Scaling Kangaroo Mother Care in Cameroon — It’s all about bringing people together

Tuesday, 12 September 2017

By Dominique Carrie, Associate at Social Finance

In the past few months, a few people have asked me what I was doing on a daily basis at Social Finance and I’ve happily told them about what designing an impact bond requires: thinking through the operational model with the service provider and the government as necessary, carefully developing the payment mechanism that outcomes funders would use to compensate investors for the delivery risk they are taking, building a financial model to determine the required budget and possible terms of investment, reaching out to potential investors, preparing term sheets and contracts with all parties, setting up governance and performance management structures that ensure the success of the project, etc. The list of workstreams and tasks is long and the amount of details that one chooses to provide only depends on the audience, their priorities, and level of interest.

The reality however is that this list gives an incomplete picture of what our work at Social Finance really is all about: bringing people together and aligning their effort towards the same goal, i.e. tackling a specific social challenge.

The Kangaroo Mother Care Development Impact Bond (DIB) that Social Finance is designing in partnership with the MaRS Centre for Impact Investing is a good example of the importance and challenge of bringing together various stakeholders. For a bit of background on this project, Kangaroo Mother Care is an evidence-based approach to caring for and saving low-birth-weight and preterm newborns who are particularly fragile. It involves long periods of skin-to-skin contact and exclusive breastfeeding whenever possible, with the caregivers basically becoming the source of nutrition and warmth for the infant. The DIB aims to scale this method in Cameroon through a train-the-trainer model: the Kangaroo Foundation Cameroon trains Centres of Excellence, which in turn train other regional hospitals, thereby institutionalising KMC expertise in the healthcare system.

So how many stakeholders are we working with?

First, a DIB requires outcomes funders to guarantee repayments to an investor if the project is successful (i.e. if agreed metrics have been achieved). This DIB has three committed outcomes funders: the government of Cameroon (drawing on funds from the Global Financing Facility managed by the World Bank), and two Canadian non-profits[1] — Grand Challenges Canada (GCC) and Nutrition International (NI). We’ve been very lucky on this project to be supported by internal champions in each of those organisations, which has been crucial to move the project forward.

Second, we need a service provider to implement the project: that’s the Kangaroo Foundation in Cameroon. As it is still a young foundation, they continue to be supported by the Kangaroo Foundation in Colombia, which has been a crucial partner in developing the project thanks to their long experience and strong technical expertise. We shouldn’t forget also to mention that the government of Cameroon is not only providing funding but is also a key player to collaborate with on the operational side since KMC will be deployed in the public healthcare system. This collaboration involves for example allocating medical staff to our project and ensuring the long-term sustainability of KMC beyond the end of the DIB. We also work with a local consultant, Abongta Moncha, who supports us on the ground in our discussions with various stakeholders, including the twelve hospitals that will likely participate in the DIB. So when we say that we’re “developing the operational model”, what we really mean is that we’re in constant conversation with stakeholders to understand how to best deploy KMC on the ground, how to navigate the local context, and how to engage people on the front line to ensure the long-term success of the programme.

Then, you have other organisations providing specific skillsets to this project, including MaRS Centre for Impact Investing (our Canada-based partner intermediary), pro-bono legal support (from Morrison & Foerster and Miller Thompson) and local tax and legal support. We’re also in the process of contracting a company to develop a data management system for the project as well as an independent evaluator, who will assess hospital records and other sources of information to determine, objectively, whether outcomes have been achieved during the DIB.

And this list doesn’t take into account the amazing people we regularly draw knowledge from, including for example the project advisory board, and the potential investors we are currently talking to. We’re indeed looking for an organisation to join the project as an investor and as such provide the upfront required capital of up to $2m USD.

So we’re looking at more than 15 stakeholders (30+ individuals) from at least 4 different countries to collaborate with and regularly update on the project. This definitely comes with challenges as it takes time to update each individual involved in the project (the time difference doesn’t help) but importantly because it takes time to listen to them, understand where they’re coming from, their points of view and the challenges they face, take into account the cultural differences, learn from their experience and discuss how best to move forward together. Once you manage to do it though, it becomes the most rewarding experience, getting closer, step by step, to launching a life-saving intervention as each piece of the puzzle is finalised and agreed on.

[1] The government of Cameroon has committed $2m USD of funds for this project, while GCC and NI have committed $800k USD each, bringing the total outcomes funding available to $3.6m USD

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