Scaling Up and Investing in Innovation

What do we know about innovative health programs that achieve scale? What do impact investors want to know about health programs when making investment decisions?

These are the key questions the Toronto Health Organization Performance Evaluation (T-HOPE) team--housed at the Li Ka Shing Knowledge Institute at St. Michael's Hospital--aims to address at the [Unite for Sight Global Health and Innovation Conference](, taking place April 13-14 at Yale University.

This conference is the world’s largest global health conference with 2,200 participants engaged in global health, social entrepreneurship, and international development from over 55 countries expected to attend. We have studied the CHMI data set of [innovative health programs]( over the past year, and will be presenting research posters on scaling up health innovations and impact investing in the health sector.

**Scaling Innovations in Global Health**

Scalable models of care are necessary for achieving universal access to health care in low-and-middle income countries. While scaling up health services is an urgent challenge, it has been difficult to assess the ability of programs to scale and identify the key factors responsible for shifting a promising pilot to a successful large-scale program, either within or across countries.

Our research focuses on programs that have scaled up by operating in more than one country. In a review of the nearly 1,200 private health services providers in LMICs in CHMI's data set, we examined 122 programs that have achieved transnational scale and compared them to 1,068 single country programs.

Key findings from comparing programs that have achieved transnational scale to those operating in one country include:

* The three most common health areas for programs that have achieved transnational scale were: HIV/AIDS, family planning & reproductive health (27%), maternal & child health (24%). This contrasts with single country programs, where general primary care (38%) was the most common health area of focus, while HIV/AIDS represented only 20% of these programs.

* Non-profit programs are particularly likely to achieve transnational scale, while for-profit and government actors are more likely to focus on single country programs.

* While donor support is important for all programs, it is particularly important for programs that achieve transnational scale; government funding, membership fees, and out-of-pocket funding are somewhat more likely for single country programs.

We will be sharing these findings and others at the conference in an aim to offer insights for policy-makers, funders, investors, and program managers who are seeking to increase health impact.

**The Gap Between the Performance Reporting of Innovative Health Service Organizations and Impact Investing Standards**

Impact investment is a promising approach to financing health care innovations in low-resource settings. In order to make decisions on which health programs they should invest in, they require information on the health impact and organizational sustainability of potential investees.

But what performance measures are most of interest to these investors, and how are programs currently reporting this information?

By reviewing the performance reporting provided by a diverse subset of 109 well-documented programs in the CHMI database, we devised a performance measurement framework identifying and defining 14 feasible and credible indicator categories. We then examined performance reporting standards expected by major impact investors and categorized these standards according to the T-HOPE framework.

In comparing current reporting levels by health programs and standards desired by impact investors, we found the following areas of interest to investors to be well covered (over 50%):

* Health output (91%)
* Affordability (54%)

The following areas of investor interest were not well reported (under 50%):

* Population coverage (16%)
* Pro-poor targeting (25%)
* Health outcome (45%)

Given these findings, we encourage the use of a comprehensive performance measurement framework that is feasible to raise the level of performance reporting to a level that attracts a bigger volume of impact investors and investment capital.

Through understanding the scale up of health initiatives and improving performance reporting to attract investment, our aim is to promote greater discourse on identifying and supporting successful innovations for improved health in low- and middle-income countries.

*Our research team will be presenting this research in the poster session at the Unite for Sight Global Health and Innovation Conference taking place April 13-14 at Yale University. **Click on the attachment** to view the posters!*

*T-HOPE is led by Dr. Onil Bhattacharyya at the Li Ka Shing Knowledge Institute at St. Michael's Hospital, and Drs. Anita McGahan and Will Mitchell at the Rotman School of Management, University of Toronto. To learn more about T-HOPE, please contact Dr. Kate Mossman at mossmank at*