Going global: How to scale an innovation from local success to international impact
Adaptation of successful programmes to new contexts was one of the key themes at this year’s Sexual Violence Research Initiative (SVRI) Forum.
Ian Brightwell, Elrha’s Humanitarian Innovation Manager for Scale and Gender-based Violence (GBV), attended the Forum. He describes the overlaps between lessons shared there and the six tactics for adoption identified in our latest learning paper, ‘How to Scale: Tactics to Enable the Adoption of Humanitarian Innovations’.
Adoption and adaptation. Both terms sit within the broader strategic aim of maximising the impact of innovation through scaling. Elrha sees scale as building on successes to ensure solutions reach their maximum potential, have their greatest possible impact, and lead to widespread change.
A key pathway to scale is adoption or uptake — when an innovation is accepted and used by a relevant person or entity, especially in a new context. Meanwhile, adaptation is a process that some interventions undergo to ensure relevance across different contexts. It might mean adapting content to a local language or legislation, adapting components to local climates or supply chains, or adapting approaches and methods to suit different cultures, customs and norms.
Experiences presented at the recent SVRI Forum showed the importance of approaching adoption and adaptation intentionally and strategically. This is a central message, too, of the successful case studies explored in ‘How to Scale’.
Practical guidance to drive adoption
As Ben Kumpf and Emma Proud recently pointed out, adoption for humanitarian innovation is rarely discussed, and the experience needed to bring it about is uncommon. Elrha grantees say that, often, guidance on scaling is highly conceptual. They say it’s hard to find concrete examples of how innovators have scaled from success in one context to a model adopted across multiple contexts or organisations.
This drove us to identify effective tactics and compile them into practical guidance. We interviewed people who’ve found ways to drive adoption of their innovations and published our findings as the third in a series of learning papers on scaling innovation.
Read ‘How to Scale: Tactics to Enable the Adoption of Humanitarian Innovations.’
Drawing on nearly a dozen successes, we identified six tactics for adoption. We include five deep-dive case studies — Wash’Em, Start Ready, RedRose, DMS-Himalaya, and Mum’s Magic Hands. Each brings the big ideas to life, outlining how at least two or three tactics have been central to uptake of these innovations across contexts.
The paper is a user-friendly playbook for innovators whose scaling strategy is based on other organisations or entities adopting their innovations.
Delving into the first tactic, we can reflect on the interplay between adoption and adaptation. The long-term role that an originator or innovator chooses (or stumbles into) establishes their relationship with the adopter. Crucially, the business model affects the resources needed to support an adoption and establishes the level of influence retained over the adaptation process.
Retaining a high level of control can be resource intensive and, unless there is financial backing, it may lead to an unsustainable or unfunded model for adoption. Taking a light-touch advisory role, or an open-source approach, may unleash mass adoption. But this can give rise to other risks, such as loss of fidelity to core components of the innovation, or requiring adopters to implement time-consuming adaptation processes.
Getting adaptation right (and wrong)
At the SVRI Forum, models such as SASA! and Indashyikirwa were frequently mentioned as highly adaptable behavioural change models. These models have succeeded in reducing rates of GBV in more than one context. Even with a strong grounding in success, though, the risk remains of an adopting agency making an adaptation too far.
A presentation on SASA!’s adoption around the world identified three ingredients for success — using the right organisations and communities, the right technical assistance, and the right funding structure. With these ingredients, the scope for successful adaptation can be limitless.
One presentation showed that crossing continents and cultures need not be a barrier. This was exemplified by the adaptation of Indashyikirwa couples-based intervention to Syria — a world away from its Rwandan origins.
But a cautionary tale highlighted the importance of retaining fidelity to the core qualities of the proven intervention. When Indashyikirwa was adopted by a new implementing partnership in Rwanda in 2018, there were significant differences to the version that had proved successful. The adaptation introduced lower levels of training and experience for course facilitators, lower ratios of supervisors to facilitators, and lower ratios of facilitators to participants. The decisive difference remains unclear but, after this adaptation, the intervention now produced negative results. Adopters’ cutting costs or accelerating timelines can optimise an innovation’s reach, but risks compromising its impact.
Participatory design — the key to successful adaptation?
The Addressing Reproductive Coercion in Health Settings (ARCHES) intervention is adaptable and scalable. This was the message from a side-event at the SVRI Forum, which showcased different adopters’ experiences of adapting the clinic-based intervention ARCHES. The intervention trains clinicians to understand and identify reproductive coercion, and to support patients experiencing or at risk of this form of violence.
Panellists stressed that adaptation takes time and requires deliberate engagement processes. Even within a single country, there may be more than one context to consider. For example, although ARCHES has been successfully adapted to urban health settings in Mexico, further adaptations may be needed to assure positive results in rural areas.
Similarly, in Bangladesh, adopting organisation IPAS recognised that it would take more than just an adjustment of language for ARCHES to be effective in health centres serving Rohingya refugees. With Elrha’s support, IPAS launched a participatory adaptation process ensuring Rohingya women and girls had a chance to express how they wanted healthcare providers to address reproductive coercion.
Each stage of adaptation took time — five or six months to adapt ARCHES to the Bangladeshi context, and then a further three or four months of user-centred co-design to meet the needs of the refugee Rohingya population.
In Nigeria, too, where Jhpiego is leading the adaptation of ARCHES, a participatory process was key to success. Engaging local stakeholders helped build local ownership of the intervention, and avoided feelings of foreign imposition. Nigerian healthcare workers contributed ideas to help ensure the intervention was linked into and enriched by existing tools, systems and processes.
Tactics to guide adoption and adaptation
After the whirlwind international conference, with hundreds of presenters reporting amazing work being done to innovate and adapt interventions to address GBV, it’s been great to return to my Elrha files and see with fresh eyes the value of our publication ‘How to Scale’.
While our paper focused on the adoption pathway, there are valuable lessons for adaptation, too. It was remarkable — and perhaps not surprising — to see how many of the lessons for adaptation from the SVRI Forum rang true with the tactics for adoption set out in our learning paper.
Take ARCHES as an example — designed to be easy to integrate into health settings (Tactic 4), using participatory approaches to ensure they build on what already exists (Tactic 3) and — through engagement with health authorities, practitioners and target communities — they’re working with the entire adopter (Tactic 5).
It’s crucial that the humanitarian sector embraces successful innovations. With significant barriers to scaling innovation, it’s vital we focus on finding and investing in new ways of working. As demonstrated by Indashyikwira, even where an intervention is successfully adopted internationally, there may be corrections to make along the journey to scale. For the adoption pathway, ‘How to Scale’ captures the experiences and lessons from those that have already successfully made the journey to scale, so that you can apply them to your own.
