This summary examines five CARE examples that produced systems-level change in Laos and Nepal, and traces U.S. policy to improving people’s lives in Bangladesh and Malawi. Across five contexts, external consultants assessed CARE’s systems-level change contributions and impact using CARE’s Systems Level Impact (SLI) framework and its six pathways to impact at scale: supporting and advancing social norms change, service system strengthening and social accountability, supporting social movements, inclusive market-based approaches, and advocacy for policy change.

Some key patterns are evident especially in relation to policy, social norms transformation, accountability structures, and institutional adoption.