The Lagos experience
In 2017, LAMP conducted one of the first social return on investment (SROI) studies on the digitisation of health systems. In partnership with E4A-MamaYe, LAMP sought to assess the value of the early stages of the digitisation of the maternal, perinatal death surveillance and review (MPDSR) system in Lagos, Nigeria. With approximately 555 maternal deaths per 100,000 live births per year in Lagos, the MPDSR system is vital to helping facilities and state health authorities understand the underlying factors contributing to maternal death and act to prevent similar deaths happening in the future. It is critical to ensure that digitisation supports this and the SROI study aimed to provide insights into how the process was working and make recommendations for future roll-out.
Why Social Return on Investment?
SROI is a framework for understanding, measuring, and reporting the social, economic and environmental value created by an intervention, programme, policy or organisation. Basically, it measures how worthwhile an investment is from the perspective of stakeholders. It accounts for direct and indirect costs and provides a method for monetary valuation of both positive and negative health and non-health outcomes. It can be used to retrospectively measure outcomes that have already occurred (evaluative-type) or can prospectively predict how much value will be generated if the intervention meets its intended outcomes (forecast-type). There has been a lot of interest in the development community in using SROI, as it has the capacity to capture broader outcomes of public health interventions and assess their value-for-money.
In Lagos, where maternal and neonatal death surveillance is going digital, stakeholders wanted to find out whether this would represent a true return on investment SROI measures how worthwhile an investment is from the perspective of stakeholders Insights generated from the research helped to improve roll-out of the digitised system
Using SROI in Lagos
LAMP worked closely with the implementers to develop a social return on investment methodology to align with the intervention’s theory of change. The research involved engaging with stakeholders at the Lagos State Ministry of Health and running a series of focus group discussions with clinicians at maternity hospitals across the State, as well as collecting existing costs and outcomes data of the digitised platform.
Findings and feedback on use of SROI
Using SROI, LAMP captured the anticipated and unanticipated benefits and challenges experienced by stakeholders during the early phases of digitisation. These included improved accuracy of data and simplified workloads as a result of transferring data entry into digital systems. Medical personnel felt the forced data-entry in the digital system made them better clinicians by helping them record a more thorough patient history. However, there were also challenges in digitisation including: stakeholders fear about losing the tablets, access to and functionality of the online data platform. These insights provided a holistic view on the progress of the digitisation and enabled E4A-MamaYe to assess whether going digital would represent a true return on investment. The findings and insights enabled E4A-MamaYe programme staff, in conjunction with the Lagos State Ministry of Health, to tailor their digital strategy which is currently mid-roll out.
How can SROI work for you?
Overall, the SROI methodology allowed for the capture of broader outcomes, positive and negative, that had not been previously characterised or associated with digitisation of MPDSR. It enabled us to provide a monetary value to typically non-monetary outcomes and include these in assessments of value for money. Unlike more conventional economic evaluation methods such as cost-effective and cost-utility analyses (CEA & CUA), in which outcomes are more unidimensional – an SROI approach can give a more reflective and honest assessment of the intervention. From our experience, this is the unique perspective that SROI can offer for your work.