"Scaling Up" in a Time of Scarcity: Some Experiences, Observations, and Caveats (Part II)

June 30, 2011

This is Part II of a speech delivered by Gara LaMarche before participants at the second annual Conference on Scaling Impact, hosted by the Social Impact Exchange. You can read Part I here.
 
When I told Ed and Joel that I wasn’t sure what I would have to say about “scaling up,” except perhaps a few caveats, they suggested I talk about advocacy with government, since the foundations I have been associated with, OSI and Atlantic, are perhaps more than any others identified with the deployment of funding to advance certain policy goals, from reducing America’s excessive reliance on incarceration to protecting the economic security of older people. Scaling up a social initiative like extended learning time or encore careers for older adults can almost never take place without significant investment by government, and that almost never happens without some kind of advocacy, some foray into the policy world. Even foundations that start out quite focused on the provision of services, or technocratic problem-solving, like our friends at Gates, eventually find themselves on the advocacy path. Atlantic, it’s true, has a good deal of experience with that, not only here in the U.S. but in a number of other geographies in which we work.
So yes, I will talk about scaling up and government. But that will have to take account of the particular moment we are in, and I want to set out a few questions to consider before I am through. What does it mean to try to scale up evidence-based programs at a time when government is struggling for money and philanthropic assets are just beginning to recover from the financial crisis? Is the money there?
In good economic times and bad, there will always be an uphill climb for programs that work, strange as it sounds to say that, because impact and effectiveness are often no match for the pull of inertia and tradition, of patronage and politics, and evidence alone has never been enough to win the day. What, therefore, do we need to do to communicate more effectively about proven programs? To build the missing constituency for effectiveness?
Most of what I have to say today pertains to the United States, but I’ve learned much about models of working with government from Atlantic’s staff in the other geographies in which we make grants, and I want to touch on those models in thinking about the relationships between government and philanthropy in the U.S. In the Republic of Ireland, a small country where Atlantic is by far the largest funder, there is little tradition of investigative journalism and few think tanks to influence policy. Civil servants are of a generally high quality, and government is very centralized, so we form relationships with them—with the permanent government, as it were. This paid off over the last fifteen to twenty years in co-investments by Atlantic with the Irish government in strengthening the research capacity of higher education, in Harlem Children’s Zone-like youth development programs, and in the appointment of key ministers to advance the concerns of older adults in both the Republic of Ireland and Northern Ireland.
In South Africa, Atlantic’s Population Health program negotiates with the national Department of Health to support some of the costs of upgrading nursing training facilities, and our Reconciliation and Human Rights program has partnered with the Department of Land Affairs to provide legal advice and support to farm workers who face illegal eviction. The Legal Aid Board, which provides legal support for indigent people, has entered into a partnership with our grantee the Association of University Legal Aid Institutions to provide support in some rural areas. The Department of Social Development provides support to some advice offices in the Western Cape which also receive support from Atlantic, and the Department of Education matched an Atlantic grant to build a Life Sciences Complex at the University of the Western Cape.
In Viet Nam, of course, the government’s role is quite pervasive, and Atlantic’s program has to interact quite closely with it. But there are many levels of government, and depending on projects’ needs and administrative requirements, we work with the appropriate level of government as needed. In Viet Nam this ranges from public health campaigns such as mandating motorcycle helmets to dramatically reduce traffic fatalities and injuries to cofinancing the upgrading of rural commune health clinics. Atlantic’s investments in Viet Nam, particularly its capital investments in hospitals and health clinics, have been able to bring major projects to scale, with incredibly positive impact on health outcomes in the country.
The Ministry of Health is our partner in raising needed matching funds for projects such as the construction of the National Hospital of Pediatrics in Ha Noi, for which approximately $10 million in Atlantic support has yielded $3 million in equipment from the Japanese government and a $40 million commitment from the Vietnamese government toward the full redevelopment of the hospital. A $12 million grant to the School of Public Health produced an equivalent donation from other sources for construction, training, and equipment; the Hue Central Hospital turned $20 million of Atlantic investment over ten years into more than $50 million from other donors; the Da Nang General Hospital pivoted $11 million in construction support into over $20 million for equipment. Atlantic’s investment in the upgrading of rural health communes like the one at A Luoi district comes in the form of a grant to provincial health departments that is matched on a one-to-one basis, and on the evidence of this success, the Vietnamese government is now prepared to commit $400 million for the next three years to scale up this model nationally.
Here in the United States, Atlantic’s relationship to government has over the years taken two forms. The first is essentially adversarial. We fund organizations that monitor, criticize, and sue the government, like civil rights groups fighting draconian restrictions on immigrants cropping up all over the country, and civil liberties lawyers challenging Guantanamo and warrantless wiretapping. I’m sorry to say that this aspect of our work has not changed very much from the Bush to the Obama administrations. Atlantic has become well known for our $26 million grant to Health Care for America Now (HCAN), the largest grant ever made by a foundation for advocacy, which played a critical role in organizing support for comprehensive health care reform from 2008 to 2010, aligning with a key objective of the Obama administration. But this grant, too, was in an important sense adversarial, mobilizing support for the public option and other more strongly progressive measures when the administration was often too inclined toward compromise.
In fact, the last two years, with a progressive President in office who is more committed than his immediate predecessor to a number of Atlantic’s strategic objectives, have been sobering—among other things, they have provided a civics lesson in how Senate rules and the institutional rivalries between legislative chambers and branches of government can combine to frustrate reform. We will be careful to study the experience of engagement during the past few years and learn from it. It seems evident to me that the campaigns and civil society organizations that have been built and strengthened by the support of Atlantic and other foundations have improved the climate for more progressive policies and helped keep the Administration accountable to its professed values and goals. But in the endgame of policy, particularly where huge economic interests are at stake, as in health care and financial reform, this is far from determinative. And the aftermath of those battles, where Atlantic and our partner foundations have had to continue a serious level of investment just to protect and implement gains only recently won, shows that big change is a long-haul proposition.
The second kind of relationship we have to government in the U.S., as elsewhere, takes the form of partnership, from working with the Corporation for National Service to provide more placement opportunities for older adults to the state of New Mexico and the cities of Oakland and Chicago to match our investments in integrated services for middle school students.
Holding government accountable on the one hand and working to leverage public funding on the other has been standard practice for Atlantic and other foundations engaged in public policy for a number of years. But in the last few years in Washington we’ve seen something that goes beyond the carrot and the stick. We’ve seen serious efforts to change the way government funding works, moving to base policies and programs on a more sound evidentiary basis. After years in which federal policy has often run in the opposite direction from the evidence, whether on climate change, criminal justice, or abstinence programs, this is quite welcome indeed.
The establishment of the White House Social Innovation Fund, inspired by the rigorous approach to evaluation and evidence promoted in recent years by foundations like Edna McConnell Clark, Gates, and Hewlett, is the most visible example of this commitment, though it can be seen, at even greater scale, in the Race to the Top Fund of the Department of Education, in the i(3) Fund, and in numerous other government agencies.
The foundations mentioned and several others have been quite closely engaged with this because the Social Innovation Fund represents a welcome and audacious effort to take a strong philanthropic trend of the last five to ten years and employ it in government, which is by many multiples is a much larger funder than private philanthropy. There are plenty of reasons why the Obama Administration’s evidence-based initiative might not work out, and of course it’s still early days yet, with the initial grants only recently made. The money being offered is relatively modest, the matches required of intermediaries and nonprofits are fairly steep, the number of qualified intermediaries may not be high enough for necessary critical mass, normal politics may at any point raise its head and compromise the effort, and so on. But I don’t see who could argue with the goal of having government funds flow to proven programs, or who would have a reason not to wish the effort well.
 
Tomorrow: Part III of Gara's speech.
 

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