HLTH 6880 Week 10 Social Venture Scale Plan Example

Scaling LinkBP: What Copies Cleanly, What Must Be Rebuilt in Each County and When Scaling Would Be a Mistake

Student Name

Walden University

HLTH 6880: Social Entrepreneurship and Innovation: A Global Perspective

Instructor Name

Month Day, Year

Scaling LinkBP: What Copies Cleanly, What Must Be Rebuilt in Each County and When Scaling Would Be a Mistake

Introduction

LinkBP, a composite venture that follows up adults with high readings, is designed for one sub-county of a composite western Kenya county. This plan asks what a second sub-county, and then a second county, would require. The answer turns on a distinction: some parts of LinkBP copy cleanly from one place to the next, and some have to be built again each time. A plan that treats the second site as a copy of the first at the same cost will underestimate what scaling takes. All costs below are described by structure and category, not invented totals, since no pilot has run and there are no real costs to report.

What Copies Cleanly

Four components copy with little change. The follow-up protocol, which sets the timing of the first visit, the clinic booking, monthly checks, refill prompts and the reading threshold for referral back to the clinic, rests on international treatment guidance and does not change by county (World Health Organization, 2021). The case-tracking application runs on any phone and needs only a new list of clinics. The training curriculum for follow-up workers and supervisors is written once; only the examples and the clinic names change. The measurement plan, with its output and outcome indicators and definitions, applies as written, which is what allows results from different counties to be compared.

What Must Be Rebuilt

Four components have to be built again in every new county. The county contract is the most important. Each county under Kenya's devolved system plans and executes its own health budget, and research on county health systems found budget monitoring and accountability practices varying in strength across counties (Musiega et al., 2023). A contract priced on control in one county gives no guarantee that the next county will sign on similar terms, or pay on time. Relationships with clinics depend on individual clinic officers agreeing to confirm visits and share refill dates; these agreements must be negotiated clinic by clinic. Hiring and supervision depend on local recruitment, since workers must know the area and be trusted in it. Community trust has to be earned through workers who arrive when they said they would, which no amount of success in another county can substitute for.

This sorting matters because the components that do not travel are also the ones that take the most time and the most senior staff attention. A second sub-county within the same county reuses the contract and many clinic relationships, so it is closer to a copy. A second county reuses almost nothing in this second list.

Cost Structure Across Sites

Costs fall into three groups. Once for the venture as a whole: developing the protocol, curriculum, application and measurement plan, which is already done after the pilot. Once per new county: contract negotiation, clinic agreements, the first cohort of supervisor and worker training, cuffs and phones for the first workers and a baseline linkage trace. Recurring per site: worker pay, transport, airtime and data, supervisor pay, cuff replacement and the half-time data role.

The one-time county costs are the barrier to scale. In an illustrative budget, a new county requires several months of senior staff time before the first adult is enrolled, while a new sub-county within an existing county can start within weeks. Unit costs in a new county will come from that county's own pay scales and transport costs, not from the pilot's, and the plan will use the pilot's figures only as a starting estimate to be replaced.

Choosing a Route to Scale

There are four routes. LinkBP could open its own operations in each new county; license the method to other organizations; partner with county governments so that their own community health workers carry out the follow-up with LinkBP's tools and supervision; or publish the method openly and let others adopt it.

The model points toward partnership with county governments. LinkBP's revenue already comes from county contracts, and the strongest evidence for the mechanism comes from a trial in which the follow-up was carried out by government health workers tied into public clinics (Jafar et al., 2020). An influential analysis of NGO scaling argued that organizations often achieve the widest impact not by growing themselves but by influencing and supporting the public systems that already reach people, which the authors called thinking large and acting small (Uvin et al., 2000). For LinkBP, that would mean a second phase in which the venture trains and supervises county workers and maintains the application and measurement system, while the county employs the workers.

That route has a cost: LinkBP would have less control over the quality of follow-up, and county workers would carry hypertension follow-up alongside their other duties, which the venture's own Week 3 analysis identified as a reason the gap persists. The plan therefore sequences the route rather than jumping to it.

Sequence

The plan proceeds in three steps. Step 1: complete the pilot sub-county, with an independent evaluation and a stepped rollout if the county agrees. Step 2: if the pilot meets its targets, expand to the remaining sub-counties of the same county, still with LinkBP's own workers, reusing the contract and clinic relationships. Step 3: in a second county, enter as a partner to the county's own community health workers, with LinkBP providing training, supervision, the application and measurement, and test whether results hold when the workers are not LinkBP employees. A framework for scaling social enterprises treats building alliances with government and replicating programs as distinct capabilities that ventures must develop deliberately (Bloom & Chatterji, 2009); the sequence builds replication first and the government alliance second, in a setting where the venture already has a contract to lose.

When Scaling Would Be a Mistake

LinkBP will not scale if any of four conditions holds. If confirmed linkage and retention in the pilot do not exceed the traced baseline by a clear margin, there is nothing to scale. If the county pays late for more than two consecutive quarters, the payment model has not been proved and a second county would multiply the risk. If quality falls in Step 2, measured by the share of supervisor repeat readings that agree with workers' readings, the venture is growing faster than it can supervise. And if, in Step 3, county workers' other duties visibly suffer, for example if maternal and child visits decline where hypertension follow-up is added, the partnership route would be doing harm and would stop. Mission drift during growth is a known risk of hybrid organizations, and stating the stop conditions now is how LinkBP guards against it (Ebrahim et al., 2014).

References

Bloom, P. N., & Chatterji, A. K. (2009). Scaling social entrepreneurial impact. California Management Review, 51(3), 114-133. https://doi.org/10.2307/41166496

Ebrahim, A., Battilana, J., & Mair, J. (2014). The governance of social enterprises: Mission drift and accountability challenges in hybrid organizations. Research in Organizational Behavior, 34, 81-100. https://doi.org/10.1016/j.riob.2014.09.001

Jafar, T. H., Gandhi, M., de Silva, H. A., Jehan, I., Naheed, A., Finkelstein, E. A., Turner, E. L., Morisky, D., Kasturiratne, A., Khan, A. H., Clemens, J. D., Ebrahim, S., Assam, P. N., & Feng, L. (2020). A community-based intervention for managing hypertension in rural South Asia. New England Journal of Medicine, 382(8), 717-726. https://doi.org/10.1056/NEJMoa1911965

Musiega, A., Nyawira, L., Tsofa, B., Njuguna, R. G., Munywoki, J., Hanson, K., Mulwa, A., Molyneux, S., Maina, I., Normand, C., Jemutai, J., & Barasa, E. (2023). Budget monitoring, accountability practices and their influence on the efficiency of county health systems in Kenya. PLOS Global Public Health, 3(11), Article e0001908. https://doi.org/10.1371/journal.pgph.0001908

Uvin, P., Jain, P. S., & Brown, L. D. (2000). Think large and act small: Toward a new paradigm for NGO scaling up. World Development, 28(8), 1409-1419. https://doi.org/10.1016/S0305-750X(00)00037-1

World Health Organization. (2021). Guideline for the pharmacological treatment of hypertension in adults. World Health Organization.