1. PLENARY:
EQUITY AND EMPOWERMENT – WHEN
COMMUNITIES OWN THEIR FUTURES
SEED-SCALE: LESSONS
LEARNED FROM FIELD
APPLICATIONS
LAURA C ALTOBELLI
FutureGenerations
Oct. 16-17, 2013
CORE Group Fall

2. Dr. Carl E. Taylor, 1917-2010
Photo: L Altobelli
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3. SEED-SCALE books
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4. Alma Ata Conference - 1978
HEALTH FOR ALL ?
or
HEALTH FOR ALL ?
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5. Alma Ata and its successors
GOBI
 GOBI-FFF
 IMCI
 IMCI-N
 MNCH
 RMNCH
 MDGs
 A Promise Renewed

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6. Dr. Halfdan Mahler, exSecretary
General of WHO
“We had it wrong in 1978.
What came about was ´Hell for all´
as the business of health
stole the idea”.
- Dr. H. Mahler, 2009
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7. Lost and (still not) Found

COMMUNITY

Values of equity and sustainability

Process of HOW to approach the
community
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8. UNICEF Task Force 1990

Dr. James Grant charged Carl and
Daniel Taylor to conduct a study and
lead a task force to examine the
dynamics of social change.
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9. Core Concept of SEEDSCALE


Find a “seed” of human energy, an activity your community
did that it views as a success
Grow that seed “to scale” so
 More people receive benefits
 Quality of life improves

SEED-SCALE is not just a "tool" in the international
development toolbox.

It allows communities to use what they have:
 What resources they already have,
 Where they are with all their constraints
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10. Basics of SEED-SCALE

5 Criteria

4 Principles

7 Tasks

3 Levels of Scale
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11. 5 Criteria to Guide Direction
The process of change needs
guidance and evaluation from 5
perspectives:
Equity
Sustainability
Holism
Interdependence
Iteration
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12. Build from Success: Principle
#1
Identify what is working,
strengthen that.
One success leads to a
next success; the
momentum of change
builds.
Vs. traditional development: “Fix the failures,”
rather than building on what is working, “Identify
needs” rather than community capacity
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13. 3-way Partnership: Principle #2
Top-Down policies and financing provide the
supportive environment for Bottom-Up growth.
Ideas from Outside-In stimulate Bottom-Up
adaptation.
Vs. traditional development: “Communities can
grow on own or with help from only one partner.”
Top-Down Enabling Environment
Outside-In Ideas and Mentorship:
Change Agents
Bottom-Up Community
Mobilization
Forward
Momentum
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14. Evidence-based Decisions:
Principle #3
Success comes when
decision-making uses facts
gathered locally.
Vs. traditional development:
Usually decisions are made byWhomever has the power,
Or money, Or the strongest opinions.
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15. Behavior Change: Principle #4
Fundamental change
happens when
people change
behaviors. One
behavior change
encourages
another.
Tool:traditional development:
Local work
Vs.
plans.
Typically programs seek measurable outputs;
results can be manipulated from outside and are
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often not sustainable.

16. A Cycle of 7 Tasks Helps Human Energy
Grow
Create local
coordinatin
g
committee
Identify
local
successes
Study
successes
elsewhere
Gather
local
evidenc
e
Create
local
workplan
Implement
the
workplan
Make
Mid-course
corrections
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17. Going to Scale is a Journey

SCALE ONE - a SEED system that represents a
successful and integrated local experience –
empowered community system supported in a three-way
partnership
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18. Going to Scale is a Journey

SCALE-SQUARED - the SEED system becomes an
observational learning/teaching center
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19. Going to Scale is a Journey

SCALE-CUBED - Policy and financing environment for
sustainability of successful strategies
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20. Some Lessons learned
From SEED-SCALE applications in the field

21. 1. S-S is not a linear process of
growth
Country
Program
China
Peru
India
Afghanistan
Haiti
Stage 1
Stage 2
Stage 3
Stage 4
Scale-Cubed
Scale-One
Scale-Squared
Scale-Cubed
Scale-Cubed
Scale-One->Sqr
Scale-Cubed
Scale-Squared
Visit to
Scale-Square*
Scale-One
Scale-Squared
Repeat multiple
times
Scale-One
Scale-Cubed
Scale-One
Scale-Squared
Scale-Squared
*Jamkhed
Scale-One: SEED center
Scale-Squared: Observational training center
Scale-Cubed: Policy environment—a self-sustaining network ofFutureGenerations
Scale-Squared Centers

22. PRE-SEED-SCALE: Primary health care in Peru
Health
Services
Network Center
Primary
Health
Care
Faciity
Regional
Health
Directorate
National Health
Programs
MUNICIPALI
TY
Roles & functions
poorly defined
COMMUNIITES
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23. SCALE-CUBED: Original Structure of CLAS 1994
Health
Services
Network Center
Regional
Health
Directorate
CLAS – Local Health
Administration Committees
(private non-profit civil association)
SHARED ADMINISTRATION CONTRACT
Primary
Health
Care
Faciity
Local Health
Plan
CLAS
CLAS Board
of Directors
MUNICIPALI
TY
Roles & functions
poorly defined
COMMUNIITES
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24. SCALE-ONE: Improve Quality of Relationships with CLAS
Health
Services
Network Center
Primary
Health
Care
Faciity
Regional
Health
Directorate
Local Health
Plan
THEN, SCALE-SQUARED:
Observational learning/teaching
center
CLAS
MUNICIPALI
TY
CLAS Board
of Directors
CWP
SECTORIZATIO
N
STRATEGY
CHW ASSOCIATIONS
COMMUNIITES
COMMUNITY WORK
PLANS
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25. SCALE-CUBED: New CLAS Law 2007
Health
Services
Network Center
Primary
Health
Care
Faciity
Roles & functions
poorly defined
Regional
Health
Directorate
Regional
Governme
nt
Local Health
Plan
CLAS
CLAS Board
of Directors
Communitybased
Organizations
MUNICIPALI
TY
COMUNSA
- Club de madres
COMUNA
- Vaso de leche
- Club de madres
-- APAFA COMUNSA
- Vaso de leche
-- Promotor
- Club de madres
-- APAFA COMMUNITY
- Vaso de leche
-- Promotor
-- APAFA
- Community leader
-- Promotor
- -CHW
COMMUNIITES
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26. SCALE-SQUARED: Improve Quality of Relationships and
Teach
Health
Services
Network Center
Primary
Health
Care
Faciity
Regional
Health
Directorate
Regional
Governme
nt
Local Health
Plan
CLAS
MUNICIPALI
TY
CLAS Board
of Directors
Communitybased
Organizations
SECTORIZATI
ON
STRATEGY
CHW ASSOCIATION
COMUNSA
- Club de madres
COMUNA
- Vaso de leche
- Club de madres
-- APAFA COMUNSA
- Vaso de leche
-- Promotor
- Club de madres
-- APAFA COMMUNITY
- Vaso de leche
-- Promotor
-- APAFA
- Community leader
-- Promotor
- -CHW
COMMUNIITES
CWP
COMMUNITY WORK
PLANS
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27. 2. SEED-SCALE is used in various
levels
a.
As a framework for program managers to
guide decision-making (with emphasis on 4
principles and 5 criteria)
b.
As a methodology for community action (7
tasks, especially the work plans)
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28. 3. Each local partner can be
considered as a separate
“community”

The seven tasks can be applied to each rural
community to arrive at a Community Work
Plan.

The seven tasks can also be applied to help
organize the work of each health facility or
municipality (organize a “management team”,
identify past successes, visit other successes,
do a self-evaluation, create a work plan for
“quality improvement”, take action and monitor
with mid-course corrections) as in
“SECTORIZATION”
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29. 4. Getting started – pick
“communities” with energy present



Not all communities (or health services) respond
to initiatives from the outside.
Solution : Contact a broad number of sites in
order to identify those with a momentum for
social change already underway.
The goal is to have the initial successes within
enthusiastic communities to lead way to interest
in other communities to also get on board.
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30. 5. The most resource-poor
communities and women
participate first



Poorest communities most likely to organize
themselves and start taking their own action.
Avoid the temptation of giving handouts to these
communities.
Women´s Action Groups and women are key
for capturing and channeling community-level
energy.
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31. 6. Role of Change Agent in the
Three-Way partnership - Principle
#2
A PVO can help create good relationships with the
government by building webs of partnership
between community and government:
 Amplify the impact of government outreach or
extension programs
 Build capacity of people in communities to
communicate and work with government.
 Connect community dreams/desires with
government resources.
 Educate the government about community
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empowerment in development.

32. 7. Sustainability of Scale-Squared
Centers through partnerships

The most successful Scale-Squared Centers
(Observational training centers) are those that
create partnerships with the private sector or
become a business to generate income that
provide incentive to continue scaling-up
activities.
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33. 8. Compatibility with the Logical
Framework Method

SEED-SCALE is not very compatible with
logframes.

But there is a solution.
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34. 9. Generation of local energy &
resources provide better costeffectiveness

Better results for less cost when projects rely on
sustainable resources in communities (energy)
and government (policy and financing).

Corollary: costs are more effectively invested
when there is a high level of flexibility to adjust to
emerging processes as communities move
forward.
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35. 10. The top-down as real partners
in development – may take time

Officials (administrators, doctors, etc.) are usually
the main obstacles to forming an effective three-way
partnership.






Habit of authority and control.
Corruption.
Threatened by new initiatives not under their control.
Officials see balanced partnerships with community or experts as
unnecessary.
Need for long-term advocacy, champions inside and
outside of government.
Need to organize consortiums of in-country NGOs,
donor agencies and other local experts to develop
and implement on-going advocacy with the
government.
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36. 11. Alignment with other new
global development paradigms

SEED-SCALE shares a general orientation with
other global commitments for giving greater
emphasis to national programs and local
ownership as opposed to dependence on or
control by the donor community, particularly
referring to the Paris Declaration on Aid
Effectiveness.
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37. HOW SEED-SCALE IS DIFFERENT
SEED-SCALE
Key Resource:
Planning Mindset:
Planning Process:
Who Does the Work:
Primary Stakeholder:
Traditional Development
Human Energy
Money
Growth in Nature
WorkplanBudget
3 Partners
Engineering a Building
BudgetWorkplan
Professionals
Community
Donor who gives money
Build on Success
Fix Problem/Meet Needs
Evidence
Power, Opinions & Habit
Behavior Change
Measurable Results
Success Evaluated by:
Strengthen 4 Principles
Budget Compliance
Process:
Iterative Learning
Do It Right the First Time
Mentoring
Control
Approach:
Guided by:
Major Outcome:
Management Mode:
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38. “Our greatest mistake has been to oversimplify
the Alma-Ata vision of primary health care… Real
social change occurs when officials and people
with relevant knowledge come together with
communities in joint action around mutual
priorities.”
-- Dr. Carl E. Taylor, Co-founder, Future
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www.seed-scale.orgFutureGenerations
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