Hi everyoneThank you for having me today and I’d like to thank Dr. Amman and the rest of the organizing committee for inviting me to be a part of this wonderful event.I’m honored to share the stage with such well-respected speakersTo give you a little background before I start, prior to my time in academia, I was working as a practitioner in global health and development sector, specifically with NGOs, & one of the challenges that kept reccuring to me across the various NGOs was how to prove the impacts of our work and convince donors to fund us. Furthermore, how could we become more effective at what we were doing? With that experience I returned to school to do my PhD and that is when I stumbled on SROI.At the time when I started my PhD, the research or academic knowledge of SROI was very limited, however, over the past few years it has been gaining attention because of the benefits it can offer and ability as a transdisciplinary approach.Today I’d like to share an overview of SROI with you in case it may be useful to your organizations in One Health.
So far in the conference, we have heard much about one health, what it is, why we need this approach, scientific bases and examples of how it has been applied.However, until we measure the success of One Health approaches, how do we know they are indeed successful? And furthermore, how can we communicate that with various stakeholders? Given that One Health approach involves various sectors, from human health, to animal, to environmental to agriculture, and also various types of organizations intersecting in this sphere from NGOs, to big business, to government, we need measurement approaches which are holistic enough to capture the various costs and benefits of One Health, and also, a common language for communicating its impacts which we can all relate to.While measuring impact may not be easy, nor perfect, ultimately, what gets measured, gets valued, and we must attempt to make more progress in that direction as we move forward in this area.
While there are various ways to measure impact, it seems to me that SROI Analysis may be a particularly relevant tool for One Health.SROI Analysis is a process for understanding, measuring, and reporting on the social, environmental, and economic value (or triple bottom line) generated by an organization, program, or policy. SROI is an extension of Cost-Benefit analysis, but requires the participation of key stakeholders in the analysis process which is particularly important in the One Health context given the various stakeholders involved in One Health.By way of background,SROI Analysis is a tool which was originally developed BY practitioners FOR practitioners. The reason I bring that up is because ultimately we need to disseminate tools that can be used by organizations in practice, not just in ivory towers. It was originally developed in the 1990’s by a venture philanthropy fund in California called REDF which was seeking to measure the impacts of investments it had made in various social enterprises. The method was picked up and refined by a think tank in the UK called the New Economics Foundation in the early 2000s, and in the past few years was standardized by a growing network of professionals who form the International SROI Network. In 2009, this Network released the 1st comprehensive guide to SROI which outlines the method step-by-step and is the basis of this study.
So why use SROI Analysis for One Health? At the macro level:We need better information about the effectiveness and impacts of One Health programs in order to improve decision-making for the ultimate purposes of producing better outcomes.2nd, we also need to get the best value for money. In a world of limited resources, we need to know how to allocate our monies and spend wisely with what we have. In addition, we should be strategic and take advantage of the possibilities to share costs when problems and solutions are multidimensional.Third, there’s a need to strike a balance between investments. As you all know very well, health outcomes are dependent on a number of factors, including environmental, agricultural, animal health, in addition to health services. Saving lives will depend on all of these factors and therefore investments will need to be balanced in all these areas to produce the outcomes being sought.At the micro level, you may want to use SROI Analysis for:Internal performance management & improvement- we need to know how we’re doing, and, how we might improve2nd, to attract funds, or if you’re on the donor side, to help you disburse fundsAnd 3rd, SROI can help to strengthen relationships with key stakeholders in One Health
SROI Analysis has 7 underlying principles on how it should be applied:Principle 1 suggests that stakeholders are best placed to describe how an intervention affects them and therefore requires their consultation throughout the analysis process.Principle 2 requires that the theory of change or impact map (i.e. how change is created) be articulated and evidence-based, incorporating stakeholders, positive and negative outcomes, and intended and unintended consequences.Principle 3 suggests the use of financial proxies to measure the social value created.Principle 4 is borrowed from accounting which suggests the inclusion of information which is material, i.e. which has the potential to affect stakeholder’s decisions.Principle 5 suggests that an intervention should only claim the value it is creating, and requires taking into account trends, benchmarks, and the work of other organizations in the area.Principle 6 essentially states that each step of the analysis, and decisions taken throughout it, be documented.Principle 7 suggests that independent assurance should be undertaken to verify results.
Carrying out an SROI analysis involves six stages. There are many steps in each stage which I don’t have the time to explain here, but in terms of an overview:1. Establishing scope and identifying key stakeholders. It is important to haveclear boundaries about what your SROI analysis will cover, which stakeholders will be involved inthe process and how. Often beneficiaries, funders and other agencies working withthe client group are included in an SROI.2. Mapping outcomes. Through engaging with your stakeholders you will developan impact map (also called a theory of change or logic model) which shows therelationship between inputs, outputs and outcomes.3. Evidencing outcomes and giving them a value. This stage involves finding datato show whether outcomes have happened and then giving them a monetary value.4. Establishing impact. Those aspects of change that would have happened anyway (sometimes called “deadweight”)or are a result of other factors (what we call “attribution”) are taken out of the analysis.5. Calculating the SROI. This stage involves adding up all the benefits, subtractingany negatives and comparing the result with the investment. This is also where thesensitivity of the results can be tested.6. Reporting, using and embedding. This vital last step involves verification of thereport, sharing findings with stakeholders and responding to them, and embeddinggood outcomes processes.
As always, with any metric, it is important to consider the metric in context, and that is why a comprehensive SROI Analysis includes multiple types of info.
To make this a little more concrete, I’ll share an example of how SROI was used, in this case prospectively.A couple of years back I was part of a consulting team who, upon the request of the Ministry of Medical Services, was trying to help plan a pilot EMS system in Nairobi which might eventually serve as a model more broadly. Of course, an effective emergency medical system requires coordination across various sectors, just like in One Health. For instance, you must make investments in healthcare services and in training of human resources, but healthcare alone is not sufficient. You also needs roads to actually get the patient to the hospital. And in settings where cars can’t reach, you need to invest in other transportation mechanisms, such as bicycle or motorcycle ambulances (which GRF has kindly and importantly been gifting in this conference). Similarly, you need investments in technology for proper communication systems between patients, hospitals, and ambulances. And you need cooperation from insurance providers, police and safety, etc. to make it work. Given the various stakeholders, we decided to take an SROI approach to the issue and convened a stakeholders conference in Nairobi in 2009. Representatives from various ministries, private ambulance companies, the national hospital insurance fund, NGOs, and private companies were all present. During this conference, our main goal was to understand from their perspectives what the priorities of an EMS should be, the inputs & activities it would take, and how the intervention might affect each stakeholder.
During the stakeholder interaction, the activities (and inputs) they prioritized included:Disparate services exist but need coordinationNeed for a Good Samaritan PolicyNeed for a centralized emergency phone number that actually worksAmbulance vehicles exist but need equipment upgrade+staff trainingAmbulance dispatch technology already exists!Pilot should include entire Nairobi, not just certain districts for political and equity reasons
Furthermore, the stakeholder interaction (along with analyzing publically available data and site visits) revealed some important information about costs and benefits which could be used to predict the SROI of the intervention. While I’m not going to go over all of them here, I will present a few of the costs and benefits identified and how they would differ using traditional CBA vs. using the SROI approach:If we had done a regular prospective CBA of the project without consulting stakeholders, our cost estimated would have included: 99 staffed ambulances (this is based on Burden of Disease study) and the cost of emergency dispatch technology. Our benefits would have been the $ value of lives saved.However, using the SROI approach, stakeholders identified that 25 ambulances already exist and simply need equipment upgrades, leaving us with only needing 74 staffed ambulances. Furthermore, benefits would include not only the $ value of lives saved, but also that of disability, of the skills acquired through human resources trainings, decreased spending on welfare, etc. as they affected each stakeholder.This brings me to 3 key points I’d like to make about the added value of SROI: #1: In theSROI, stakeholders specified the costs and benefits- costs are more accurate, benefits are more holistic (as accrued to each stakeholder)#2: Calculations are essentially the same, but what data you include and how you arriveat the ratio are completely different processes#3: SROI can be used as a management tool in addition to just an assessment of costs/benefits as the stakeholder participation revealed critical information for project implementation (which I presented on the previous slide) including some unintended consequences to be considered and averted.Of course, the flipside of stakeholder involvement is that its expensive. But, the payoff can be well worth it both for attracting funds and successful implementation. And depending on the capacity of your organization, you may already be doing some PM&E activities which you can build off of to do an SROI analysis.
Involves multiple stakeholders; documents assumptions; considers impact over time
Sk presentation one health summit final
Social Return on Investment
(SROI) Analysis: An Innovative
Framework for Measuring the
Impact of One Health
Shubha Kumar, PhD, MPH
Assistant Professor & Director of Distance Education Programs
Disease Prevention & Global Health
University of Southern California
GRF One Health Summit
Measuring the Impact of One Health
“What gets measured, gets valued”
What is SROI Analysis?
A process for understanding, measuring, and
reporting on the social, environmental, and economic
value created by an organization, program, or policy
Why SROI Analysis for One Health?
Better informationbetter decisions- better
Get the best value for
Strike a balance between
with key stakeholders
At the policy level
At the organizational level
At the program level
Non-profits/NGOs, Government agencies, Forprofits/CSR, Donors, Investors, etc.
Principles of SROI Analysis
Understand what changes
Value what matters
Only include what is material
Do not over-claim
How to do an SROI Analysis:
Establishing scope and identifying key stakeholders.
Evidencing outcomes and giving them a value.
Calculating the SROI.
Reporting, using, and embedding.
Key Features of SROI Analysis
Multiple Types of Information (Mixed Methods)
Quantitative, Qualitative, Financial, Narrative
For example, an SROI of 3:1 indicates that for every $1
invested, the program delivers $3 in value
(economic, social and/or environmental)
Example: Applying SROI to an
Emergency Medical System (EMS)
Disparate services exist but need coordination
Need for a Good Samaritan Policy
Need for a centralized emergency phone number that actually
Ambulance vehicles exist but need equipment upgrade+staff
Ambulance dispatch technology already exists!
Pilot should include entire Nairobi, not just certain districts for
political and equity reasons
Selected Differences in Estimates
of SROI and CBA
Cost Benefit Analysis
74 Staffed Ambulances
25 Ambulance Equipment
99 Staffed Ambulances
$ Value of lives saved
$ Value of less disability
$ Value of skills acquired
$ Value of less welfare spending
$ Value of lives saved
Findings Summary: SROI Analysis
Encourages accountability, transparency, and sustainability
Places stakeholders at the center of the process, including
beneficiaries of aid whose voices have often been ignored
Some challenges: monetization, comparability, etc.
Not a magic bullet, but can provide added value over
SROI Resources & Support
The International SROI Network
New Economics Foundation (www.neweconomics.org)
SVT Group (www.svtgroup.net)
SROI Online Training (www.globalsroi.com)
My email: email@example.com