Beyond Scaling Up: Making markets work for the poor

Beyond Scaling Up: Beyond Scaling Up: Pathways to Pathways to

Universal AccessUniversal Access

IDS, Brighton 24th- 25th May 2010

Alan Gibson, The Springfield Centre

Learning from the ‘Making Learning from the ‘Making Markets Work for the Poor’ Markets Work for the Poor’

(M4P) approach (M4P) approach

Objectives

The M4P approach as a framework to conceptualise “scaling-up”

Examples of interventions in other sectors where:- things have been done ‘differently’- larger, more sustainable impact achieved

Potential implications for the health sector

Springfield Centre | Making markets workSpringfield Centre | Making markets work

Different sectors …. but familiar issues

The poor as consumers

How to expand access (and not just “more of the same”)

Impact now and the future (sustainability)

Need to make systems more effective/inclusive

Roles of key players - the state, private sector, other etc

‘Public goods’, ‘merit goods’


Health is distinctive….. ….. but there is common ground

Finance Agriculture

Land Water

ServicesEnergy,

CommoditiesEducation

Etc

Example 1: Financial Services in South Africa


ProblemLow access to financial services

Approach: set-up and fund organisations to provide directly.

OutcomeMinimal increase in access

Weak organisationsLimited sustainability

Conventional aid programme

Different analysis: causes not symptoms Poor coordination, weak information services, inappropriate ‘rules of the game’ (formal and informal) - undermine incentives and capacitiesDifferent actions: introduce new syndicated info service, technical assistance for better regulation and new coordination mechanisms, selected support for innovation

Different outcomeAccess grows by 8m people (38% to 60%)

New information serviceBetter regulation

New business models/innovation

Systems approach

Improving access to financial services in South Africa

What happened? - looking through the systems framework


RULES

Laws

Info

rmal

rules

&

norm

s

Standards

Regulations

Informing & communicating

Setting & enforcing rules

Demand SupplyCORE

SUPPORTING FUNCTIONS Information

Stak

ehol

der

Coor

dina

tion

Related

services

Product

Dev’t

Conventional focus

Intervene to address

constraints

What happened? - enhancing the ‘access frontier’

Have now

Existing system can reach now

Existing system can reach in future

Beyond reach of existing system

Don’t want it

Changing the system –

expanding access

Usa

ge

Time

Example 2: Horticultural information in Bangladesh


ProblemOutput and productivity low among small farmers

because they lack access to appropriate information.

Different analysis: causes not symptomsIdentify - existing info providers, incentives to provide

accurate advice, constraints to better advice

Different actions: Introduce new training programme provided by input suppliers for agriculture retailers, Build on retailers incentive to offer good advice, work with several suppliers

Different outcome:4,000 retailers - up to 1 million farmersIncreased yields on average one-third

Crowding-in more suppliers with incentive to grow a

Systems approach

Approach: provide information directly or support government

extension services

Outcome: low coverage

limited sustainabilityInfo. constraint not addressed


Example 3: health worker training in Bangladesh


ProblemA shortage of qualified health personnel caused by lack

of access to appropriate training.

Different analysis: causes not symptomsInappropriate rules on curricula, entry criteria and

performance.

Different actions: Series of actions to work with private and public players to ‘move’ govt from provision to oversight/regulation.

Different outcome:More registered training providers (more access)

More standardised qualityMore acceptance of pluralistic system

Systems approach

Approach: set up or fund public or NGO training

providers

Outcome: low coverage

limited sustainability‘bifurcated’ training market


Other initiatives of interest (without the M4P label)

• New partnerships in the supply chain• Crowding-in competing actors• Technology transfer and investment in domestic manufacturing

• Ultra-low cost private start-up enterprise enters slum area

• Model for expansion aims for 150 schools across Kenya alone

Primary education in urban

slums

Competitive markets for bed-

netsSubstantial price drops for ITNs

• Local diagnosis finds local, workable solution• Donors supported infrastructure rehabilitation; delivery options left open • New private company established to manage municipal delivery

Large retail sale increases High equity levels

Working together for water

In-demand and affordable even to slum parentsFree schools aren’t free

Household connections increase eight-foldWater available 24 hours/day

Learning from other spheres

External facilitator – as catalyst for change

Engaging with different players in system

Driven by vision of systemic change

Interventions shaped by analysis of constraints

Implementation arrangements that allow flexibility

Key question – ‘what’s wrong with the system’?


Key ‘how to’ points

Implications for health?


Potential advantages

Fits reality of pluralistic systems - multi-player- multi-system

Approach = analysis + actions (understanding and changing)

Sustainability and scale

Acknowledge the general message - not a panacea but applicable in health as any other system

Opportunities for action?- existing programmes through M4P lens- new action-research-pilot programmes

Challenges

More information?


• You can access the suite of M4P documents on the SDC website:

http://www.sdc-employment-income.ch/en/Home/Making_Markets_Work_for_the_Poor/Resources_on_the_M4P_approach



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Beyond Scaling Up: Making markets work for the poor

Health & Medicine