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INTRODUCTION
In early 2014, the Ebola virus began its devastation of West Africa, moving through countries, communities, and families with grim efficiency. Over the next two years, 60 percent of those infected with the virus diedāover 11,000 people. One of the hardest-hit countries was Sierra Leone, which had just 136 doctors for more than 6 million inhabitants.
A brutal killer, Ebola renders its victims delirious and unable to cope on their own. Almost immediately, it fell to family and friends to act as caregivers. Ebola killed them, too. In the worst-hit areas, the virus eliminated entire families. Those who fell ill started running off to die alone rather than risk infecting loved ones. Eventually, social gatherings were banned, schools were closed, and households were separated. Society and the economy ground to a halt.
The crisis was unprecedented. Since Ebola was first detected in 1976, each of the subsequent 27 outbreaks was stopped in less than three monthsāuntil 2014. In 2018, another outbreak of Ebola in the Democratic Republic of Congo was again rapidly brought under control. Why did the West Africa outbreak of 2014 last for two years and kill more than all other outbreaks combined?
A complete answer has yet to emerge, but two factors played a critical role. First, we lacked know-how. There were no pre-existing, evidence-based solutions to combat an outbreak of this magnitude. Second, the context was pernicious. A variety of circumstances, including unprepared health systems at the community, national, and international levels and social disintegration, compounded the problem and destabilised even the most holistic solutions.
In these types of circumstances, the way we usually scale solutions is ineffective. The traditional approach to delivering interventions at scale starts with the assumption that we have reliable solutions and favourable contexts. When this is the case, as it sometimes is, we are urged to scale āwhat worksā by efficiently allocating resources to organisations with evidence-based solutions. But as the Ebola crisis in West Africa demonstrates, this is not always the case. āWhat worksā is not always known, let alone ready for deployment and easily transferable to new settings. Instead, many of our most pressing problems are the ones we have been unable to solve, perhaps for years, decades, or longer. Most are not crises on par with an Ebola pandemic, but fixtures of the status quo. Issues that in the development sphere are often called wicked problems. So, how do we scale when we donāt know what works?
Toward a new paradigm
In the absence of reliable solutions, or when new or changing contexts reduce the reliability of existing solutions, scaling depends on research and innovation.
For our purposes, research and innovation are broadly defined and often intertwined. Both occur along the entire path to scale, starting with ideas that hold promise and culminating in impacts that matter. In this way, scaling comes from innovators and researchers who are connected to systems of diverse actors. Scaling depends on a dynamic body of evidence that develops before, during, and after scaling. Scaling solutions driven by research and innovation is justified by assessments of risk made by those put at risk, including those being served. Scaling implies that trade-offs and values are carefully considered. In essence, when scaling rests on research and innovation, it entails much more than resource allocation.
In this light, there is a need for a broader way of thinking about scaling that takes this uncertainty into account and can be applied to a broader range of contexts in which researchers, innovators, impact investors, funders, NGOs, social enterprises, and governments are currently acting.
We are witnessing such an approach emerging across the Global South. One of the organisations that is involved in combating the Ebola virus in West Africa is the International Development Research Centre (IDRC), a Canadian institution that supports innovations developed by natural and social science researchers in the Global South. Along with partners from West Africa and beyond, IDRC supported efforts to combat Ebolaāfrom long-standing support to public health innovation in West Africa to rapid response mechanisms, including the trial and scale-up of a new vaccine.
The science behind clinical trials and large-scale vaccination is well understood. With some variation, it is the approach to scaling championed by organisations such as the Campbell Collaboration, What Works Clearinghouse, and 3ie. This approach has merit, yet it was not appropriate for a situation like the Ebola outbreak in West Africa.
Without turning their back on clinical trials and other accepted approaches to scaling, IDRC and its partners worked to end the Ebola crisis differently. Their effort is one example of an emerging paradigm of scaling that we call Scaling Science. We have come to understand it through an expansive review of IDRCās work undertaken with the objective of using evidence and experience to develop a more systematic approach to scaling. The purpose of this book is to organise what we have learned into a set of principles, and, in doing so, contribute to our collective understanding of how to scale research and innovation in appropriate ways.
The term Scaling Science purposefully embraces two meanings. The first refers to the objective of scaling scientific research results to achieve impacts that matter. We define research broadly. In our review, it is a likely component and critical driver of innovation. It is how solutions to stubborn problems are generated. From this perspective, researchers are innovators, and innovators can be researchers.
The second meaning refers to the development of a systematic, principle-based science of scaling that this book will argue can increase the likelihood that innovations will benefit society. The aim is to contribute to building a culture of critical thinking on the topic. All approaches to scaling should be questioned, tested, refined, and used thoughtfully. We have learned time and time again from innovators in the Global South that it is the careful combination of imagination and critical thinking that leads to meaningful change.
Traditional scaling paradigms
Most of what we understand today about scaling up social change has been borrowed from 19th-century industrial expansion, 20th-century pharmaceutical regulation, and 21st-century technology start-ups. We refer to these as the industrial, pharmaceutical, and lean scaling paradigms. While there is much that we can learn from these paradigms, they are insufficient for contemporary social innovation. They reflect a mindset in which organisations, rather than impacts, are scaled up. Scaling is an imperative, bigger is better, and the purpose of scaling is commercial success.
The industrial scaling paradigm is premised on the need to produce and distribute many standardised physical objects at the lowest cost. The key is operational scale, and it is achieved by exploiting the efficiencies of large-scale manufacturing and distribution. Its purpose is to increase market share and, if possible, secure monopolistic pricing power. Replication, franchising, and train-the-trainer models, which are common in the non-profit sector, are modern extensions of the industrial paradigm.
The pharmaceutical scaling paradigm is based on the need to capture the sole rights to an approved innovation. The keys are authority to scale, in which the government grants an innovator permission to scale up a drug based on phased clinical trials, and exclusivity of scale, in which the innovator is empowered through patents and trade secrets to deny others the right to scale up the innovation. The subsequent challenges of operational scaleāthe manufacture and distribution of a pill, for exampleācan be trivial in comparison. Around the world, this paradigm structures the development of market-based solutions that promote health and combat disease, as well as evidence-based programmes of all types implemented by for-profit and non-profit organisations.
The need to grow fast in a competitive market is the basis for the lean scaling paradigm. The keys are rapid learning, quickly iterating product designs to understand what markets value, and resource scale, securing timely funds in order to exploit what has been learned and grow market share. The lean development processābuild a minimum viable product, bring it to market, learn rapidly from customer behaviour, modify the product or pivot, and repeatādrives many of todayās leading tech start-ups. Unlike pharmaceutical companies, these innovators do not require authorisation to scale, only the support of customers and investors, and they often find exclusivity difficult to enforce. As with pharmaceuticals, the problems of operational scale are usually negligible, especially if the innovators are selling intangible goods, such as software as a service. This is the paradigm that social entrepreneurs and impact investors are often encouraged to follow.
These three paradigms were formulated as strategies for achieving commercial success, not social impact. They do provide some useful guidance for social innovators who want to scale up impacts in certain areas, such as education, health, civil society, and public policy. A developer of low-cost irrigation systems for sunflower farmers, for example, may benefit from adopting elements of the industrial paradigm in order to expand production. Advocates for changing an environmental protection policy will likely benefit from the staged collection of evidence as one does with the pharmaceutical paradigm. And a non-profit e-health software provider may benefit from basing its development process on the adaptive and nimble elements of the lean paradigm.
The existing paradigms are not wrong when applied to social impact; they are incomplete. A more comprehensive approach will focus on an alternative or additional objectiveāthe public good. With the Scaling Science paradigm, we set out to describe a framework that does just that. Our hope is that it will encourage innovators to consider scaling from a broader perspective, with tools that are inspired by the vast and eclectic problem-solving experience of the Global South.
Scaling impact
Scaling operations, revenue, market share, financing, and other aspects of an organisationās work are familiar concepts. Scaling in these contexts is synonymous with growth, and more is better. They are legitimate organisational purposes. But, when it comes to development efforts, the deeper interest is in scaling social impact. Social impact is not synonymous with growth, an...
