Now we’re going to get started.
A couple of things before 
we get started.
Please silence your cell phones.
We’re going to have a report 
out at the end.
There’ll be a microphone coming around 
because it’s such a large room,
wait for the mic.
And after the sessions,
please fill out the short survey 
that’s right before you on the table.
My name is Jeff Walker.
I am really happy to be here and connect 
with you all on the topic of Systems Change.
This is something I’ve done 
a lot of research on,
and work in, and collaborative 
discussions around.
And I’m an old private equity guy 
that turned good ten years ago
and started working 
in the social change.
Teaching some at Harvard Kennedy 
School and Business School
and being involved in global health,
working on community 
health record strategies
with a number of you 
that are in the room.
Worked on the malaria effort.
These large problems are 
areas of interest to me.
But also, you know, interesting because 
it requires, in my experience, collaboration.
People coming together because 
no one organization
can affect the change 
that we all need.
I’m a music freak and so a lot of my analogies 
are related to playing music together.
Being a jazz player 
in the old days.
How do we listen to another 
player so that
we can create our own 
even better sounds?
How do we produce 
a sound as a group?
And how do we remember this audience, 
so that there’s an impact?
And so that process for me, 
I get goose bumps when I talk about it.
You know, it’s like, that to me moves me 
in this collaborative process in finding
these opportunities and finding 
ways to connect people together
for these larger skill changes 
is really what moves me.
So I want you to for one second 
get the feeling of working together.
So I want you to hum together.
When I raise my hand and lower it.
For just a second.
[HUMMING]
We did something together.
We’ve accomplished something.
That’s a system change.
That’s all.
It’s that feeling of flow working together.
So, I’ve done a lot of research on this one
and this question of systems 
change and how we do this.
And so I’m going to walk you 
through for the first 20 minutes,
a few slides on kind of what we’ve 
discovered at the Kennedy School,
some work we’re doing, 
what I tend to write about.
I have an article that just came 
out literally today in SSIR
about systems change focusing 
on the big problems of the world.
I’d love to have your thoughts 
and comments on that.
It’s a topic that’s gone from 
the consulting world,
the FSG’s and the Bridgespans 
and Collective Impact worlds,
to now the application.
How do we translate this to the large scale 
changes that we all want to work on?
And so we’ve been 
putting together cases.
We brought together last 
June 30 different systems
change organizations 
for funders of those.
System incubators, 
there’s actually organizations
that fund incubation 
of systems change.
So I’ll talk to you a little 
bit about those.
And you start saying, what is 
in common with all of those?
What are we thinking about when 
we’re thinking about systems change.
There’s a funder’s viewpoint.
There’s a non-profit’s view point.
There’s a government.
There’s a multi-lateral.
And so the topic is coming up.
I’ve taught at Aspen last week.
I helped teach at the Schwab Fellows 
Meetings at Harvard, 8 days,
where the average experience of the social 
entrepreneurs at that meeting was 15 years.
Many social entrepreneurs 
are frustrated about,
gee, I can’t scale within my own organizations, 
how do I think about this?
Or frustrated that my Board 
doesn’t get it.
Or frustrated that the donors 
aren’t funding me to do that work,
and I think that’s really important.
And so you’re saying, oh okay, well, 
maybe doing more cases about this,
sharing knowledge with 
funders and others
and collaborating is potentially 
an effective idea.
You cannot read this slide and you’re not meant to read this slide.
But it helps me kind of like follow the process.
But it’ll show you that there’s complexity.
So each of these system change things that we’re working on, it’s not easy.
So finding others to do this.
Nick Grono here, he’s the Freedom Fund, is over there and we talked about,
you want to do this with people you like.
You want to do this with people that you can work with because this is a long trip.
This isn’t like, gee, I’m just going to take one idea
and we’re going to scale it and it’ll all be done.
This is my old private equity days.
This is what we used to do.
You know, we funded the early start of something called Office Depot,
which eventually grew into a competitor to Staples,
and they own their office supply business because they went public,
and it was all straight and pretty easy when you look back.
It’s obviously not the case in the social change world.
So, the first thing that the successful systems change groups have done is say,
what’s the problem?
You don’t jump to the answer, right?
So many of us just fly into this just kind of look at,
what’s the new great NGO that has all the answers?
We’re going to get, in 20 minutes or 15 minutes or so now,
Ellen Agler and Raj Panjabi up here and so many people will say,
ah, well, they’re the answer.
I’m done.
No. That’s not even close.
What’s the problem you want to solve
and do they agree with the problem that you’re going to solve?
And does the group that you’re talking to, working with, agree on a solution.
In malaria, when we worked on malaria,
it took us a year to get from 660 organizations that were looking at malaria,
in a White House conference and working the case,
to come up with 30 organizations that really wanted to work together
for this large scale change.
And agree on the fact that it’s deaths from malaria,
and using bed nets to do that, to prevent deaths from malaria.
It took a while.
So, what “was the problem” came before “what was the answer”.
And then, two, this is a system map.
If you’re interested in how to do system maps and you haven’t done one before,
you don’t have to do a great PowerPoint.
I just list out people in the system.
But who cares about the same problem that you care about?
Do the system map before you try to come up with the answer.
At (DRK? - 00:07:52) they’re talking about looking at system mapping
as a requirement before they will fund a social entrepreneur.
Because if the social entrepreneur doesn’t understand
who cares about the same problem, what’s the point?
The person clearly is isolated.
So at least think about this.
So going around saying who are key influencers?
Who are relevant assets that I can maybe use.
In Malaria, we found that Exxon was going to be a great partner.
In the 25 years before us no one had ever talked to Exxon.
Talked about their employees who were exposed, the communities were exposed.
They became our largest corporate funder.
Without doing this white board mapping…
You know, it’s actually kind of fun.
So you go to other donors, you go to other NGO’s and you say, what have I missed?
Here’s kind of what my white board looks like.
Is there somebody I haven’t talked to that I really should?
Or some resource that I really ought to come together with?
And this is government.
This is corporations.
This is multi-lateral.
Over in malaria, we always talked about health-care experts.
That’s all we talked to.
No wonder we didn’t kind of understand the impact that’s possible.
Going to convenings.
And so, doing the white boarding solutions or having dinners with other people,
is also another really fun and interesting experience
with something that people don’t always do.
And so do that before you’re coming up with the answers.
(inaudible) right back here, she convened all of the different non-profits
that are in the community health worker space and saying,
we just need to talk to each other.
And brought multiple funders in the same room and said,
what do we have in common, what are the issues we have,
and what can’t you do as NGO’s by yourselves
that together we can do in a larger system impact?
So, it’s a good use for a funder to help convene and bring these ideas together?
And then, lastly, figuring out what’s the objective?
What are we trying to go after?
Some common measurable outcomes.
Hopefully simple ones.
At New Profit we scale social enterprises but we also now,
in the last five or six years, take the system’s viewpoint,
we have seven different ones.
One of those is around skill-based employment.
In the United States there are 10 million individuals
between the ages of 18 and 25 that are under employed.
Flipping burgers at McDonalds,
that we want to take to another level to get out of poverty.
Looks like, it turns out there’s not enough innovation in that field yet
because it’s not all about giving people tech jobs.
It’s about going into health care, it’s about going into the solutions.
And so they said, let’s do an XPRIZE.
So we’re going to do an XPRIZE.
We have Walmart Foundation.
We have Starbucks Foundation.
We have 12 foundations all coming together saying, you’re right.
We haven’t figured out the solutions yet that we really want to support,
so let’s go be creative, let’s come together.
And so, New Profit, as that systems change agent said,
let’s go do that, a little more innovation,
because we haven’t figured out what to scale yet.
And so then we break down systems change into six categories.
The typical social entrepreneur who is awesome, is an innovator,
who comes up with great ideas and tests them
and develops their tools and techniques to bring their ideas out to the world.
And we love funding those and we should continue to fund those.
But understanding what you are as an organization is really important.
You made me an innovator that just innovates.
I’ve been on boards of nonprofits and we tortured our CEO to scale.
And they didn’t know how to do it.
They weren’t really meant to do it.
But we said, we  have to, and that’s the way we did it.
It’s what the venture capital business does, we take things to scale.
And so we’re going to have to fire you
and we’re going to have to bring in somebody else.
And you say, no, well wait a minute,
maybe that person’s a really good innovator?
Maybe that’s okay.
In fact, I would assert 80% of social entrepreneurs are really good innovators
and let’s let them do that.
But there’s also some other things that have to happen
to think about that larger system wide question.
Let’s do research.
Who’s going to look at all the different innovations to figure out,
that one works, this one doesn’t work.
And, you know, these three together, you know,
AIDS was three drugs that came together, not one.
So, who figures that out?
Well researchers spent some time doing that,
that’s clearly universities, consulting firms, a variety of other people.
And the funder schemes can fund this,
who are going to help you analyze that and help analyze how it all can come together.
Again, in the CHW space, there’s a group called CHW15,
they now are saying to everyone, what do we have in common,
what are the innovations that we want to bring out to the world,
that we want to bring to WHO?
Because WHO’s more likely to talk to us if we are talking as a team and a group.
And when we’re going to a Health Minister,
instead of saying, here’s 100 different ideas for you as a Health Minister,
and 100 different NGO’s that are all sitting there going, we have the best idea.
What if we had somebody sitting there going,
we actually worked together and figured this out,
and here’s what we want to bring to you, Health Minister.
And we’re going to actually help you talk to your finance minister about those questions.
And we’ll do this in a more thoughtful way.
In the United States, that’s the same thing.
Every school system has a thousand non-profits
who have the better idea about how to run the education.
And so the Principals and the Superintendents are going,
I can’t do this, I just can’t listen to all this.
And so, how do you find somebody who can translate that?
Research is part of it.
Communication and awareness.
How do you get people are aware of innovations?
In malaria, we actually brought awareness to malaria
from 23% in the United States, over a two year period, to over 70%.
They never knew what malaria was.
We worked with a guy names Peter Chernin who was running American Idol,
we brought it out there, we need nothing but nets.
So yeah okay, well that seems easy.
Well, it wasn’t easy.
It was years into the process when we were building our networks,
when we finally figured out there are people who would work with us.
And he was doing communications awareness.
No non-profit could have ever done what he did.
And so he set up Malaria No More to do that.
It was a single purpose entity to build awareness and communication around that topic.
Policy change.
I don’t know one non-profit by itself who was very good at policy change.
Working with governments to try to figure out how to change laws,
how to influence the political process, to support them.
Setting up AmeriCorps programs if you’re, for example,
in the States and looking to find talent, two from America and a variety of others.
American Forward, which is under New Profit has 80 organizations
that are joined together to influence political process.
And so we we’re sharing those resources and so the Board is moving,
torturing the CEO’s and saying,
“You got to get active, because you have to protect the AmeriCorps program.”
Well, we are, but we’re not going to do it by ourselves,
because that’s less important.
Not only less important, it’s less effective.
So, there’s single purpose entities doing that measurement.
It’s not enough data being sourced by honest brokers.
Honest sources of data that you can measure how you’re doing.
Without some common measurable outcomes,
you will not have a collaboration that works.
What are you all working together, and how do you measure that along the way?
Chris Murray in University of Washington’s funded by Gates,
300 individuals in America who measure maternal
and child health around the world.
Major input in all of the work where Gates is funding, but not just Gates.
It’s how UNICEF evaluates itself.
It’s how we all look at activities under the UN,
but also, like any other global health strategies, Chris is an open resource for us.
We did this on malaria, set up ALMA, which is African Leaders Malaria Alliance.
Sharing data by country, so that every four months we sit with the African Ministers,
and the Presidents and Prime Ministers at the African Union meetings.
And we have one woman who runs this organization,
and now we’ve moved in the last two years,
the organization’s under the African Union, it’s not ours anymore.
It’s the African Union’s.
And you can go online and look up on ALMA and see a red,
green and yellow heat map, and see how we’re doing by country.
How the malaria issue’s are popping up.
And we need this almost in every area.
My music space, we have one that tracks by school,
number of music directors, number of kids taking different programs.
Until we have that resource, we couldn’t unify the 70 organizations
that are working on bringing music back to all kids across America.
We didn’t have the resource.
And we empowered them, the next group,
which is integrating the innovation, which is,
we empowered the people who were running the music programs
in the District schools so that they can start saying,
“You’re working with us to achieve a common goal.”
Rather than, “You’re just telling us what we need to do”.
We’re empowering the Health Ministers
because we’re giving them information and data that they can use
to evaluate how do we bring in community health worker systems?
How many do I need?
How do I finance it?
So you’re not just telling me, just give you all the things that you want,
you’ll do it for me.
It’s actually empowering them to do it for themselves.
And so these are the six things that we tend to see,
and if you’re looking at a systems change
and you don’t see people in these categories, maybe you ought to find some.
And if you’re a social entrepreneur and you think you need to do all of these,
you’re crazy.
That you ought to really start figuring out how to delegate that.
How many people here call themselves social entrepreneurs?
How many are funders?
How many are system entrepreneurs?
So here’s how I think about system entrepreneurs and social entrepreneurs.
They’re natural partners.
You need them both.
So it’s not an either/or.
But you don’t necessarily look at social entrepreneurs and say,
“I just need to identify a social entrepreneur and not a skill.
And all I need to do is find the best and the greatest social entrepreneur.
And so I’m going to figure whether it’s Last Mile Health, or it’s Purpose,
or it’s Living Goods, or it’s Muso.”
Come on,are you kidding me?
Each one has something useful to offer,
but isn’t necessarily going to be the answer.
And then the Health Ministers don’t want to hear one answer.
They want to have a set of tools.
You know, that works over here, that works over here,
and so Ethiopia’s going to be a government system,
and Uganda’s going to be a blended system with our… whatever.
So, who brings that together?
That’s what a system entrepreneur does.
A system entrepreneur has a different skill base.
You can be a social entrepreneur and become a system entrepreneur,
Jordan Kassalow’s a great example of that one,
where he had for years run a great organization called VisionSpring
which is bringing eyeglasses to the world.
But Jordan, I’m speaking for you, and you can talk later,
but you know, it’s like, this is frustrating because I want to do the billions,
not the millions, right?
And so he set up the Eye Alliance.
And that’s being incubated,
it was incubated when you were (inaudible) if I remember correctly,
but also now with Tides Foundation, saying,
“How do I grow this?”
And so finding places that will allow you to incubate your idea,
is a high value opportunity.
So, Doug Balfour at Geneva Global has done that in conjunction,
in partnership with Nick Grono, Freedom Fund, the (inaudible) Institute,
set up the END Fund, Ellen Agler,
who you’re going to hear from in a second, (inaudible) and a variety of others.
And so he’s in place and we give him something else that he’s working on for us.
But, you know, how do I be the backbone
that allows multiple funders to come together to bring these ideas?
Tides Foundation is doing that in San Francisco.
We’re doing it in profit. We’re setting up a new democracy fund,
for example, with many people who are coming around.
And now (inaudible) Foundation’s done 25 of them.
The oldest ones in the ocean space, The Ocean Legacy,
where they have protected millions of miles of the ocean, from trawler fishing.
There are six philanthropists that got together, hired scientists in common,
and worked as a team to accomplish that.
And both Obama and George W. Bush
signed into law these millions of miles of square ocean,
and they were the key influencer to that process.
So, we need, as philanthropists, I do it all the time, I will back somebody,
I have two individuals that work with me in the health worker space,
who full-time, do nothing but think about connecting other people together,
evaluating data, trying to find those levers in the system that we need to pull or fund.
We set up the financing alliance which says,
we need to help Health Ministers figure out how to finance their health system.
So let’s get Credit Suisse, we get Rockefeller Foundation,
we get GSK and others funding this,
because they all agree that that was a key and important point.
We did something called (M? - 00:22:00) for Health,
where we’re sitting there going,
ah, we need to actually put talent in the ministries,
because the average health minister is in office only 1.2 years,
and they're doctors, so they've got no management experience.
So what if we vetted talent for two years that are mid career,
and what if they're Africans who are going to stay in Africa doing the work,
and they're connecting multiple countries together
to share knowledge around community health workers.
And they're leveraging off the CHW15 effort,
because they're preparing all these innovations for the social entrepreneurs.
Isn’t that a really interesting role?
And so, English actually paid for an individual
to hold that all together around the CHW15 space.
There's back loan organizations, there's ways to start these up,
but the bottom line is, start talking with each other.
Start finding others that have common passions.
And the second after our discussion,
that's what I hope you all will start or will continue to do,
is find others passionate about a common area of interest.
Figure out how to do something small together.
And I'm going to challenge you after our discussion to say,
what are two things in your area, that if you had to look at the system,
if we invested in it, and if we did it, and if we wrote about it,
and if Skoll took time to think about it more deeply,
what do we want to communicate
that are important to think about related to the system change space?
So, I've had more fun doing this and building our ensembles for change,
because that's what we're doing,
we're connecting to others and leveraging off others,
and I think it's probably the only way you're going to go after the big issues of the day.
So, now we're going to go, if I can ask Ellen and Raj to come up,
and I'm going to ask them a few questions about this.
Because I would say Raj is in the space of moving as a social entrepreneur,
while continuing to have a direct service operation, Last Mile Health,
but also very concerned about the system wide space.
And he's becoming, because he's been the Skoll Award winner,
and the TED Award winner, and Schwab Award winner,
and you know, he's a hot property, but he's got to manage me though, (inaudible).
And he’s just learned he’s going to have a daughter so that’s all good news.
And then Ellen Agler, a great friend, but also one of the best system entrepreneurs
that we'll ever run across, which says, you know, she wasn't a social entrepreneur,
she was in the health space, but she said,
"I'm really good at holding people together. I'm really good about connecting."
Well, I mean, you may not think that, but everybody else does, saying you know,
here's someone who can hold this conversation about ending neglected diseases,
and unify them.
And I continue to write about this because you’re probably online,
but, she at the Gates Foundation annual meeting was the only outsider speaker.
3000 people, and she spoke between Bill Gates and Warren Buffet,
and she held a bucket of worms,
as an example of one of the diseases that we can prevent, right?
So, so fun.
So, thank you guys, thank you for spending the time.
So, it's fun to partner, right?
Hanging out and talking about tough topics,
and finding others to share that experience with.
So, how would you define systems change, you know, from your own perspective?
Well, first of all, hi everybody.
There's like so much wisdom in this room
and I know I'm just here to get all of you involved in this conversation.
How do I define systems change?
I was thinking about this.
You know, I think about this in like a three dimension way.
Skills, time application, work values, and how your organization…
if you're a social entrepreneur,
if you're thinking whether you're a systems entrepreneur or social entrepreneur,
or a social entrepreneur that focuses on systems change,
I think the ones who either are systems entrepreneurs or social entrepreneurs
like us that are concerned about systems change,
the kind of skills in addition to the ones
that you normally would have as a social entrepreneur,
I believe negotiation should be added on to that,
and someone who’s able to prioritize shared interest over individual positions,
or sometimes getting deeper in the world of positions that are there.
I think the other skills that matter, obviously, are diplomacy, advocacy,
those are some of the ones that come to mind.
In terms of time applications, and we've struggled with this,
you know, the metrics for systems change, when we've gotten involved.
I see everybody, you guys should come sit up here,
but I see Muso, and our friends Hope Through Health in the corner,
and English, you know, and we're all part of this consortium in community health,
and I know there are a few of us in the room that,
you know, none of us are staffed to do that.
Our boards don't staff us that way, our funders don't pay for our staff that way,
but we still all prioritize staff time to do that.
So, I think for the time applications, you're a social enterprise
or a non-profit social entrepreneur that's willing to allocate your own time
and/or your staff time towards helping the collective,
even if that's a long-term, and not necessarily short-term gain
for your four walls of your organization.
Spend time on…
(inaudible)
Yeah.
To have the ability to say, “This is how it goes.”
Yeah, yeah, that's right, that's right.
And I think you're then spending time on advocacy that's promoting the cause,
not necessarily promoting your own organization,
and you're actually, that's something you deliberately seek time to do.
And then just two things on values, which, one that you just mentioned, manage ego.
I think the humility to do work that others may not do,
and later I’ll give an example of how that happened during Ebola for us.
And then the other one is just again, the same thing, values,
the success of the cause of the success of your organization,
is a mantra we have at Last Mile Health,
that we're much more interested lower case Last Mile Health succeeding the idea
that we should get healthcare to everyone everywhere, it's not our idea,
that's shared by a lot of people, over the success of capital LMH.
That sounds like heretic to anybody that’s running a company
but we see ourselves as a means to that greater end,
and that means we also need to be successful.
But it's lower case lmh first over capital LMH.
And then the last thing, in terms of humility,
I mean, sorry, in terms of work values is, you know, if credit and attention is given,
as much as you can to redirect that attention to the cause.
I think that's really another piece of it.
And actually, that's hard to do, I would argue, we can get into that later.
Because I don't think the incentive structure here is set up that way.
Here at Skoll?
Yeah, well, not Skoll, but I think, I just think, you know, there's such a…
entrepreneurship comes from a history
that is actually very strong of individual empowerment that's individualistic,
yet everything we all do in systems change is collective based,
and it comes from the philosophy of collectivism.
So somehow we've just taken that social history
and it's normalized us to think we celebrate individual heroes
or individual organizations that are heroes,
and there's nothing wrong with empowering and celebrating success,
I just wish there was also, you know, a chance to celebrate collective and teams.
I don't know what award exists for a systems initiative.
You got one.
Yeah, well, but...
Do you think you were being celebrated for systems change?
I think we were, but I don't think that's the way we were, yeah, I mean...
I'd love to hear Skoll team’s (inaudible) figure that one out,
but I'm feeling like there is something for this.
But there are so many great systems initiatives, right,
that are out there that I just don't see,
where are the awards for the whole group of those?
It’s just an example of like where people put money is where,
there's one place that recognize what they value,
and I think we just borrowed that entrepreneurship,
which has been good for this sector,
but also, I think we're not thinking about
how that impacts or disincentivizes collective collaboration.
So those are the three things, skills, time application, work values,
that help me make a little more three dimensional shape of
what a systems entrepreneurship might look like versus social entrepreneurship.
So, do you think you're a systems entrepreneurial, Ellen?
Does it fit?  
-Well, you keep telling me I am,
so, I'm trying to embrace that.
I'm just really excited to be here.
It’s so great, I’ve gotten to see so many friends and partners.
And I think I was here, I was kind of having this,
I haven’t seen Paul Farmer for a while,
and just seeing like his dynamic with Jim Kim this week,
and how long they've been friends, and how much joy,
and how much tears, and I don't know about you guys,
but I feel like I've had a lot of laughter and tears the last couple days here at Skoll.
I'm thinking, ah, I really want to have that something,
and I'm like, I get to be on a panel with Raj and Jeff,
what do you mean, I do have it.
And just like the warmth and appreciation
that I feel for getting to accompany each other
and all of us together through this work.
I think that is part of systems change, it’s relationships,
being in authentic relationships over a long time,
and being able to reach out for help.
And you know, collaboration is messy and complicated,
and I love that a tool set, you know, the problem is the humans in the middle.
That's the problem and that's the door that we walk through and the opportunity.
So, for me, I think it's interesting that a lot of the community here—
and I worked in direct service organizations for a long, long time, in global health—
that had trouble collaborating and trouble thinking about a systems view.
They really had a very strong sort of founders culture,
and individual way of doing things, and it was very hard for me ,
who’s kind of a natural collaborator,
to be in an organization that didn't see things on a systems level.
So when the END Fund came,
when Doug Balfour from Geneva Global and (inaudible)
came and found me for this role, I thought, wow, he problem is so big,
people have to collaborate in this space.
It’s 1.5 billion people have the five neglected diseases
that we're trying to end in the coming decade.
And if that's going to possible,
it's got to be a lot of people that come together in a pretty coordinated way.
So that motivated me.
And I think what's interesting about the END Fund model, that I was attracted to,
was that it was designed with systems change in mind from the onset.
It isn't necessarily a direct service organization,
scaling to being a systems entrepreneur,
it was  designed from the onset to be a systems lens,
and to look across the entire space of who's working
in the neglected disease space from small implementing partners.
I mean, we're working with some small local NGO’s to really large NGO’s,
to (inaudible) directly ministries of health, to, what's the agency inside of WHO,
the World Health Organization,
that needs to be stronger in order to be support this globally.
And being that lens to see the whole space.
And so I think it was an organization started with a systems map in mind.
And some of our initial founders and funders
that had spent a lot of time working in Africa and funding projects,
they sort of said, we don't need any more boots on the ground,
there are so many great organizations and great people,
how can we be the glue between those things,
and how can we help inject ideas, or capital,
or technical assistance in places that could scale up,
so that we could rise the whole, sort of, all the organizations.
And I also sit on a sort of backbone organization on the board called,
Uniting to Combat NTD’s,
and there's about a hundred or so organizations coming together,
and we were talking about prizes for them,
they're coming together in a couple weeks.
Somehow, I don't know how Guinness found out about this,
but they're now giving the Guinness Book of World Records prize
for the largest like drug delivery program.
Because this year we've reached, the data just came in from 2016,
and as a collective community,
we will have reached 980 million people in treatments last year.
As the END Fund, we support about 26 organizations,
to treat 100 million people in that space,
but also it's our efforts, which is incredible,
but it’s also our efforts beyond that to partner with the whole range of organizations,
and figure out what can we do together around policy and advocacy,
and broadening the tent.
I think that five years ago when I started and realized,
okay, I was hired to solve a lot of problems, I kind of looked around and I was like,
I don't think the smartest people are in the room yet,
I think we've got a lot of figuring out what are the on-ramps to this space.
And when I would bring like a new donor into the space,
they would say, my gosh, I don’t speak NTD’s, they're very complicated,
all these names are very long, you know, long, complicated, unpronounceable,
but how do we lower those barriers to bring others
in a way that they can feel connected.
So a lot of the partners that we've supported are not traditional actors in the space.
We've got NGO’s that have never worked…
I'm seeing Jack (inaudible) here, we met a few years ago,
he works in the Eastern Congo,
he didn't even realize that NTD’s were such a big part of the problem there
until he started looking at mapping.
He’s like, oh my gosh, 90% of the people in the population I serve have these problems,
how can we work together to ensure that population has access.
Or some malaria organizations now that may have,
you know, worked with the mosquito vector,
but not on NTD’s, how can we provide technical assistance to them?
And we've done a lot of work with governments,
what do we need to do to help support a national plan for ending these diseases
and bringing together a coalition at a national level of partners that need to coordinate.
So, how do you both look at talking to your boards about the systems question,
do they all get it?
Or how are you talking to them about the funding?
I know you went to Gates, for example,
and got significant funding for communication awareness.
Not for any non-profit. It's kind of like, now we just need to do that. Right?
So how do you talk to your own boards,
and then how do find donors who get it too?
Well, I think because our organization was started with a systems lens, they do get it.
I think that, it's interesting though,
because there's still a tension when we're bringing in—I always think like,
well, if all of us sat around the table and talked about politics,
no one would get along, but everyone gets along
because they believe that we can end these diseases.
And so there are people who would prefer to fund all community based organizations
to solve this effort, versus all, you know, sort of academic research.
And finding that tension and balance I think is what's interesting.
It was a group of Western philanthropists, primarily, that started the END Fund,
and more and more, we we’ve been trying to engage,
we’ve got a great African philanthropist on our board now,
who's really helping bring on board more African philanthropists and corporate leaders.
So it's not that systems change is so controversial,
it's just how, and how to prioritize and what to do first.
Well, they're still learning, in my experience with them, right?
It started out as, it will be a fund of funds, almost,
like we'll just do the smartest allocations, and then they're, oh, wait a minute,
that just doesn't work, right?
And you had to educate them.
Well, it's interesting, because I think there's a lot of confusion.
And the name is END Fund,
it’s like we're only a funder and we're an endowed organization.
I'm like, not really, we're aggregating capital
from a lot of different philanthropists and sources and trying to do joint granting.
I think one of the things that the ministries of health have said over and over,
like, oh, we so appreciate that you're kind of like the one stop shop.
In fund comes, you know what the other major funders are doing,
but you're actually coordinating maybe 50 different philanthropists,
rather than us needing to have 50 more visits from the ministry of health.
But yeah, it's a learning journey.
I think that we've come a long way in figuring out how to do it well,
and realizing that we're not just a funder,
now we have much more of a technical assistance team
that really have great knowledge.
We’ve hired people from many organizations,
a wide range of them in this space,
to kind of be in house and help design programs,
and do a lot more advocacy and policy work than we were able to at the beginning.
Has your board just got it?
Well, I'm lucky because I have a board member in the room,
Kim Keller in the back, so you can ask her.
But I think that yes, I mean, we were born from the Ministry of Health.
We literally started the organization
because the Ministry of Health didn't have the funds
to pay community health workers.
We didn't have a business plan, we just raised money from grassroots,
and, you know, the first R & D project we ever did,
we went to the Minister of Health
and asked her to not just tell us what problems she wanted to solve,
but actually literally asked her what three policy questions
does she have that she needs a demonstration project for.
I thought we were doing, you know, I knew she would give great ideas,
what I didn't realize, and it’s unexpected,
was that they would actually give us one of the core innovations,
which was to put a clinical nurse, in our case, a really excellent coach,
to coach these community health workers.
So she completely reshaped what we did.
So I'm giving that back story because it was part of our DNA,
part of our culture,
so the board members we recruited always were people that had that background.
But I think now when we talk about it, Kim, in the board room,
after getting off the hum in the back with that big noisy vent
in our room in between the board meetings,
I think, we always come back to what we first started to do,
which is serve the patient.
So we're always interested in leverage
that increases the ability to reach more patients
or increase the quality of care for patients.
So we've always argued from that perspective.
Why are we working with the government of Liberia?
Because the government of Liberia, Partners in Health,
I see Ken here, and a number of other actors, are interested in the same thing,
around trying to professionalize community health workers
in these remote rural areas in Liberia.
We all want that opportunity,
we're not going to get a chance to do that if all of us are doing different things.
Because the government of Liberia,
we've all given our leadership support to them,
they've been able to then take the sum of our efforts for the whole country
and be able to crowd source in more funding, not crowd source,
but actually get in more public sector dollars,
which has made all of us more capable of being able to reach more patients.
So I think it's always been from a leverage point,
coming back to the original mission, which is to shave lives in remote communities.
And I don't know if that would be different from a systems entrepreneurship,
so, how you would argue it in a boardroom, but for us, if it fits the lever—
And having the bigger goal, you know, I keep hearing from a couple sources,
that in the end, to be a systems change agent,
I need to leave my direct service operation, that it might like a Jordan, who did that.
You know, say, Europe is now spinning out their systems change group,
because they're finding that other NGO’s didn't trust them,
that they were going to be the ones getting credit,
or the ones getting the funding from all the donors.
And you know, honestly, I have heard other donors saying,
I'm not giving it to Last Mile Health because they're the hot one,
I need to find otherwise.
And you say, well, wait a minute, they may actually have the really good answer,
you know, but, you know, I'm not doing that.
So there's this conflict.
I think there is, I think there is.
I think at the country level for those of us
that are interested in helping the public sector succeed,
it's a little easier, I’ve found, because we're trying to help the government succeed,
it's not the Last Mile Health model that's scaling,
it's the national community  health assistant program
that each of the different NGO partners can help shape and inform.
The curriculum in that program, the HIV/TB curriculum
is the one that Partners in Health developed in Haiti and Rwanda,
the IRC put the Family Planning curriculum in.
But I think that backbone organization
is essentially the government for the most part in that situation.
I think when you get to the global level,
I know Arnie and Mark, and others are here in that CHW15,
the group that English pulled together,
I do think there is that underlying tension.
I mean, I think it's very hard when you're sitting there saying,
let's all do something as a collective,
but when we go back into our boardrooms to our staff,
we have to worry about making sure we serve patients in Mali and in Togo,
and in Nepal, and that's our first mission,
and that's actually what systems change wants.
We need good examples of programs on the ground, but then what?
How do you help get to that?
Words like "umbrella organization" get used,
and I just don't know what that means.
"Consortium" gets used, I don't know what that means.
We look to you, Jeff, and others who have really studied and are studying
the science of collaboration to tell us what are the effective ways to do that.
You know, you've done that with END Fund.
So I think there's a real struggle.
I think it’s a real struggle.
So, before we go out and have you all talk around the tables, one last question.
So, where are we going with this?
Where would say are the things that we should be spending time
thinking about if we're trying to go after the big problems of the day?
You all in your particular areas of expertise,
but also maybe stepping back if you're advising Skoll community,
you know, here are some things to work on.
I think if you're Skoll or you're a forum like that, you know, part of your job,
part of what you do is you shape the culture of each of us.
You shape the norms of what the community does.
I think part of the task there is to shape the values,
to shift it from being four walled focused, capital, you know.
Yeah, the first time I ever did that was Nepal, right?
Capital Partners In Health, but there's a mantra, lower case partners.
So, let's shift the capitals of each of our organizations to the lower case version,
go from org to cause.
I think that's a values orientation.
People like you who are esteemed saying managed ego leaders,
I mean, those are things that are valuable.
I think that's one.
So if you're a philanthropist or an investor,
I think finding ways like English is trying to do, and Bonnie is trying to do,
to invest the time and capital to create a collaboration is really important and maybe,
at that point, I don't know if you would say, English,
but I think it's still early, how to do that, even as a philanthropist,
so perhaps sharing some best practices there,
or what's worked and what hasn't, would be useful.
And then I think if you're an entrepreneur,
to me, what big thing that we can all do, is, boy,
would I love to figure out what metrics Jordan is using at the Eye Alliance
and figuring out how our KPI’s of Last Mile Health could in some way be,
you know, if we could find a way to judge our success
in a way that is contributing to the success of the collective,
and that's metrics properly,
I think that would help rationalize some of the way the investments and the time is spent.
I don't know how to do it, but...
I think that's a huge opportunity, to think about measurement, data.
We're just beginning to figure that out, to work on systems level data,
measurement of what we're doing.
I think probably in the health space, there are so many examples of good coalitions,
and you know, whether it's malaria, or TB, or END Fund is model,
but we also work with other coalitions that, sort of, put your logo aside,
and work underneath a broad umbrella,
and that actually helps so much with moving an agenda forward.
I also think that this tension between social entrepreneurs and system entrepreneurs,
I feel like it's a lot of pressure for social entrepreneurs,
and I worry about losing the quality of just great implementations and if not,
just that point about not everybody has to become a systems entrepreneur.
And actually systems level leadership, and how to run coalitions well,
how to manage backbone organizations,
that that's actually a full time job with a different set of managerial expectations.
And I feel like sometimes I get a little bit of like,
you're only doing systems level work.
You do realize I’m not actually a direct implementer,
which is, like, that's the golden thing, to be the implementing organization,
and doing this other focus.
This is a really complicated full time job,
having a team of people mapping the hundreds of organizations
and thousands of different partners,
we're working in the space and figuring out
what needs to get done to move the whole space forward.
Why is that also not, you're right, why is there not a prize for that?
It's not about getting prizes,
but that feels to me like a whole area of study
that does have its own science and its own training programs,
and I think that is what you're leaning on.
And I think that even to me,
when I always think about the way that you support organizations,
is sometimes it's not that much funding to put the glue in place,
to help the coalition come together,
to create the one person that can kind of pull everyone together,
a little bit of funding for that.
And I've seen you influence so many other funders for that.
So I think it's happening, little by little,
but all of us that are committed to that systems change approach,
it's not systems change in a very ethereal way, it's practical.
Going to donors and getting a commitment for funding one or two people
who are going to hold this altogether as NGO’s doing things
that we have a hard time doing separately, is cheap,
and it's high leverage, and will get you more funding.
Like doing this, and walking in to a donor,
and saying, wait a minute, you've figured out how to work the area?
I'm funding you, right?
As opposed to I've got to figure it out myself.
Pay for glue?
A little bit, it doesn't take a lot.
So, we're going to go to tables for 15 minutes,
and there's going to be people, I think there are people at all the tables.
So Doug is going to be the moderator here, Nick over here, Jordan over here.
Can you raise your hand if you want to volunteer?
Amy, you're going to be on that table maybe?
Thank you.
Corner table, raise your hand,
whoever wants to be the documenter of what you guys are talking about?
Thank you.
English, you’re the one over here.
Enviroment, you’re supposed to be… raise your hand.
You’re it.
Okay.
And this table?
You can either be your own table or you can work with others,
it’s up to you how you want to work that.
So again, the goal is two things in the space
that you think we ought to focus on going forward as systems oriented individuals.
And then we’re going to communicate to the Skoll community,
and we will write about this, and we will spend time on this,
and you’ll report back to those two items, and you've got 15 minutes.
Okay, so now we're going to go to some quick report backs.
So we're going to keep track of your comments.
We have a microphone that's going to be coming around.
So can we start at this table on education?
You have a long list of things, but you're only allowed two.
So, Doug Balfour is going to report back on education.
And you may want to stand up just so people can see you.
So, our collective here, our coalition,
decided to ignore all the requests from higher authorities
to actually do what we were told and come up with two things.
But we did talk about a lot of other stuff.
And essentially the conversation started with reflecting on education coalitions
that we’d seen that didn't work, and asking the question why not.
And then thinking around a couple of,
sort of two different coalitions that we’d seen that did work, one,
Fair Education Alliance in the UK which is 14 different organizations working together,
and one in New York, with collaboration of not for profit community,
parents, and the New York school system working together.
And that kind of like prompted us to start to think about,
well, what is it that facilitates the successful, in our experience,
the successful bringing together of coalitions, both in education and elsewhere.
And we started to talk about common vision metrics.
Gates Foundation came up a couple times
in terms of acting as using their funding power,
but to try and facilitate collective action.
Polio eradication came up as part of that.
Recognizing how, we went back to an example
in South Africa where the coalition failed,
because essentially the temptation to use the power
of the coalition by one particular party made them
the powerful independent social entrepreneur, but basically wrecked all the trust.
So, the trust is actually very fragile, it's really, really easy to use your power,
and to lose that trust.
If you abuse the trust, the whole thing sort of falls apart very, very quickly.
And then mapping your organization essentially is really good to actually figure out,
do we actually have people that are actually missing.
Have we got lots of people who do the same thing,
but what about the people that are doing different things?
Awesome.
The hardest, I'm not sure which one this is,
if it's environment or the food security,
but we'll soon hear, who's reporting back?
I find the environment to be the hardest group
to focus on building collaborative networks.
Maybe you have the answer.
Well, we actually broke the rules as well and stuck to non-sector
because we had some good friends from the other table.
But we actually started off with a couple questions,
just like, where do you draw the lines of the system.
So you get to that system level, at what level do you draw that line at?
Within the country, within the department, within the continent,
or potentially even the world.
And we threw out a couple things that are important,
like getting rid of the ego, not capitalizing letters
and really focusing on the cause, what is the problem.
And we also had a question about the level of impact,
or do we focus in on one thing, focus in one really important issue,
and help make a really big impact on that, but potentially smaller numbers,
or go wide, go shallow, have a huge number of people impacted,
maybe not as high of a value.
Alexander mentioned systems are always changing,
so, you know, trying to be adaptive and adjusting for that
and redefining what the system is, and mapping that out.
And then finally, I think a really good point to end on,
identify who has power and then how does power move?
I thought that was a really good point
that I wouldn't give justice to continue talking about,
but I think, you know, identifying that,
that can have a big change in what you’re doing.
There's a new book coming out called, The New Power, by Henry Timms,
and he wrote an article in Harvard Business Review.
It's really interesting thinking about the new power networks that are coming up,
more flat structures, so you may want to check that one out.
This focused question, we're also finding that the simple measurable outcomes,
what are those.
It's not like I'm going to fix early childhood,
good luck collaborating on that one.
But, I'm going to focus on Boston and 25,000 kids that are 3 to 5 years old,
and all of a sudden you're saying,
ah, now maybe I can do something over the next five year period?
English, you had a big group.
Okay, so we sort of started by going over
what some of the major gaps were in the global health space.
And global mental health was brought up, primary care was brought up,
and just sort of a lack across the board of collaboration in those areas.
So that's sort of allowed us to narrow down maybe
what is missing to help foster those collaborations.
Financing was another thing, just the lack of collaboration on financing,
just through all the mechanisms of global health.
And then finally, we sort of came to the agreement
that lack of empowerment within partnerships
and within collaborations can be really detrimental.
So Jacques brought up a great point about his collaboration with END Fund,
and saying that one of the reasons
that it's so successful is because END Fund
has really empowered him and empowered his organization.
And then lastly, overall there's not really an agreement on what the outcomes are.
What are the outcomes that we're trying to achieve in global health,
and then in all these sort of silent sectors of global health?
Perfect.
Now we're going to go quickly,
because we've got five minutes left on each group.
Yeah this was, I would say, impossible.
So at this table there were I think a dozen different issues represented,
we're the open table.
And so maybe the only thing I can say that's useful here
 is that we began to talk about what collaborations
will enable systems to communicate with themselves,
and then what kinds of systems are required to activate engagement,
and are they the same things or not?
We were particularly looking at film making for social impact
and other means of engaging youth for social impact,
and are those really the same systems?
Developing empathy around the issues, and then engaging action.
And how do we form collaboration that do both of those things.
Okay, that’s great points on communication strategies.
Movement building also have skills and tools
to start creating the movement that can support your collaboration.
Okay, so on the poverty table,
which by the way we thought was the hardest issue,
everyone probably thinks the same thing about theirs.
Two points came across loud and clear.
So, first it's good to have a single message that you can rally people around.
So, we thought of the example of Malaria No More
and Nothing But Nets was good in perhaps you could get people
to rally in a similar way around at least some issue around poverty, and show progress,
that would be better for the sector than having to try and go in different directions.
So that was one.
And second, there's something to be said about the right message at the right time.
So looking at the UK case,
for example, there was a time when social investment
became highly regarded as a good thing by government,
that's when big site capital was created and the sector made a lot of progress.
Maybe there's a similar time now to look at, say, poverty,
the poverty premium that people are paying just for being poor,
and these have a wide appeal. So finding a framing that has a wide appeal
and there’s a policy in terms of civil society, and capitalizing on that,
rather than a new idea that people aren't ready to adopt.
That would be good, as well.
Two more ideas I'll say in 10 seconds.
One,  that it’s probably also good to think about positive language,
so maybe prosperity instead of poverty,
and also good to think about potentially involving more women
in systems development thinking.
It’s just been said, sometimes entrepreneurship is seen as a male thing,
very analytical and tactical, maybe the systems can be more of a woman thing,
and those would be the right people to bring.
More Ellens.
We were charged with immigration and refugees.
The first point is that this issue area, albeit,
there are refugee crises that last for decades,
this is often an issue that is a shorter term crisis issue,
versus some of the intractable problems
that are century long problems that other leaders are facing.
In order to gain some leverage in this area,
the table felt that it was important to create a common brand around the cause
that can rise above any specific organization.
And we used Syria as an example.
But then, although a common brand was agreed to be useful,
the question is, well, what stands behind that common brand
for action and can actually affect change.
And there we felt maybe a central database
of all organizations in this space of immigration and refugees
who could be pulled together and create processes
to pull together subsets of those organizations to address the specific problem.
A lot of them, but just an example such as John offered,
refuge points king of work in that segment,
I'm sure you guys are working with him,
kind of pull together that discussion about the organizations.
So there is always somebody else working on this.
If you don't know who they are, that's the really interesting task to go after.
Nick?
So we had human rights and that was the easiest of all problems to solve.
So easy that we started talking about Brexit.
But the reason we talked about Brexit as an example of a failure of a system,
i.e. that there were 18 or so really well funded pro-remain organizations
that had egos and disincentives to collaborate that led to a failure,
in part, of the campaign to remain.
So as an example of, you know, when systems don't work.
The two lessons that we kind of came out of it
and I'm being very liberal in my interpretation of what we took out of this,
but one is that often organizations are doing systems change without realizing it,
if I speak in pros. And the example of Crisis Action
that I was involved which Nick leads here in the UK,
were doing systems change 10 years ago, we didn't have the language,
and in fact we didn't know how to articulate it.
But the organization was standing in the background,
pulling together organizations working on conflict,
with no ego to get them to collaborate around a single campaign,
taking no publicity for itself and investing hugely
in overcoming the transaction costs of building a campaign or a moment.
So I think that is very successful example,
and now we know how to talk about it.
And then Donna I think made a very practical observation that,
you know, to build greater collaboration,
we need some tools to share infrastructure,
particularly for small organizations,
and so some thinking around how do we just share basic resources among ourselves?
Expertise on security awareness, IT expertise, comms expertise.
I mentioned that Geneva Global, in a slightly different context,
have been thinking of a fund to fund that had resources
that various organizations could draw on.
Some call it the back bone.
Yeah, well, that's it, and so a more conscious investment
in that kind of infrastructure might be really useful to build collaboration.
That's great.
And Crisis Action is a great example of somebody
who was an systems entrepreneur that didn't know it.
There's lots of them.
So, I appreciate the time you all took coming together.
There are a couple things.
One is, if you want any of the slides or anything else,
just give me your card and I'll send it to you.
There's an article that literally came out today,
I think I told you about it, at SSIR,
that talks about the points that I’ve made here.
It might help you communicate.
It talks a lot about the Freedom Fund,
it talks about what we're doing in education in the US,
New Profit and a variety of others, trying to use examples.
So the conversation I hope will continue.
There are lots of people that want to talk about this.
So there are more convenings coming together.
Join those.
Doug is going to run at three o’clock, a breakout,
taking this conversation to another level.
Yeah, Seminar Room 5 which is just downstairs
and it’s a small room so I think it’s like the first 12 that get there,
we’ll fit into a clinic and we’re just going to talk about your issues.
And he’s one of the experts so take advantage of that.
With Ellen and Raj, I want to thank you for spending your time with us.
While you were talking we were also doodling about,
and his objective at the TED conferences asked for an action focus day.
We weren’t calling it that.
Action focus day.
No, we weren’t calling it that.
Action forcing events.
But setting a date when you actually have to accomplish something.
So, actually using his speech at the TED conference saying,
there’s a lot of people that can unify around a common goal
like CHW’s are using that as an opportunity.
It’s what malaria did all the time with the General Assembly.
It’s what the Clinton Global Initiative did as well.
So, thinking about that in coalition building and collaborative building,
using some things like, I’ve got to get it done by, right?
And so we were talking about how to do that and thinking about it.
I think someone just tweeted “action focus dating” by Jeff Walker.
Oh great.
Please don’t.
Thank you all.
I appreciate it.
