Systems Innovation Blog Series - Part Four: Systems Innovation – Building Blocks
By Benjamin Kumpf (OECD), Nina Strandberg (Swedish International Development Cooperation Agency) and Robbie Barkell (UK Foreign, Commonwealth and Development Office). Illustrations by Vidushi Yadav.
*Disclaimer: The views expressed in this blog series are the authors’ own and do not reflect the official positions of their home organizations, and not of the International Development Innovation Alliance.
In this five-part blog post series we share some of our lessons on advancing systems innovation practices in bilateral development organizations. With this, we seek to advance conversations on improving innovation efforts in the international development sector. In the first post, we describe what systems innovation is. In the second post, we make the case for systems innovation. The third post discusses some lessons from international development cooperation that inform our approach. In this fourth post, we present promising practice and building blocks of systems innovation. The final post shares five questions to help advance systems innovation practices in international development organizations.
Today, there are about 218 million women and adolescent girls in low and middle-income countries who would like to avoid or delay pregnancy, and who do not have access to contraception. Ensuring universal access to family planning methods is a complex challenge. Its success depends on making cost-effective contraceptives in low- and middle income countries available, also on improvements in national and local health systems, renegotiations of power dynamics in households and a shift in gender norms – to name a few. Gender equality is both a precondition and an accelerator of women’s reproductive health and rights.
Obviously, a single technological innovation doesn’t suffice to address this complex problem. Rather, a set of integrated interventions and innovations to advance changes in social, cultural, economic, political and technological systems. We call this “systems innovation”. We are working in our agencies and together as a working group of the International Development Innovation Alliance on advancing the practice of systems innovation.
Currently, all of our organizations are working on universal access to contraceptives in low- and middle-income countries. To highlight some of the components of systems innovation in practice, let’s take a closer look at a programme of the UK Foreign, Commonwealth and Development Office (FCDO). The programme ‘Establishing a New Contraceptive Method’ is a collaboration with USAID and partners such as national governments from low-income countries, civil society and feminist organizations, and local health care providers.
The fact that our unit of analysis is a time-bound programme is revealing and representative of barriers for systems innovation in our sector. As we will lay out, systems innovation requires sustained commitment and financing that exceeds the limited time spans of development programmes. Along with space for experimentation that goes beyond the ‘projectification’ of bilateral development provision.
We outline the building blocks of systems innovation by describing the FCDO programme with these limitations in mind, as it reflects realpolitik in our agencies.
Let’s start first with the goal of the programme: the main objective is to establish DMPA-SC – a self-injectable contraceptive – as a new, commercially sustainable contraceptive method in over 20 low-income countries. A key element of the programme is a public-private partnership between Pfizer – the product manufacturer – and a small donor consortium. This partnership brokered and supports a volume guarantee between 2017 and 2022 in which Pfizer commits to increasing production capacity and reducing the price of DMPA-SC in return for minimum market sales over a five-year period. This price deal aims at the product exiting its high price/low volume market trap, and to make it widely available and commercially sustainable. The programme anticipates that from 2022 and beyond, generic suppliers of DMPA-SC will enter the market.
A closer look at this programme and other promising practice led us to propose a set of building blocks for systems innovation. We lay these out with brief descriptions of the UK FCDO’s programme components, as we are now embarking on a learning journey with the Systems Innovation initiative
of the Rockwool Foundation. Part of this journey will be to challenge and refine these building blocks of systems innovation:
Imagination: the notion that women and men deserve equal rights and opportunities was once a radical one. The concept of providing every woman with the right to decide if and when she wants to be pregnant, and separating sexuality from reproduction required imagination of a future state that was fundamentally different to the lived realities of the women and men who shaped this vision.
Individuals, activist groups and organizations historically played and still play an important role in shaping systems by challenging the status quo and imagining not only better but radically different futures. In the case of contraceptives, the development and approval of the daily oral contraceptive pill in the United States in 1960 wasn’t only a success of medical researchers. It can be traced back to individuals and feminist groups, advocating and mobilizing for gender equality and for women’s reproductive choices over a prolonged period of time.
Our work today is shaped by the long history of struggles for gender equality, premised on shared social imagination.
A key challenge for all systems innovation endeavours is to collectively imagine radically different futures, for our and for future generations. In international development, a further challenge is to establish better ways to have local partners lead such imagination. And to lead experimentation to put such visions into being.
Strategic intent: the overarching intent is to contribute to gender equality, to choice and dignity for women and girls. This is further specified in measurable objectives. For example, the provision of universal access to sexual and reproductive health services and rights by 2030 is embedded in the Sustainable Development Goals 3 and 5. In 2012, governments and partners committed to addressing contraceptive needs, with a vision of reaching 120 million women and girls with modern contraceptives by 2020 at the first London Family Planning Summit. This goal was not reached, but building on lessons from the past eight years, the core conveners of the global family planning community are facilitating a new process with government-led visioning exercises for 2030. The investments in coalitions, in movement-building and the role of organizations that act as facilitators across networks, geographical and social boundaries are essential in catalysing this global commitment across stakeholders.
Nested in the global commitments and the local ownership of the family planning goals is the market-shaping programme for new contraceptives led by the UK FCDO. The objective is to expand the number of women and girls having access to safe contraceptives, and to contribute to sexual and reproductive health and rights.
Systems innovation endeavours require a strategic intent, and the openness to broad participation and sequential and iterative processes of further defining and periodically renewing this intent with partners.
Complexity appreciation: the colleagues working on this programme face a challenge that is permeating development organizations and governments worldwide: how can we design and manage programmes and advance policies that effectively address complex development challenges while attributing the implementation of public funds to progress, and without creating too much staff workload? The programme was not designed as an explicitly adaptive programme. However, it is designed to make adjustments in response to new information and changes in context. This includes the joint development of systems maps for global and national sub-systems with partners. Also in-depth analysis of gender and power relations, assessment and continuous monitoring of potential unintended consequences such as increases in numbers of new HIV infections, and incorporating diverse forms of evidence including lived experiences of frontline health workers, and women and girls seeking access to safe contraceptives and women who do not intend to use contraceptives. The colleagues managing the programme emphasize the importance of making national health systems, their dynamics, outputs and paradigms visible and graspable with the partners working in this system.
Systems innovation is premised on critical reflections of how formal and informal aspects of systems have historically evolved, how people in the system represent them today and how these insights can be generated by people living in the system and put into practice through a range of experiments.
Diverse innovations: providing more choice and agency for women and girls requires a multitude of innovations and interventions. A key aspect of the programme is a technological solution, the injectable DMPA-SC. The programme acknowledges the importance of other family planning methods in the mix and is currently working on operationalizing lessons learned from the DMPA-SC partnership to shape other family planning commodity markets. For example, multiple organizations from the reproductive health community are now working to increase access to the hormonal IUS – a highly effective long-acting reversible contraceptive that has been available in high-income countries for over 30 years but is still not widely available in low- and middle-income countries. But as all systems innovation practices, the programme focuses on other innovations. For example, designing new procurement and partnership modalities to facilitate the advanced market commitment between Pfizer and the donor consortium. This market-shaping approach is not about top-down implementation of international organizations to solely de-risk investments and level the playing field, but rather about tilting the playing field in the direction of desired social outcomes. Shaping markets also includes investments in movement- and alliance-building with national governments, health care providers, education systems, religious institutions, pharmacy and health centre networks as well as with women’s and feminist organizations. The programme accordingly budgets for investments in the relational ‘dark matter’ that is in practice so decisive for how social systems work and what outcomes they produce. With ‘dark matter’ we refer to “the often imperceptible yet fundamental facets—the organisational cultures, the regulatory or policy environments, the business models, the ideologies—that surround, enable and shape the more tangible product, service, object, building, policy, and institutions” as Dan Hill describes the concept.
Systems innovation entails a broad range of innovations, alongside traditional interventions. It combines technological advancements with advancing innovations in social and cultural domains, on multiple governance levels, within established institutions and to develop new business models.
Portfolio approach: not one intervention or innovation, nor one single organization can strengthen or transform a system. It requires a multitude of interventions, for a government or a funder nested in a portfolio that puts diverse forms of innovation at its core and that is premised on continuous collective learning and adapting. Along with other development organizations, a number of our agencies are currently exploring innovation portfolio approaches. This approach seeks to bring together multiple organisations that address the same or a similar complex challenge. Chora Foundation frames innovation portfolios in a Green Paper as “portfolios of strategic development options. These are system capabilities, learning, sensemaking and problem-solving mechanisms designed and leveraged by an entity or a constituency with the intent to induce transformational effects.” Mikael Seppälä from the Finish Innovation Fund Sitra describes the distinct functions of innovation portfolio practices in the paper ‘Radical uncertainty requires radical collaboration’ as: “1) identifying challenges that require systems transformation; 2) setting out how the whole portfolio seeks to make an impact; 3) composing a collection of projects with shared intent; and 4) engaging in sensemaking, generating insights and changing activities.”
The market-shaping programme is in fact not a prime example of an innovation portfolio approach. It is a time-bound programme, designed in the predominantly linear parameters of a bilateral development agency. But it does include a number of practices of innovation portfolio approaches. For example, the programme consists of a set of inter-related interventions and multiple innovations, and these programme components are being managed with a sense-making approach. For each focus country, partners from the global coalition and from the national level get together on a regular basis for reflection and planning sessions, considering available evidence, including lived experience on changes in the operating environment, on progress of the multiple programme elements and to leverage available quantitative data along with qualitative reflections –to generate insights and extract intelligence.
The programme itself is part of a global effort comprised of multiple programmes and initiatives by a variety of organizations and coalitions that seek to advance access to safe contraceptives. The sum of the various initiatives does not constitute an innovation portfolio that is stewarded by any player. Rather it emerged from successfully mobilizing political will around family planning across nation states and international organizations. While the accumulated efforts are not managed as a portfolio, some stakeholders took on roles as orchestrators, helping with collective learning and adapting such as the FP2030 initiative.
Systems innovation is about trying to orchestrate systems change through portfolios of diverse interventions and innovations that practically explore how to make progress in shifting a system to a healthier state. Systems innovation entails investments in coalition- and movement-building, and it progresses through continuous collective learning and adapting across the portfolio.
Sustained commitment: providing all women and girls who would like to use family planning methods with safe access often requires changes in dominant gender norms, among other shifts. Such norm changes take a long time, and often progress plateaus before further advancing – or rolling back. Systems innovation requires long-term support, and as such it requires different forms of financing, beyond traditional programme or project designs. This is a true statement also for scaling single-point solutions, as we know that successful single-point innovations can take up to a decade or more to scale
The market-shaping programme was designed for an initial period of five years, linked to other programmes supporting family planning interventions under the FP2030 umbrella. The colleagues who designed and manage the programme know that sustaining political support for the market-shaping endeavour is a prerequisite for success. Accordingly, there is deliberate effort to secure political buy-in with a multitude of (behind-the-scenes) advocacy and influencing tactics, requiring dexterity in navigating political economies and shifting priorities. However, to move beyond the current time-bound finance design which is premised on budgeting for projects, the team is looking at emergent alternative financing models.
Systems innovation requires sustained commitment and to help secure this, new financing modalities are needed. Along with monitoring frameworks to monitor shifts towards intended outcomes.
Power reflections: There are multiple forms of power in any system, and in any systems innovation effort in international development we deem it necessary to interrogate our position of power in the respective systems. In the case of the FCDO programme, explicit discussions on how this intervention might contribute to shifts in power within families and within national cultural contexts, and how it might perpetuate existing power and exclusionary dynamics were emphasized from early design stages. An essential component of the programme is to not only expand access to contraceptives but to improve agency of girls and women. Shifting gender norms and advancing gender equality necessarily touches upon power and privileges. This entails a broader understanding of power and is not limited to a ‘power over’ framing, which describes power of those with leverage over others.
There are three additional aspects of power: ‘power to’ refers to the capability to act upon an intent, ‘power with’ depicts collective power and ‘power within’ describes personal self-confidence and self-efficacy. Measuring shifts in power dynamics and improvements in agency is highly complex, and the programme partners are working on testing monitoring pathways that can measure attributable shifts in women’s and girl’s agency. Behind the scenes, partners discuss openly the various power dynamics between funders and partner governments, between funders and implementers and between ‘norm entrepreneurs’ within partner countries and people who seek to maintain the status quo, or seek conservative roll-backs.
Systems innovation requires the commitment to understand and shift multiple forms of power. This includes reflections of power dynamics we introduce, the historical context in which we operate and our role as development providers.
The FCDO programme is one of many examples of development programmes that entail important building blocks of systems innovation, albeit with limitations. It deals with specific levers in the various systems, but it doesn’t challenge the current market paradigms. It connects to other initiatives and partners that work on different levers and we are working on a number of similar initiatives to advance systems innovation. This includes work in the Dutch Ministry of Foreign Affairs on circular economy systems, in Swedish Sida on helping to transforming energy systems in a number of partner countries, to name a few.
In all of our agencies, promising practice is happening. We are “mapping, observing, and listening to the system to identify the spaces where change is already happening and try to encourage and nurture them,” as Ben Ramalingam suggested back in 2013. Many of the promising practices we identified in our agencies are not labelled as ‘innovation’. Our intent is to learn from such practices, to create the space for further testing and learning within and across agencies. In the next post, we are sharing some practical steps we are taking and challenges we are addressing in operationalizing systems innovation.
We would like to thank Ben Ramalingam for his kind and critical support throughout the drafting process of this blog. Huge thanks also to Aarathi Krishnan (United Nations Development Programme), Alan AtKisson (Swedish International Development Cooperation Agency), Ammaarah Martinus (Western Cape Government), Anne Germain (Global Affairs Canada), Asha Meagher (OECD), Angela Hanson (OECD), Antony Herrmann (UK Foreign, Commonwealth and Development Office), Constance Agyeman (Nesta), Dave Milestone (McKinsey) Dominik Hofstetter (Climate KIC), Emma Foster (UK Foreign, Commonwealth and Development Office), Karlee Silver (Grand Challenges Canada), Morag Neill-Johnson (Results for Development), Peer Priewich (German Corporation for International Cooperation GmbH), Rahul Malhotra (OECD), Will Spencer (USAID Centre for Innovation and Impact) and Yara van Heugten (Dutch Ministry for Foreign Affairs) for critical and constructive feedback on earlier versions of this blog series.
