafa (pictured right) with young girls attending his clinic in a Pakistani classroom.

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Skoll Centre launches Impact Lab programme

The Skoll Centre for Social Entrepreneurship this year launches the “Impact Lab”, a one year co-curricular programme designed to enable Oxford MBA students to take a leading role in tackling the complex and pressing social and environmental challenges of our world.

The programme cultivates the knowledge, tools and personal leadership qualities needed to drive ambitious and systemic change across sectoral and organisational boundaries. Weekly workshop sessions and in-depth bootcamps with leading practitioners and thought leaders cover topics such as systems thinking, human centred design, impact measurement and impact investing. In tandem with this, through action learning and access to executive coaches, Impact Lab participants are supported in deepening their self-awareness, developing character, and understanding their own impact leadership journeys. The programme concludes with an opportunity for Lab members to create and deliver a personal talk on their own journey, how they have changed and the impact they wish to have on the world.

Building on our successful pilot “Skoll Academy” in 2017, the Impact Lab launched on October 6 this year with an inaugural cohort of 38 fantastic MBA students selected through an application process. Lab participants include students from a range of backgrounds, including:

  • Julie Greene, a social entrepreneur who ran bakeries across East Africa providing vocational training, employment and wellness services to women;
  • Sergio Navarro, a former VP at Goldman Sachs, doctor and founder of a health-tech company using augmented reality to deliver rehabilitation therapy;
  • Kudzai Chigiji director of a Pan-African advisory and infrastructure development company, currently operating in education and healthcare across East, West and Southern Africa;
  • Mridhula Sridharan, an investment strategist who has advised high net worth individuals, corporates and foundations across India and enabled investments to be directed into development initiatives.

The ethos of the Lab cultivates peer-led and peer-to-peer activities, and students are actively engaged in shaping the evolution of the Lab across the Oxford year.

In light of the United Nations Sustainable Development Goals, the ambitious targets in the Paris Climate Agreement and the multiple social and environmental challenges facing our world, now more than ever, we need leaders who can understand these interconnected and complex issues, design and execute effective interventions, and lead teams, organisations and movements.

For more information or if you would like to collaborate, feel free to contact us. Many of the Impact Lab presenters are also running public sessions as part of the Skoll Centre Speaker Series. More information can be found on the Saïd Business School events listing.

By Shruthi Vijaykumar, Skoll Centre Associate

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On blackberries and change

Skoll Scholar, Sandra Fisher-Martins, poetically portrays her life in Oxford since arriving here with her husband and son 1-year ago to join the MBA programme at Oxford’s Saïd Business School.  

If I followed the fence of the train station and turned left onto the Botley Road, I could walk to the Business School in less than 10 minutes. I rarely did. Almost every morning I took a right onto a dirt path overgrown with brambles and crossed a short bridge over a swampy ditch to walk along the 50-metre stretch of canal to the railroad underpass, brimming with urban wildlife.

In September there were still some blackberries on the tallest bushes and the odd fish in the water. In October the spiders were out. Come November, the riverside grasses had died, and the paths widened. December brought snow, silence, eerie light. In January and February robins, squirrels, and the occasional fox were still there, braving the cold. March gave us more snow and the first blooms. By April the iridescent bugs and the flowers were back. In mid-May, the river was blanketed with fluff from the poplar trees, and the pikes and roaches congregated in the shade of the train tracks. At the end of June, the brambles’ pale pink flowers crowned bright green berries, promising another Autumn feast.

I have never felt the passage of time more distinctly. As the seasons changed and the riverside path went from dusty to muddy, from frozen to flooded, I noticed and cherished the sunny spells as much as the drizzly days.

Image of the Oxford Canal Pathway with snow on the ground

I came to Oxford looking for change, uncertain of the direction it ought to take or where it could lead. The encounters, experiences, conversations, and opportunities awarded by the MBA created the fertile conditions for it to occur. In fact, they made it unavoidable. It would be impossible to be in this environment, with these people, and not be permeable to ideas, ways of being, aspirations.

In Michaelmas, Herminia Ibarra’s lectures had me wondering whether the identity I had built over the years still suited my goals — and what could replace it. In Hillary, I could feel my priorities shifting and a pull towards areas that had never been on my radar, like innovative finance and climate change. At the beginning of Trinity, darkness threatened to take over. In Oxford we learn to take things apart and question them from all angles — a valid approach if applied in moderation; however, indiscriminate use can undermine the modicum of optimism necessary to keep ‘daring greatly’. By the end of the term, hope had been restored, as I started exploring a partnership that will take Claro’s mission global, as well as working with a colleague on an impact fund that picks companies based on their ESG performance.

I am grateful for the transformative opportunity to have spent this year at Oxford Saïd and to everyone who challenged and supported me — colleagues, lecturers, and particularly the Skoll community. Sustained by their thoughtfulness, I was able to engage with the ups and the downs, learning and changing every day. As I prepare to continue my journey, enriched with dozens of new friends and fired up by fresh, better questions, I hope that I will remember and cherish the sunny spells as much as the drizzly days.

Close up on blackberry blossom

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Vanilla, blockchain and the circular economy – one year on the Oxford MBA

Skoll Scholar and circular economy entrepreneur, Nikhil Dugal, highlights the best part of his year at Oxford on the MBA programme. 

The Oxford MBA is quite a unique experience in the world of business education. The extent to which our class discussions and interests differ from other business schools is apparent when I travel to London to meet friends enrolled in other MBAs.

Over the course of the past year, the MBA has helped me keep pace with many issues of recent development, including emerging technologies, climate change mitigation and the circular economy, all while keeping one foot firmly in the business world.

Sustainable Vanilla

Another opportunity to undertake learning was the entrepreneurship project (EP) in Trinity term. In addition to encouraging novel business ideas, Oxford Saïd also invites external collaborators to come pitch live projects to the MBAs for the EP. This offers individuals in Oxford the opportunity to work with MBAs on their project for a semester, while the students get the opportunity to work on a live project and contribute to real-world impact.

My team used the opportunity to work with an agro-ecologist from Oxford who is working on preventing deforestation in Indonesia by encouraging local farmers to grow Vanilla in the rainforests. Vanilla is the second-most expensive cash crop in the world. However, only 1% of the world’s supply comes from natural sources, while the majority comes from synthetic vanilla manufactured from petrochemicals. Natural vanilla grows as an orchid and can be planted in degraded rainforests to help restore the natural ecosystem in a polyculture system. Establishing a larger market for forest-grown organic Vanilla from Indonesia can help restore degraded rainforests and provide smallholder farmers a more lucrative alternative to engaging in unsustainable palm oil farming. We spent a semester working on their business models, financial projections and market entry strategy. Meanwhile, they have started a pilot in Kalimantan and planted 18000 saplings on 500 hectares of land leased from the government. Moving forward, their team will be using our research and projections to scale the project, raise funding and enter the market.

Nikhil debating at the Responsible Business Forum.

Nikhil debating at the Responsible Business Forum.

Circular Economy

Before joining Oxford Saïd, I was working on a circular business in India, making eco-friendly infrastructure for development sector organizations. The circular economy elective in Trinity term gave me the opportunity to interact with a diverse set of stakeholders working to establish the circular economy in the UK. This included entrepreneurs from companies such as Toast Ale and Elvis & Kresse, investors such as LWARB and Circularity Capital as well as practitioners from the Ellen MacArthur Foundation. This gave us a broader view of how the ecosystem works in the UK and provided opportunities to network with people working on the front-lines of the problem.

Blockchain for Impact

Over the course of  ‘Strategy and Innovation’, we were given the chance to apply concepts learned in class to an emerging field. I took the opportunity to research the use of blockchain technology for sustainable supply chain tracking. After learning more about this topic for my final coursework, I was given the opportunity to interact with two practitioners working on applying the technology on the ground and hear their perspective on it as well. Hugh Locke, the president and co-founder of the Smallholder Farmers Alliance in Haiti visited to speak at the Responsible Business Forum 2018. Their partnership with Timberland is using blockchain technology, built from the ground up with beneficiaries in mind, to help source sustainably grown cotton and revive the Haitian Cotton Industry. At the same forum, we were also visited by David Davies, the founder of AgUnity, which is using blockchain to increase the transparency of financial transactions in farmer cooperatives and increase farmer’s trust in the institution.  During Trinity Term, our Tech for Impact class hosted one of the founders of Alice, which is using blockchain technology to undertake social impact tracking to help create a new type of cryptocurrency based social impact bonds. At Saïd Business School, what I’ve appreciated about the learning style is the ability to balance both theory and practice.

Nikhil and his peers in traditional Oxford exam attire.

Nikhil and his study group on the MBA.

Systems Change

The issues social entrepreneurs work on are extremely complex and involve many stakeholders with diver interests. Tackling complex problems like climate change can seem overwhelming because of the complexity of the problem itself. Systems change constitutes studying how systems work, identifying stakeholders that are part of a system, understanding their preferences and identifying inflection points in the system where an intervention can lead to a significant impact. At the Skoll World Forum, I had the opportunity to also meet system entrepreneurs who are working in the field of systems change, in organizations such as Participatory Cities and Forum for the Future.

Moving forward, I will be spending the summer researching systems change and meeting practitioners to undertake landscaping research with the Skoll Centre for Social Entrepreneurship.

This past year has given me the opportunity to step back, reconsider the impact of my work, and inform my opinion by giving me a broad exposure to topics that are interrelated to my work. Although the year has gone by unbelievably fast, it has also reformed my perception of the world. There are an uncountable number of people of all ages and professions, who are working to help realize the world of the future. It’s a world that includes autonomous electric vehicles, distributed ledger technology and a global shift towards renewable energy.

The opportunity for me to be at the center of this transition has been made possible with a Skoll Scholarship and it will continue to shape my thinking as I transition out of Oxford, back into the world.