Social Return on Investment for Emergency Obstetric Care Training in
Kenya
Dedication
To philanthropy and all those contributing to making the world a better place
List of tables
Table 1?1: Summary table of social impact assessment methods
Table 2?1: WHO emergency obstetric care signal functions ..
Table 3?1: Krlev et al. 12-point quality assessment framework
Table 3?2: Sources of retrieved SROI studies .
Table 3?3: Criterion quality scores of health SROI studies across the 5 dimensions
Table 3?4: Health interventions that have been measured with SROI
Table 3?5: Summary table describing application of the SROI methodology in Health
Table 3?6: Summary of duration of health SROI analysis .
Table 4?1: Outputs of the current phase of the Making it Happen programme
Table 4?2: Content of the LSS-EOC & NC .
Table 4?3: Distribution of Kenyan population across age groups .
Table 4?4: Kenyan Key development indicators ..
Table 4?5: EmONC indicators in Kenya compared to UN standards .
Table 5?1: Description of SROI principles .
Table 5?2: MiH outcome and output data indicators relevant for SROI analysis
Table 6?1: Stakeholder analysis of the EmONC training component of the Making it Happen programme
Table 6?2: Primary and secondary data required from the included stakeholders
List of figures
Figure 1?1: Types of Social Return on Investment Studies
Figure 2?1: Annotation of the logic model (version 1) .
Figure 2?2: Annotation of the logic model (version 2) .
Figure 2?3: DFID 3Es + CE framework for Value for Money ..
Figure 3?1: Schematic representation of the conceptual framework underpinning the review
Figure 3?2: PRISMA flow diagram summarising the search process .
Figure 3?3: Mean quality scores of health SROI studies since 2005 .
Figure 3?4: Number of public health SROI articles published since 2005.
Figure 3?5: Number of health SROI studies published by year, showing countries where the methodology was applied
Figure 3?6: Distribution of countries conducting SROI studies
Figure 4?1: Map of Kenya showing the eight provinces and the surrounding countries
Figure 5?1: SROI process map
Figure 5?2: Methods to be used within the SROI data collection stages..
Figure 6?1: Analysis of stakeholders related to EmONC training in Kenya
List of appendices
Appendix 2: Systematic review results
Appendix 4: Materials relating to Making it Happen
Abbreviations
ACAFIAtkisson Compass Assessment for Investors
AIDSAcquired Immune Deficiency Syndrome
BACOBest Available Charitable Option
BEmOCBasic Emergency Obstetric Care
BEmONCBasic Emergency Obstetric and Newborn Care
BoP Base of Pyramid
BScBalanced Scorecard
BVABlended Value Accounting
CAQDAS
CEmOCComprehensive Emergency Obstetric Care
CEmONCComprehensive Emergency Obstetric and Newborn Care
CBACost Benefit Analysis
CEACost-Effectiveness Analysis
CMA Cost-Minimization Analysis
CMNHCentre for Maternal Newborn Health
CRTCluster Randomised Trials
CSOCivil Society Organisation
CUACost-Utility Analysis
DALYs Disability-Adjusted Life Years
DFIDDepartment for International Development
DHDepartment of Health
DHS Demographic and Health Survey
EEEconomic Evaluation
EmOC Emergency Obstetric Care
EmONCEmergency Obstetric and Newborn Care
EOC & NCEssential Obstetric Care and Newborn Care
FGFocus Group
FGDFocus Group Discussion
GRIGlobal Reporting Initiative
HCPHealth Care Providers
HEFCEHigher Education Funding Council for England
ICPIntegrated Care and Prevention
IDIIn-Depth Interview
KHSSIP Kenya Health Sector Strategic and Investment Plan
KIIKey Informant Interview
KPIKey Person Interview
LADSILabour and Delivery Satisfaction Index
LATHLiverpool Associates in Tropical Health
LEMLocal Economic Multiplier
LMICsLow and Middle Income Countries
LSS-EOC&NCLife Saving Skills Essential Obstetric Care and Newborn Care
LSTMLiverpool School of Tropical Medicine
MARPMost At Risk Population
MDG-ScanMillennium Development Goal Scan
MICSMultiple Indicator Cluster Survey
MIFMeasuring Impact Framework
MiHMaking It Happen
MMRMaternal Mortality Ratio
MNHMaternal and Newborn Health
MOHMinistry of Health
MOMSMinistry of Medical Services
MOPHSMinistry of Public Health and Sanitation
MSCMost Significant Change
nefNew Economics Foundation
NGOsNon-Governmental Organisations
OASISOn-going assessment of Social Impacts
OVCOrphan and Vulnerable Children
PLHIVPeople Living with Human Immuno-deficiency Virus
PLHWAPeople Living With AIDS
PSIAPoverty and Social Impact Analysis
PTOPerson Trade-Off
QALYsQuality-Adjusted Life Years
QIQuality Improvement
RCOGRoyal College of Obstetricians and Gynaecologists
RCTRandomised Controlled Trials
REDFRoberts Enterprise Development Fund
RFRoberts Foundation
ROIReturn on Investment
SAASocial Accounting and Auditing
SBASkilled Birth Attendant
SCStakeholder Consultation
SCBASocial Costs-Benefits Analysis
SDRSocial Discount Rate
SIASocial Impact Assessment
SIAASocial Impact Analysts Association
SRASocial Return Assessment
SRHSexual and Reproductive Health
SROISocial Return on Investment
SSQSix Simple Questions
STDsSexually Transmitted Infections
SVAStakeholder Value Added
TBLTriple Bottom Line
ToCTheory of Change
TSOThird Sector Organisation
UKUnited Kingdom
UNUnited Nations
UNICEFUnited Nations Children Fund
VfMValue for Money
WBWorld Bank
WHOWorld Health Organization
1
Introduction
1.1
Purpose of the chapter
This chapter introduces the social return on investment methodology its definition, history as well as strengths and weaknesses of its application. It then proceeds to identify examples of previous applications of the method, explores any previous intersection of the methodology with the maternal and newborn health field and provides the rationale for the study. Finally, the objectives of this research and an overview of the thesis are provided.
1.2
What is Social Return on Investment?
The first definition of Social Return on Investment (SROI) is
a simple financial assessment of socio-economic value. SROI compares a projects net benefits to the investment required to generate those benefits over a certain period of time
(Emerson and Cabaj, 2000).
Over time, this definition has been modified. In the most recent SROI methodology guidance, SROI is defined as
a framework for measuring and accounting for the much broader concept of value. It seeks to reduce inequality and environmental degradation and improve wellbeing by incorporating social, environmental and economic costs and benefits
(Nicholls et al., 2012). This definition is most commonly referred to in the literature, when authors define SROI, probably because it is stated within the SROI guidance.
New Economics Foundation (nef) also defines SROI as
an analytic tool for measuring and accounting for a much broader concept of value, taking into account social, economic and environmental factors
(nef, 2014).
SROI measures change from the perspective of stakeholders that experience or contribute to a particular activity, intervention, project, programme or policy. It tells the story of how change is being created by measuring social, environmental and economic outcomes and uses monetary values to represent them (Nicholls et al., 2012). Data collection and subsequent analyses allow calculation of a benefits-to-costs ratio. For example, a ratio of 4:1 indicates that an investment of £1 delivers £4 of social value.
There are two types of SROI (Nicholls et al., 2012) [
Figure 1-1
]:
- Evaluative SROI: This retrospectively measures outcomes that have already happened.
- Forecast SROI: This estimates how much social impact will be generated if the activities to be conducted meet their intended outcomes.
Figure 1.1: Types of Social Return on Investment Studies
1.3
History of SROI
A review of the development of the SROI methodology would aid understanding of the initial considerations of those who developed the tool and the capabilities and potentials of the tool. This understanding is critical for this research as it provides a foundation upon which the application of the SROI framework in the maternal and newborn health (MNH) area can be better understood.
Roberts Foundation (RF) developed the initial SROI framework in 1996, presented in a report titled
New Social Entrepreneurs: The Success, Challenge and Lessons of Non-profit Enterprise Creation
(REDF, 1996). The purpose of the first SROI report by REDF was to demonstrate the blend of financial, social and environmental value that all the social enterprises within REDFs funding portfolio were producing compared to the total investment the organisation was making. This first SROI did not attempt to account for all benefits accrued from a programme, but estimated the cost savings or revenue contributions that are attributed to the programme. The framework utilised a modified discounted cash flow analysis for this calculation to demonstrate impact (Emerson and Cabaj, 2000; Emerson et al., 2000).
In 1997, the RF, under its new initiative Roberts Foundation Enterprise Development Fund (REDF) updated the framework so to have the capacity to account for total organisational social return on investment and adjusted to be able to account for actual performance that could be continuously updated. REDF recognised more limitations in the methodology (Emerson et al., 2000), but has since not produced any further SROI reports or guidelines. However, the concepts that underpinned the development of this initial framework have been built upon in the subsequent development of the methodology over the past two decades (Tuan, 2008). Guidelines for SROI application have been produced in year 2000 (Emerson and Cabaj, 2000), 2004 (Lingane and Olsen, 2004) and 2006 (Scholten et al., 2006). In 2008, the United Kingdom (UK) Office of the Third Sector (Now referred to as Office for Civil Society (Civil Society Media, 2010)), which is responsible for charities, social enterprises and voluntary organisations in the Cabinet Office (UK Government, 2014) launched the Measuring Social Value project (Arvidson et al., 2010) and this led to the development of an updated guideline in 2009 (Nicholls et al., 2009) and the production of another revision three years later (Nicholls et al., 2012).
These revisions have over the years integrated the initial REDF SROI methodology, which was essentially a social impact measurement tool with principles and processes normally used in economic evaluations and financial return on investment to build a framework that captures social, economic and environmental impacts of interventions (Rotheroe and Richards, 2007). This concept of capturing the broader impacts is widely referred to as the triple bottom line (Norman and MacDonald, 2004), which is in itself encapsulated within the blended value accounting theory (Emerson, 2003). Furthermore, through this evolution, a more detailed stakeholder analysis is now included, shorter time frames are used for estimations and a process to adjusts the results for outcomes that may be attributable to different organisations has been incorporated into the calculation of the SROI ratio (Tuan, 2008).
Discussions on how best to structure the methodology are on-going and networks such as the European SROI Network (ESROIN), formed in 2004, the SROI Network (international), formed in 2008 and subsequently affiliated networks formed in Sweden, Canada and Australia, are constantly leading and shaping this process (SROIN, 2014a). The methodology is gradually gaining interest in Africa and Asia too. The drive to develop the methodology has come from within and without the third sector, as third sector organisations (TSOs), such as not for profit organisations, charities and voluntary organisations, are increasingly getting involved in delivering public services and are viewed as development partners who need to show value for mone
