Thank you Tony! These are really interesting and tough questions.
We certainly see a potential route for government as a doer and payer at scale. Re payer: we’ve seen examples in Pakistan where he government outsource service provision in both education and health to NGOs - so NGOs deliver but government pays. Re doer: when there is a strong community based health worker force it’s more possible to layer TB into what they do. There are some alternatives to consider e.g. Commcare Connect https://labs.connect.dimagi.com/ to essentially allow government staff to pick this up as gig work. But we haven’t looked into these a tonne yet. I think the routes here are most promising in Punjab province and potentially other countries.
However, with the advent of the third wave of philanthropy the time pressure to handover to government as the payer at scale I think has lessened. I’m interested in your take on this too. It does seem possible to me that providing this intervention support directly in Sindh and elsewhere funded by philanthropy could be a more viable route than it has previously been. Right now I think that actually means viability of different funding sources is probably my biggest uncertainty to shed light on the best scaling strategy.
Thanks Verónica!
Co-founders moving on is an interesting topic that I’ve changed my mind on a bit over time.
Looking at AIM-incubated organisations there were a few initially that kept the same two co-founders for a long while. But more recently there has been more diversity of routes:
Organisations doing really well with only one founder from the start
A bunch where where one founder left around the 2 year mark and it seems like the right decision for the org. (By then you’ve built something that exists a bit beyond the two of you and having one organisational leader building an exec team around them could make more sense. )
I think that generally has pushed me (and I think others at AIM) to think that two co-founders staying for the long haul isn’t always the ideal to strive for. As I understand it, AIM’s messaging in the incubation program at the moment has shifted a bit to accommodate that.
Some other things to note:
There can certainly be cases where a co-founder leaves because of conflict, or especially early on, or it might not have been ideal timing for the organisation
There have been organisations initially in category 1 and 2 that then did bring a second person into the exec team who is co-executive again, and
I think more traditional wisdom in other sectors can often be that they’d love to see founders really be driven by their commitment to this project and stick it out for a long time.
I think that didn’t directly answer your question but hope that helped!