In 2017, my colleagues and I at NEST 360°, the initiative of the Rice 360° Institute for Global Health to develop solutions for preventing newborn mortality, had the opportunity to vie for a truly big bet through the John D. and Catherine T. MacArthur Foundation’s 100&Change competition. This inspired us to step back and think about what it would take to make substantial progress to end preventable newborn mortality in sub-Saharan Africa in a way that could be sustained. Being named among the runners-up for the 2017 prize had lasting benefits beyond the $15 million reward we received as a finalist. The competition helped us build the right team and articulate a bold vision to solve this critical problem.
This collection of articles, sponsored by The Bridgespan Group, explores how big-bet philanthropy is changing the ways that social entrepreneurs, nonprofit organizations, donors, and advisors are working to have an impact on major social challenges.
Prior to 100&Change, our team members were working to address components of newborn mortality in sub-Saharan Africa. We were each approaching the issue from the perspective of our own discipline at a smaller scale, and we were making progress. For example, our group at the Rice 360˚ Institute for Global Health worked with global partners to develop and introduce a robust, low-cost breathing device, the Pumani bCPAP, that nearly triples the survival rate for premature babies born with respiratory distress syndrome (RDS). Still, based on current rates of progress, it will be nearly 100 years before a baby born in Africa will have the same chance for survival as one born in North America.
With a group of global and local partners, NEST 360° is now working to equip hospitals throughout sub-Saharan Africa with essential solutions and technologies that can cut newborn mortality by 50 percent. The opportunity for a much higher level of funding through 100&Change helped inspire our goal to scale across the continent in 12 years. Our team’s new vision is an integrated package of lifesaving neonatal technologies that work in low-resource settings. We plan to build the evidence base to generate demand for new technologies, develop distribution channels to deliver these technologies, and educate a pipeline of clinicians and innovators to use these technologies and develop even better tools. We have made substantial progress towards raising the funds to implement this vision.
As we thought about how we would employ a truly big bet, we realized that a problem of such breadth requires a multidisciplinary approach, involving various institutions, sectors, and implementation partners in different places. First, we created a multi-disciplinary dream team of experts who shared passion for and dedication to ending preventable newborn death in Africa and who could work in collaboration to address the challenge. We brought together engineers and innovators, academics and researchers, clinicians and medical practitioners, as well as local and global institutions and health experts who have been working on various aspects of this problem for decades. Our core team includes Dr. Queen Dube, a pediatrician from Queen Elizabeth Central Hospital in Malawi who is perfectly situated to manage our clinical studies and provide on-the-ground perspective; Joy Lawn, director of the Maternal, Adolescent, Reproductive & Child Health Center at the London School of Hygiene & Tropical Medicine, who focuses on evaluating the quality and effectiveness of new interventions; Kara Palamountain, executive director of the Global Health Initiative at Northwestern University’s Kellogg School of Management, who is an expert in the development and adoption of medical technologies in Africa; Robert Miros, founder and CEO of the California-based 3rd Stone Design Inc., who brings expertise in medical device commercialization and takes the lead on manufacturing and distribution for NEST technologies; and, at Rice University, Maria Oden and I bring engineering and innovation experience and a track record of developing novel low-cost solutions for global health challenges. Each team member brings a unique perspective to the challenge.
In addition to this core team, we are working with a total of 13 implementing institutions. These partners help ensure that our work happens within—rather than outside—the system. We know that solutions developed in a high-resource setting cannot simply be transferred to a low-resource setting, and we aim to put local context and experience at the center of how we design products and solutions to ensure local ownership, leadership, and sustainability of the program.
We’ve also created a strong team culture. A large group spread out in different locations may seem unwieldy, but every member is energized and united by the mission. This drive means everyone is willing to take calls at all hours to work with people across the globe. The group has deep mutual respect for what each member contributes. Our shared commitment helps us support each other through the highs and lows inherent in complex, international collaborations. In challenging moments, our team of persistent, positive people support one another.
The 100&Change experience taught us about clearly articulating our vision and building a plan to implement a sustainable solution at scale. Positioning NEST 360° for a big bet has not been simple. Because we try to think holistically about the problem as well as the solution, and because there are a lot of moving parts to our work, it is difficult to make a 90-second pitch. But we have found ways to communicate our message. For example, we invited potential funders for on-site visits, including a recent trip to Malawi—where we were able to share our overall vision with them firsthand. They saw how each part of the solution, and each part of our team, is necessary to solve the problem as a whole.