By Jason Walton, change management lead, the BID Initiative
Oct 7, 2014
Posted in Policies & Practices
A recent article by Joseph Wong, Stanley Zlotkin, Carmen Ho, and Nandita Perumal, “Replicating Parts, not the Whole, to Scale” published in the Stanford Social Innovation Review resonated with me as my colleague and I returned from a visit to Tanzania as part of the Better Immunization Data (BID) Initiative. Wong et al. clearly highlight, while we have succeeded in creating viable solutions to the developing world’s challenges, innovations have rarely achieved scale and transformative impact. Thus, the difficulty of translating efficacious innovations into effective innovations beyond a local setting remains elusive.
To address the challenge of scale, Wong et al. discuss two strategies that are often applied by social innovators and entrepreneurs – custom design and replication. Wong et al. do not recommend an either or approach, but rather a combination of the two in what they term the “early identification of the efficiency core of a proven solution.” Their replicating parts principle rests on the idea of dissecting successful interventions to identify the fundamental component or innovation that enables success and then using that component as the piece to replicate while adjusting the intervention to local context. This is the same theory that the BID Initiative is working to apply to improve both data quality and data use.
For instance, the BID Initiative’s approach to supportive supervision provides a salient example. While much has been documented regarding the benefits of regular supervision through the use of trained supervisors, structured checklists and the provision of immediate feedback, the reality is that logistical issues (e.g., budget, transport, and adequate time), often derail routine supportive supervision efforts before they even start. Therefore, the BID Initiative is attempting to harness the principles of regular and structured supervision along with the immediate feedback by empowering district immunization officers to provide targeted supervision to a limited number of low-performing facilities during a given month.
The supervision will leverage pre-existing touch points (e.g., submission of monthly reports and restocking from district medical stores), that enable the district immunization officer to have access to a representative from the facility, ideally the in-charge nurse. Moreover, by providing the district immunization officer with facility- and district-level dashboards and data use guides, they will have the resources available to provide targeted instruction and to review a given facility’s performance.
The replication and adaptability, as discussed in the article, is achieved by giving the individual district immunization officer the flexibility to adjust the mode of communication to whatever touch points are occurring in their particular district. Moreover, they can adjust the number of facilities they target in a given month to what their particular bandwidth is for that month. The priority will be on the efficiency core of one-on-one supervision, targeted review of a particular facility’s performance, and the use of dashboards and guides to bring structure to a tailored supervision session.
Despite the best intentions with the example above, the BID Initiative fully acknowledges that iterations will need to be made to tweak the components of the intervention addressing the adaptability as additional regions and countries apply this approach, but hopefully we will find success in leveraging the efficiency core so that impact and scale can be achieved by replicating the parts and not the whole.