Can social outcomes contracts really catalyse lasting change?

In the US, prior to the launch of the Utah High Quality Preschool SIB Programme in 2013, the state of Utah did not fund any preschool education programmes. The results of the initiative were compelling enough to shift the mindsets of Utah lawmakers and unlock more federal funding to expand access to preschool programmes, as explained at last year’s Social Outcomes Conference by former Congressman and Mayor of Salt Lake, Ben McAdams. In Cameroon, a development impact bond designed to test and refine Kangaroo Mother Care (KMC – an evidence-based approach to reducing neonatal morbidity and mortality), influenced the country’s National Strategic Plan for Maternal and Child Health and embedded KMC training into mainstream clinical training.

In very different contexts, these examples illustrate how social outcomes contracts (SOCs) might have impacts beyond their immediate scope. Achieving this kind of system-level impact is what gets many practitioners out of bed in the morning, but beyond individual case studies, robust evidence remains scarce. If we are to fully unlock the ability of SOCs to drive lasting change at scale, it is imperative to better understand the evidence behind current practice in a systematic way, learn from new initiatives designed with sustainability in mind, and think carefully through the approach’s wider implications for public accountability and power in public sector reform.

We started exploring these questions at SOC22, but we still have a long way to go. Here are three things that, as a community of practitioners, policymakers and scholars we need in order to progress our understanding of how, under which circumstances and for whom social outcomes contracts can lead to system change.

1. More clarity on definitions

Terms such as ‘system strengthening’ are broad and can mean different things in different disciplines and sectors. In international development, it’s often understood as ‘capability for policy implementation’ – the capability to deliver effective services to meet population needs. This is a helpful starting point, although framing system strengthening using the language of international development can make it seem relevant only in low- and middle- income country contexts. In high-income contexts, references to public sector ‘reform’ or ‘improvement’ capture a similar ambition to improve systems of public service provision, including through partners in the social and private sectors. Starting with clarity as to what we mean when we make claims around system strengthening impacts is vital, and recent attempts to distil conceptual pathways to longer-term system strengthening are an encouraging step in the right direction, but they require empirical validation.

Furthermore, a conclusive, comprehensive definition of social outcomes contracts or impact bonds remains elusive, as the model is being stretched and flexed to adapt to different contexts. Rather than thinking of social outcomes contracts as a fixed model, it is more helpful to think about the set of underlying mechanisms at the core of SOCs, and how these distinct mechanisms relate to system-level impacts. What are underlying mechanisms to which we can attribute long-term impact, what is the interplay between these different mechanisms, and how do they relate to the complex social, economic and political contexts in which they operate?

2. A deliberate approach to embedding sustainability from the onset

When trying to get a project off the ground, it can be tempting for those involved to overstate the benefits. However, asking too much, of too little, too soon can be perilous. It risks setting the bar so high that no project, no matter how well implemented, can ever achieve success, given the complexity of the kinds of entrenched social challenges being addressed. It can be equally tempting to retrospectively claim spill-over effects without a robust evidence-base to substantiate such claims.

Regardless of its particular focus, starting with the long-term goals in mind and articulating a clear theory of change will shape the project. Beyond this, we ought to seek more clarity as to the long-term impacts that can be attributed to the SOC through robust evaluation work. Given the complexity of systems change, attribution is certainly not easy or straightforward. However, well-designed evaluations, baked into projects from the start, can help shed light on the long-term impact and spill-overs of social outcomes contracts – both positive and negative.

3. Careful consideration to where accountability for system strengthening lies

While most would agree that system strengthening is a worthwhile goal, so far there seems to be little consideration given to where accountability for this change lies. What kind of systems are we building or strengthening when looking to extend the impact of a particular social outcome contract? In the absence of strong state capability, who has the power to shape institutions and mechanisms for public service provision, and how can we ensure that they reflect the choices and values of those they seek to serve? And are we building capacity within or outside government?

Data-driven decision-making and active performance management are often highlighted as core engines of impact in SOCs, but often these functions are managed by third parties, rather than government. For those social outcomes contracts where government is an active stakeholder, a deliberate learning agenda can help ensure that capability building and long-term change are achieved, embedding good data practices and systems into government beyond the life of the project. However, achieving change is likely to be more challenging in the absence of a deliberate, shared learning agenda across the project stakeholders, where greater barriers to institutional change remain.

Reforming public services is a monumental task, with few (if any) straightforward answers. Recognising the need to be transparent about how social outcomes contracts might influence public service provision in the long term, and their ability to set or influence policy agendas and funding allocation, is vital for ensuring public accountability. This also highlights the need to invest from the onset in building government capability to be an informed and active stakeholder.

The urgency of the challenge

Reading the latest headlines, from failures to tackle homelessness in the US and challenges with health and social care in the UK, to the barriers to access high quality health treatments in low- and middle- income countries, it is hard to avoid the feeling that the systems of public service delivery around the world are in need of reform. This adds urgency to the imperative to deliberately design robust social outcomes programmes that have long-term impact built in from the start. Designing social outcomes contracts in a way that ensures they are sustainable is crucial, as is being realistic about what can be achieved given the huge scale of the challenges communities across the world face. Optimism can be a powerful, positive force, but wishful thinking can be dangerous.

This is why we need a more nuanced understanding of the role social outcomes contracts can play in addressing at scale the multifaceted societal crises that we face. Despite the daunting challenge at hand, there are many grounds to be optimistic. New ambitious initiatives designed with sustainability in mind can offer valuable insights, and so does emergent academic research in this space – join us at SOC23 to explore these important questions and lots more.

Acknowledgements

This blog piece draws on conversations with GO Lab’s Dr Harry Bregazzi and Dr Mara Airoldi, and on the discussion ‘The work never stops: how do we make social change stick?’ at SOC22, which featured contributions from Louise Savell (Social Finance), Professor Carolyn Heinrich (Vanderbilt University), Avnish Gungadurdoss (Instiglio), Thomas Kenyon (World Bank), Andy Brown (Anglian Water), and Ben McAdams (Former US Congressman and Mayor of Salt Lake City).