The Quest for Scale

An effort to improve sanitation in developing countries yields lessons in how to achieve enduring, broad-based social impact.


(Illustration by Matthew Hollister) 

In December 2006, I flew into Aurangabad, a city in the Indian state of Maharashtra. Before the trip, when I mentioned my destination to an Indian friend, she asked, “Are you going to visit the caves?” She was referring to the main attraction in the area—a series of Buddhist shrines carved centuries ago out of the nearby hills. No, I replied. I wasn’t planning to visit the caves. I was planning to visit some toilets.

In fact, what I’d typically seen when I visited India was the absence of toilets. More than 600 million Indians practice what is politely called “open defecation.” But in the Jalna district, which is near Aurangabad, officials had made real progress in persuading large numbers of rural households to install and actually use toilets. The key to success in Jalna, I learned, involved a community-based program that spurred demand for toilets and rewarded the desired outcome—villages free of open defecation—instead of simply paying to install toilets that few people used.

That trip was part of a quest for durable and scalable ways to improve sanitation. A year and a half earlier, I had joined a small team from the Bill & Melinda Gates Foundation that had a mandate to develop new program areas. My focus was on the field of water, sanitation, and hygiene.

For decades, that field had stymied government officials and international development experts. When I joined the Gates Foundation, the situation that we faced was daunting. More than 1 billion people lacked access to drinking water, and more than 2.5 billion people—half the population of the developing world—either relied on unsafe sanitation facilities or had no sanitation facilities at all. The consequences of these problems were profound: Each year, 1.5 million children under the age of five were dying from water-related diseases. The economic and social costs of days lost from work and schooling were significant, too. In addition, there was the simple indignity faced by billions of people who have nowhere “to go.”

The Gates Foundation brought to this challenge not only a considerable array of resources, but also a very ambitious goal: to make a real difference in the lives of the poor on a large scale. Between 2005 and 2012, the foundation funded more than 150 water, sanitation, and hygiene grants, at a total cost of more than $400 million. From the experience of helping to make and administer many of those grants, I gleaned several lessons in how to pursue social innovation in a scalable way.

Test at scale | Most international donors and implementers embrace a pilot-to-scale paradigm. They support innovative pilots and then just assume that the most promising pilots will be adopted at scale. But, as I came to realize, very few pilots are actually scale-ready. Too often, something is missing between the pilot stage and the stage of widespread adoption. What’s needed is a stage in which worthy programs are tested at scale. “Scale” here means the minimum level (district-wide, for example) at which a government or another large implementer would operate a program. Such an approach is consistent with the production of commercial goods: No manufacturer would assume that what works in a small job shop would translate readily into production on an assembly line. Instead, a company will typically develop and test manufacturing processes that will allow it to achieve economies of scale.

Several Gates Foundation grantees tried this test-at-scale approach in different settings. One grantee achieved mixed success by taking a community-led rural sanitation model—the model used in Jalna, India, that I mentioned earlier—and implementing it at a scale of more than 1 million people in each of four locations. Another grantee figured out how to support village-level water services at the district level (and did so in two separate countries). And a third grantee began testing several delivery models at the scale of hundreds of thousands of people for a remarkably user-friendly device that chlorinates water drawn from wells and springs.

Change the system | New or improved interventions—providing vaccines or water purifiers, for example—generate lots of excitement. And clearly, there is a need for technical innovation. (That’s why, for example, the Gates Foundation launched its Reinvent the Toilet Challenge.) Yet such innovations can succeed in the long run only if they are embedded in local service delivery systems. Social innovators who seek scaled impact, therefore, should focus on altering how pivotal institutions set policy, allocate funding, and deliver services on the ground. Applying influence at institutional leverage points can generate long-term, wide-scale improvements in services for the poor.

New or improved interventions generate excitement. Yet such innovations can succeed only if they are embedded in local service delivery systems.

One grantee in Kenya, for example, changed its strategy from one of delivering sanitation services in schools to one of advocating an increase in government funding to maintain school latrines. The impact of that shift exceeded any outcome that would have come from a direct intervention. Another grantee understood the power of systems change right from the start. Aiming to improve water and sanitation services for the poor in more than 400 municipalities throughout Maharashtra and Gujarat, another state in India, this grantee developed a common performance-assessment system that includes specific indicators to measure access by the poor. Today, that system is taking effect at the municipal and state levels, and the Indian national government has committed $300 million in additional funding to the program.

Change the debate | Improving water and sanitation means digging wells and installing toilets, right? That’s the common perception, and it leads funders to focus on capital investments in hardware and to measure success by access to water and sanitation facilities. But that approach, we learned, is neither the right way to allocate money nor the right way to gauge progress. What really matters is whether the poor are receiving services in a sustained, affordable, and convenient way. So we worked to change the debate from “Are we funding that well or toilet?” to “Are we providing sustainable water and sanitation services?” One of our grantees, for instance, developed a new method for correctly estimating the full, life-cycle cost of water and sanitation services and then worked closely with governments, NGOs, and other parties to implement that approach in several countries.

Define success carefully | During my time at the Gates Foundation, I visited water and sanitation programs across Asia and Africa—programs run by NGOs, by governments, and by private companies. Many NGOs did a good job at the village level, but few could figure out how to scale up effectively, and often they struggled with long-term sustainability. Government programs typically operated on a large scale, but rarely were they as effective as NGO-led efforts undertaken at the village level. Those programs, too, struggled to sustain services over time. Private-sector providers, meanwhile, often faced challenges when it came to extending services to the poor or to providing services at an affordable price.

These observations led me to define success in terms of three equally important goals:

  • Impact: Does it demonstrably improve the health and socioeconomic well-being of the poor?
  • Sustainability: Does it have enough resources to keep running for many years?
  • Scale: Does it have the potential to reach millions of people?

Achieving success concurrently across all three goals isn’t easy. But for social innovators, they are important guideposts on the path to making a real, lasting difference.

Pair implementers with evaluators | A notable advance in international development has involved the application of rigorous evaluation methods to assess impact and to identify which interventions really work (or don’t). Yet too often such analyses end up in academic studies that don’t influence how programs are implemented on the ground. Most implementers, meanwhile, have weak learning systems and often rely on anecdotal evidence to guide their practices. From the outset, we paired implementers—governments, international organizations, NGOs, private ventures—with evaluators. That way, the former could learn more effectively, and the latter could achieve greater impact. Some of these pairings fared better than others, but in each case the learning on both sides was substantial.

Build a diverse team | The colleagues whom I recruited to our team included a PhD in fecal sludge management, a professional with 30 years of field experience in water and sanitation in Asia and Africa, a systems thinker extraordinaire, two social science PhDs with deep expertise in measuring impact, a policy and advocacy whiz, and a former investment banker. They hailed from an equally diverse range of countries: Cote d’Ivoire, Italy, the Netherlands, Romania, and the United States. Given our varied perspectives, conflicts inevitably arose—but some of our most productive dialogues emerged from those conflicts. In retrospect, I see that assembling this multi-disciplinary cast of characters may have been an effort to internalize a “systems view.” In any event, it reflected my recognition that taking a single-discipline approach was unlikely to yield strong results.

I have one last thought to share about the quest for scalable innovation: The common thread that united our most effective grantees was an ability not only to focus on systems, but also to listen—to listen very carefully to the poor. In other words, they were able to observe the choices being made by the poor and to understand the motivations behind those choices. That combination generates approaches that have the potential to achieve large scale and sustainability.

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  • PRESCOTT STEVENS, ex-WHO Environmental Engineer's avatar

    BY PRESCOTT STEVENS, ex-WHO Environmental Engineer

    ON October 15, 2013 10:50 PM

    What kappened to the “SULABH” program, an NGO created in 1970 by Dr Bindshwar PATHAK?    It set up over 5500 use-and-pay community toilet facilities and more than ten million household toilets. 

  • Charles Muhigirwa's avatar

    BY Charles Muhigirwa

    ON October 16, 2013 04:31 AM

    Are there any scholarship opportunities for the courses commencing Nov 13?

  • Dom Jermano's avatar

    BY Dom Jermano

    ON October 16, 2013 06:17 PM

    The motivation behind positive change, and longevity is money. If India people see a way to make money by having clean sanitation, and the ability to create clean energy it will work. The reason why programs fail is because they run out of money, in which the money comes from outside sources. 

    Discovering True Wonders of the World.
    How It Can Be.
    By: Dominic E. Jermano
    September 14, 2013

    Society at large is aware and unaware of it’s problems, and unable to come up with true logical sound solutions. The masses of people in need of support, work toward those support mechanisms that are submarginal in standard. They indoctrinate such submarginal standards as a basis of societal approval within Government, Economics, Education, Defense, Law, Transportation, Housing, Energy, and Private Sector Institutions.  Insodoing, their generational perceptions view positive change, as threats coming from terrorists networks, wherewith the thoughts of losing control of their submarginal standards, keeps society enslaved to the mediocre, not very good, methods, that ultimately become the causes of major problems within Society and the Environment society must live in.

    How do we know when we evolve from the submarginal standards to the True Wonder Solution?  It’s clarity is recognized when we witness how the new process heals, or prevents the damage created to attain a desired goal. For example: People need Electricity to power their homes; and the cost to get that creates massive air pollution, from burning coal, or using toxic dangerous methods that can be unleashed upon society, by using Nuclear Power. An earthquake, or sinkhole incident or any type of Act of God, or Human Error can change submarginal standards to devastation, and catastrophe.

    When we can create electricity that does not pollute, or doesn’t have the potential if unleashed to cause a violent seismic change; we know we have reached the Summit of the True Wonder Solution.

    To change the way people do things, we must get them to stop their unaware of bad behavior, in order for them to clearly see and witness the right way to move forward for the betterment and support structure that provides the real True Wonder Solution.

    People rely on hope that their Education Institutions produce solutions. The failure is that people who graduate from their University, and later acquire the Jobs that guide society; only speak of improving society as being really the submarginal standard. They rationalize and kick the can down the road, until it is too late. They fail to realize that a higher power from God, is the maker of people who are seeded with talents unbeknown to themselves, until they discover it. Education is thought to be the key to open the garden gate to witness the seed to sprout. Because a person who became famous went to a particular University, the University likes to take credit for itself for being responsible for that persons talent. The reality is, the other way around. It is the person or student that has the real creditability, and the University is but the secondary influence.

    We also know that God and his Wonders of the World, never went to a University. Yet he holds The Wonders of the World, in his bosom, in comparison to all the Universities in the World.

    Mankind has been struggling to achieve the ability to create wealth in support to mankind which makes up society.  People fight for wealth and have established Armies and Militaries to protect their ability to control the limited resources that are needed to build The Modern Age, according to their submarginal standards.

    There are people who say they do not believe in God. They claim if there is a God, then where is he?  I can only say that if you believe in some other religion, then where is Buddha, where is Muhammad, where is Confucious? If you do not have a religion or are an Atheist, then I say where is your nothingness?  Where is the proof of your imagery?  You can only see that what is before us, and the processes that created it. Insodoing we know that there is an intelligence that exists, and that is the essence of the discovery that there is God.

    Revealing God’s True Wonders of the World, is no easy task. If people can not believe in God, how much more difficult to get them to understand the makings of inventions, processes and methods? Many will claim they believe in Science and the Big Bang Theory, but I assure you, that Science can not explain how life exists? How is it that a human can breathe, has a non-stop beating heart, can think, and do things. Science can not explain this, as Science can not explain the reality of death.  Where did the life go? Science can not explain how the coming and reality of the many species of animals, and plants that support life.

    Mankind fails because we are not in tune to the direction of God on how to do things. Mankind is destroying the world as we know it. It is becoming a hardened place of nothing but a Concrete Asphalt Jungle of Junk, to capture peoples interest to get their money. People multiply, and the population expands as the limited resources shrink. More people means, using more land space to create housing and the spaces used for work. This takes away land for growing food to feed the people, and then we have the problems created because of the lack of water, and clean air.

    Global Warming grabs us by our deteriorating surroundings, while we use and burn more and more Coal and Oil. People have created alternative electric methods such as Solar Power, and Wind Power, but even those ideas are submarginal, because they are limited in use. The Sun shines only during the day, not at night.  Solar is also limited in use on cloudy days. So Solar Power is in reality only 50% or less in a gradient scale. This makes it submarginal. Wind Power suffers from this as well. The Wind does not blow everyday, and when it does, it may be very strong, or too weak. This makes Wind Power submarginal as well, with in reality only 50% or less on a gradient scale.

    For the sake of argument, let me tell you, that I am one of the people on earth who believes there is God. There is certainly a power that directs me and my thinking. My thinking is always for the correct and most beneficial means for the people, and I do those things with the hope it is Gods good benevolent way.

    I have found some of Gods, True Wonders of the World. And I know this gift is from God which is given to me, to expound to the world. I am his instrument and worker to let people know; because even God knows how difficult it is for people to stop and learn, and grab hold of the truth.  Being the inventor and messenger so more people know, will only benefit mankind as we interact with each other in the Society.

    The invention I have made, can make Electricity, Water, and New Air.  I call it The Flying GEM-G.  The GEM-G stands for Gyro Electric Machine Generator. This machine does not pollute. It does not burn any combustible resource.

    My invention can replace the coal furnances in the Electric Plant. It creates the heat necessary to heat up the steam power generators, that then exports the large quantities of electricity throughout the grid.

    It can also be used individually, to make you independent from the Grid.

    The Flying GEM-G is a Gyro that spins non-stop 24 hrs. a day. It’s Electrical Production is 100%. It is a True Wonder Solution on the gradient scale.  While it spins in the Air; being supported by a central axel, it spins 8 wind turbines in balance, according to the Laws of Physics and Motion.  My invention is used inside a room inside a building. I can control the speed of how fast the Gyro spins. It can go from 10 - 50 mph; just as an electric bike can travel from 10 - 50 mph. Insodoing as the Gyro spins the Wind blades move into the Air and spin; creating its own wind.  The Wind Turbines meet the air as the Gyro spins, creating electricity. This Electricity is used for whatever Electrical intention.  As the Battery or Capacitor power, supplies the energy to make the Gyro spin, the Wind Turbines spin creating power to recharge the battery or capacitor. This allows the non-stop effect to continue in motion, creating nonstop electrical power.

    Each Wind Turbine has the same Wattage, to afford the correct balance across the radius of the Gyro wheel.  The turbines come in various sizes, from 50 watts, 100 watts, 200watts, up to 1,000 or more.

    If an Electric Bike can easily carry 3 people, as it’s rear wheel powers the bike forward, think how much easier for my Gyro wheel to spin in the air, with much less weight and friction as the Electric bike travels on.  If I use {8} 500 watt wind turbines, that is 4,000 watts. They weigh approximately in total only 80 pounds.  Very light weight in comparison to 3 guys on an Electric bike.

    My invention can power an Air Conditioner. An Air Conditioner can provide cool air, and produces water. This water is used. It is not discarded like the rest of Society does by allowing it to go down the drain as waste water. The water is only slightly acidic. Since water on the PH scale is 7, the condensed water from the A/C is 6 PH. This is not bad, since of course people eat oranges, and Lemons that have a PH of 2. The water is filtered, boiled and a few drops of peppermint, makes it a tasty drink.  I can also use this water to wash clothes, dishes, etc;  or bathe, or use to water plants for Agricultral purposes.

    So I have explained how my Electricity Machine can make both Electricity, and how it powers an A/C that produces Water.  The 3rd Wonder is that now that I have water, I can split that water, by placing an electrical charge into it. This will split the water and turn the water into Oxygen and Hydrogen. As we know Oxygen is Air, and Hydrogen is a gas, that can be used for other energy needs. When hydrogen is burned it turns back into water.

    Theoretically my machine can create new air for the Planet Earth, in aiding trees and green plants to increase the Oxygen content on the planet. These 3 True Wonder Solutions can be used to make it liveable in any hostile environment on earth. Many people can live in desert regions. Also the 3 True Wonders can be used to make available to the Space Program, to use on distant planets and even live on the Moon for mining. Not to mention the real possibility to live and dwell on the Planet Mars.

    My machine can be used to end the Pollution in the world. People can drive Electric Cars in Cities within their communities. If people really want A/C or Heat in their cars, they can install a small hydrogen powered generator in their car, that would provide the electrical power to run their Car A/C or Heat Supply. When they come home, they can recharge their hydrogen tank produced from my invention.

    Also people can have food security, by having the means to grow their own food, while escaping from crowded cities. They also are assured a steady non-stop producing water supply. We can save the ever declining supply of Oil, and stop burning it up in engines that only pollute our air.

    The Wonders grow, by thinking about other ways to use my invention. It can power a steam generator that would provide the electrical supply to power ships in the ocean, and very possible power airliners as well, not to mention the Speed Bullet Trains, around the world.

    It can supply the needed power for mining operations. 

    Another great Wonder is the fact how inexpensive it really is to make, in comparison to all the other submarginal electrical producing methods now in use today. After pricing Wind Turbines, I have found that the most it will cost to make the Machine is about 12,000 rmb, or about $1,800usd.

    Once we have established a means to select my Machine as the Energy source in the World, we have established a means to create wealth that does not pollute the Air or the Earth’s Environment. In fact it will benefit the health of the World’s Environment. It means having the capacity to have real growth, that builds upon the fact of Space Exploration, and Living on other planets in the Galaxy.

    It means real jobs, and real prosperity. It means an end to fighting over limited energy supplies, because now we have an infinite method in creating energy.

    Hope .

    Dominic Jermano

  • Mike Klug's avatar

    BY Mike Klug, The Radix Group

    ON November 20, 2013 11:04 AM

    Louis, I would like to discuss this with you at your convenience. I am also currently advising organizations in this sector, and I believe one in particular (currently working in India and Honduras) could benefit from your insights as they scale their perspective from local, small implementations to an organization with global impact.

    Please feel free to contact me at .(JavaScript must be enabled to view this email address).


    Mike Klug

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