Social return on investment (SROI) analysis

Almost half of the world’s population still struggles to meet basic needs (World Bank, 2018).  An estimated 689 million people of the global population live in extreme poverty (United Nations, 2022).  Communities around the world, and vulnerable populations in particular, face a myriad of complex challenges, including access to primary health care which remains out of reach for millions of people, particularly in low and middle-income countries (LMICs).  Frameworks, such as the Sustainable Development Goals (SDGs), adopted by the United Nations, provide a blueprint to achieve a better and more sustainable future for all. They address the global challenges we face, including poverty, inequality, climate change, environmental degradation, peace and justice.

While around the world there are plenty of organizations, policies, and programs contributing to the SDGs and aimed at improving lives, measuring and improving the impacts of such efforts continues to be challenging.  In the global health and development sectors, organizations often measure and report outputs of interventions, but not their outcomes or impact, falling short of critical insights for actionable change for performance improvement.  Furthermore, current measurement approaches tend to be varied according to a particular organization’s or funder’s requirements. These approaches are often aimed at reporting to managers or donors, with limited engagement and input from the communities they are trying to serve, missing key opportunities for accountability to the community and ownership.  There is a need for better measurement methods and low-cost accessible tools in global health and development that can help to measure and report the impact of interventions and provide actionable insights to improve impacts.  Organizations need practical methods that can be employed consistently and comprehensively, which provide a common language across stakeholders and sectors, that meaningfully involve all key stakeholders to facilitate performance improvement and optimize impact. 

These measurement challenges exist in the health and development sectors broadly and primary health care is no exception.

General description of our solution

Our solution is to support health and development organizations globally to measure and improve their impacts using social return on investment (SROI) analysis methodology.  Our specific solution to this challenge is to conduct SROI analyses of primary health care organizations in LMIC and develop a low cost, easily accessible SROI dashboard that can be used and scaled across PHC organizations in LMIC for ongoing measurement and performance improvement (more details provided below).

About SROI Analysis

Social Return on Investment (SROI) analysis is a process for understanding, measuring, and reporting the social, economic, and environmental value created by a program, organization, or policy. It is a mixed methods approach employing both quantitative and qualitative techniques, with an emphasis on stakeholder engagement throughout the process.  It is based on a set of principles, articulated by Social Value International (SVI) (the standard bearer for SROI methodology and assurance), which underlie how SROI should be applied. 

Principle 1:  Involve stakeholders. Inform what gets measured, how it is measured and valued in an SROI analysis by involving stakeholders.

Principle 2:  Understand what changes. Articulate how change is created and evaluate this through evidence gathered, recognizing that positive and negative changes can occur as well as changes that are both intended and unintended.

Principle 3: Value the things that matter. Value refers to the relative importance of different outcomes and is informed by stakeholders perspectives.

Principle 4: Only include what is material. Determine what information and evidence must be included to give a true and fair picture such that stakeholders can draw reasonable conclusions about the impact.

Principle 5: Do not over-claim. Only claim the value that activities are responsible for creating.

Principle 6: Be transparent. Show the basis on which the analysis can be considered as accurate and honest and show that it will be reported to and discussed with stakeholders.

Principle 7: Verify the result. Ensure appropriate independent assurance.

Principle 8: Be responsive. Pursue optimum social value based on decision making that is timely and supported by appropriate accounting and reporting.

Conducting an SROI analysis involves six broad stages.

Stage 1: Establishing scope and identifying key stakeholders. It is important to have clear boundaries about what your SROI analysis will cover, who will be involved in the process and how.

Stage 2: Mapping outcomes. Through engaging with your stakeholders you will develop an impact map, or theory of change, which shows the relationship between inputs, outputs and outcomes.

Stage 3: Evidencing outcomes and giving them a value. This stage involves finding data to show whether outcomes have happened and then valuing them.

Stage 4: Establishing impact. Having collected evidence on outcomes and monetized them, those aspects of change that would have happened anyway or are a result of other factors are eliminated from consideration.

Stage 5: Calculating the SROI. This stage involves adding up all the benefits, subtracting any negatives and comparing the result to the investment. This is also where the sensitivity of the results can be tested.

Stage 6: Reporting, using and embedding. This vital last step involves sharing findings with stakeholders and responding to them, embedding good outcomes processes and verification of the report.

A key result of the analysis is the determination of the SROI ratio, which compares the value of the benefits with the investment.  For example, an SROI of 1:3 indicates that for every $1 invested in an intervention, it delivers $3 in value.

SROI Analysis can be used for strategic planning, monitoring & evaluation, communicating impact, attracting or disbursing investments, and decision-making.  

How SROI analysis incorporates inclusive human-centered design

SROI analysis incorporates inclusive human-centered design in the measurement process through its requirement of engagement with key stakeholders, including but not limited to beneficiaries, throughout the process to identify: the theory of change, the relevant key stakeholders, the outcomes they experience (both positive and negative), the indicators they would use to describe those outcomes, how important those outcomes are to them, and how they would value them.  In addition to the methodology itself, the SROI dashboards we intend to design and develop as part of this solution will incorporate inclusive human-centered design in that they will stem directly from the SROI analyses that are conducted.

 How SROI analysis complements and adds value to existing methods used in LMIC

SROI analysis complements existing measurement and evaluation approaches, such as measurement and reporting of outputs, or the use of theory of change, but takes these further to measure and report impact.

SROI includes the measurement of outputs in the process, but takes them further to answer the question, so what? So what you trained 500 nurses from an activity? So what you administered 1000 vaccines? What actually changed as a result of that activity? Did people’s health improve? What’s the value of that improvement? And how much of that change was a result of your program? SROI takes the measurement process much further to actually measure the impact of an intervention, as opposed to just measuring and reporting the outputs of an activity. 

While the process of identifying and measuring outcomes as part of a theory of change is common to other outcomes models, such as logical framework and results-based frameworks often used in the development sector, and the involvement of stakeholders is also a key feature of SROI that is emphasized, to a greater or lesser extent, in other outcomes models, the main difference between SROI and many other outcomes approaches is the importance of giving financial value to their outcomes.  Additionally, the explicit focus in SROI on taking into account unintended and possible negative outcomes. The common ground between the initial stages of SROI and other outcomes approaches means that organizations that have already done a lot of work on outcomes are likely to find undertaking an SROI analysis much easier than organizations looking at outcomes for the first time.

In addition, the SROI framework and principles are an excellent option for organizations that wish to monitor and manage their contribution to the SDGs, especially to socially orientated indicators, and for incorporating the concerns and perspectives of their directly influenced stakeholders. 

In addition to the benefits it provides in measurement, SROI analysis can also be used as a management tool.  The insights gained through stakeholder engagement are useful in identifying opportunities for performance improvement.  It also encourages decision-making based on impact, not outputs or outcomes which often do not reflect the whole picture but have been the basis for most decisions. 

Detailed description of our solution in response to MIT Solve Challenge:

In response to the MIT challenge, our specific solution would be to (1) conduct SROI analyses of primary health care centers in LMIC, (2) design and develop an SROI dashboard that can be used by primary health care centers all over LMIC, and (3) scale the solution via training users how to do SROI analysis and use the SROI dashboard. 

We propose a phased approach as follows:

Phase One: Our solution team to conduct SROI analysis of up to 4 PHC centers in one country (Kenya).  Specific PHC centers will be determined in partnership with key partners/stakeholders. Our solution team will partner with the management of the PHC centers to conduct each SROI analysis.  This effort will allow for the development of a tailored approach to SROI analysis of PHC centers.

Phase Two: Our solution team to conduct SROI analysis of PHC centers in 3 additional African countries (countries to be determined in partnership with AMREF Health Africa).  Specific PHC centers will be determined in partnership with key partners/stakeholders. This effort will allow for the tailored approach to SROI analysis of PHC centers to be tested and further developed in additional country contexts.  At the end of this phase, we will develop an SROI dashboard that can be used by PHC centers for ongoing measurement at regular intervals for performance improvement.

Phase Three: Once SROI analyses of PHC centers has been conducted in 4 countries and processes validated and lessons learned, we will adopt those lessons toward scaling the SROI approach in multiple LMICs in Africa and other regions of the world.  During this phase, our solution team will provide online training on SROI analysis to interested stakeholders and access to and training on how to use the SROI dashboard for additional PHC centers to use and adapt as relevant for impact measurement and performance improvement in their respective contexts.

To note, primary healthcare data can continue to be collected by those who currently collect this data or by other individuals as a PHC center deems appropriate. The key change intended from implementation of the SROI methodology will be in what data is collected, how it is collected, how it is analyzed, how it is reported, and how it is responded to and acted upon to facilitate performance improvement.  

SROI methodology as a solution serves any community that seeks improvement in key areas of social change and development, including health, well-being, education, employment, climate, peace, etc. As SROI methodology facilitates measurement and improvement of social impact of programs, organizations, or policies, it leads to increased social equality, environmental sustainability, and well-being.

For example, our solution team is currently pioneering the use of SROI analysis in the peace-building field. In partnership with various organizations including UN agencies, USAID, NGOs, and peace-building organizations, we are using SROI analysis to evaluate peace-building programs in Kenya and develop a toolkit that can be used in this sector globally for ongoing measurement and management. This has helped in identifying and quantifying the value of peace-building programs, strengthening impact measurement and accountability to key stakeholders, and providing actionable insights that managers of peace-building interventions can implement to further improve programming, such as the types of interventions (i.e., mediation skills training, interfaith dialogue, social enterprise development, etc.) that stakeholders and communities benefit from most in advancing peace.

We envision a similar process and benefits of advancing the use of SROI analysis in measurement of primary health care performance improvement (if awarded the funds to do so).

Our Solution Team:

Our solution team is well-positioned to deliver this solution given our diverse experiences and backgrounds, expertise, organizational strengths, along with our history of teamwork. We have 30+ years of experience with SROI analysis, business, public and global health, and monitoring & evaluation.  This includes experiences around the globe with health systems, government, non-government organizations, bilateral and multilateral agencies, corporations, universities and research centers, and community-based organizations. 

Our solution team for this challenge is composed of four organizations and five core team members:

 Global SROI (Lead Organization):

Shubha Kumar, PhD, MPH (Founder & CEO, Global SROI; Associate Professor at USC Institute on Inequalities in Global Health; Los Angeles, CA, USA) (Team Leader)

Aaron Mallett, MPH (Research Associate; Global SROI; Toronto, Canada)

AMREF Health Africa:

Samuel Muhula, PhD, MSc (Monitoring, Evaluation, and Research Manager, AMREF Health Africa; Nairobi, Kenya)

Rural Senses:

Ngesa Maturu (Partnerships Manager, Rural Senses; Nairobi, Kenya)

SVT Group:

Sara Olsen, MBA, MSW (Founder & CEO, SVT Group; Palo Alto, CA, USA)

Our team members have close proximity to the communities we are serving.  I am the daughter of immigrant parents who migrated from India, where I spent significant time while growing up and becoming familiar with the inequalities and key challenges faced by vulnerable communities in India, many of which are shared across LMIC. I grew up as a minority in the US and have visited and/or worked in health and development within many underserved communities around the world, including underserved parts of Los Angeles County to various LMIC around the world in Asia, Africa, and Latin America.  Three other members of our solution team grew up as minorities and/or in LMIC, including two members who live in Kenya, with extensive experience in research methods and health systems strengthening  throughout the African continent.  More than 5 languages are spoken by our team members.  All five of us have been working together over the past few years across multiple SROI projects and have a solid understanding of each other’s work styles, organizational strengths, and optimizing our performance as a team. 

What we are doing to understand the needs of communities and how we are engaging them in the design and implementation of the solution

In terms of what we are doing to understand the needs of those we are serving and engaging them as we develop the solution, SROI analysis fundamentally relies on the engagement of key stakeholders throughout the process. Engagement with key stakeholders in an SROI occurs in various ways including focus groups, interviews, surveys, validation meetings, etc. Key stakeholders are involved in all stages of an SROI, including identifying a theory of change, the inputs, outputs and outcomes they experienced (including both positive and negative outcomes), the indicators to describe those outcomes, how long outcomes lasted, how important those outcomes are to them, what would have happened anyway, how they would value the outcomes they experienced, and the recommendations they have for future programming.  Key stakeholders input is central to the SROI process and the results, including verifying the results.  As such, they are engaged in both the SROI analysis itself and also the development of the SROI dashboard for future measurement, as they are the ones who determine which outcomes should be measured, how they should be measured, and how they should be valued. 

In the case of primary health care performance improvement, some examples of key stakeholders we would be engaging with in the design and implementation of the SROI would be patients, healthcare providers, administrators, policy-makers, and donors/funders as relevant.

We are applying to this Challenge given the alignment with what we do and the types of solutions being sought. We would not be able to implement our solution for an improved and innovative method (SROI) to measure primary health care performance improvement without the financial resources to do so.  Additionally, it would be valuable for our team lead to go through the support program hosted by the WFP Innovation Accelerator to continue testing and building out solutions.  We are seeking to grow the use of SROI methodology and Global SROI as an organization and believe the support program would provide an excellent opportunity towards these goals.

Our solution is innovative in that the SROI methodology has not yet been widely used to measure and improve primary healthcare to date. Its primary uses have been in other areas.  Given the added value of the SROI approach compared to current methods (as described earlier), combined with the broad applicability and common language of return on investment that it offers, it can change how society understands and accounts for value by providing a common approach to measure and improve impacts that can be used by various stakeholders and sectors.
This is one of the leading reasons for proposing a growth approach – SROI analysis as a solution that has already been rolled out in several communities and countries around the globe, which is poised for further growth in this particular area of primary healthcare and in multiple country contexts.

Our impact goals for the next year and next 5 years are to create a better world by increasingly helping health and development organizations around the globe to measure and improve their social impacts, using the SROI methodology. 

We will achieve these goals through three key approaches:

1) Provide consulting services to organizations to measure the SROI of their programs, organizations, or policies (or those that they invest in).

2) Capacity building of organizations to measure and improve their social impacts through the design and development of low-cost easily accessible SROI dashboards that they can use for ongoing performance measurement

3) Training interested individuals and organizations how to do SROI analysis on their own

We are measuring progress toward our impact goals using key indicators such as:

• The number of organizations we serve
• The types of organizations we serve 
• The number of organizations we serve that respond to SROI results and improve performance
• The countries in which we work
• The number of people we train in SROI analysis

If we support organizations in health and development through consulting, capacity building and training on measuring and improving their social impacts, then organizations will be better equipped to measure and improve their social impacts, their impacts will be greater, and communities will experience increased well-being.

This solution uses low-cost technology that is fit to scale.  Specifically, it is powered by the Kobo app used for data collection during the SROI analysis (including focus groups, interviews, and surveys) and by Microsoft Excel used for (1) data analysis and (2) development of the SROI dashboard to measure performance year over year.  These technologies facilitate data collection and analysis anywhere in the world and also facilitate sharing of and contributing to the dashboard easily and widely.

The primary health care data for our solution will continue to be collected by those who currently collect this data, be it frontline health workers, administrators, or others that a primary healthcare center deems appropriate.

Our solution team will work with leadership of the primary healthcare centers to design and implement the SROI analyses and dashboard.  This process will include input from all key stakeholders, including those who currently collect the data.  While the data collection for the initial SROI analyses will be collected by our solution team, we will work in partnership with the organizations to collect this data and identify best practices for ongoing data collection for monitoring performance improvement, including who should collect the data and incentives for doing so.  Generally, the SROI analysis process, including reporting processes, creates a shared purpose among key stakeholders and strengthens accountability to them and ultimately strengthens ownership of the interventions.

Our approach to incorporating diversity, equity and inclusivity in our work is to ensure that our work is guided by the communities we serve and that our solution teams for any project are reflective and in close proximity to those communities.  Global SROI Founder & CEO is a woman of color of Indian descent, and Global SROI frequently partners with other individuals and organizations in our work.  Central to our approach is to have team members not only with relevant expertise, but also to be reflective of that community, to have sincere understanding of the community needs, be able to communicate with communities effectively, and build trust.  

Our business model to provide value to the populations we serve and generate revenues includes a three-pronged approach:

1) Provide consulting services to organizations to measure the SROI of their programs, organizations, or policies (or those that they invest in).

2) Capacity building of organizations to measure and improve their social impacts through the design and development of low-cost easily accessible SROI dashboards that they can use for ongoing performance measurement

3) Training interested individuals and organizations how to do SROI analysis on their own

Global SROI is financially sustainable through the consulting services it provides to various organizations, including government agencies, non-government organizations, bilateral and multilateral agencies, foundations, corporations, universities, and more.  In addition, the online training on SROI Analysis that we offer provides an additional revenue stream.

We have achieved financial sustainability through our provision of consulting services.  A few examples of our recent consulting engagements include:

• SROI evaluation of peace-building interventions in Kenya (funded by USAID)
• SROI evaluation of a public health program for underserved pre-school children in Los Angeles County (funded by UCLA)
• Capacity building and training development for disaster preparedness in ambulatory care centers (funded by Veterans Health Administration)