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Novartis, for example, has managed to achieve scale with its Arogya Parivar healthcare initiative in India.
To achieve scale and profitability they would need to spend a lot of money, billions more.
American officials, he says, "have no problem making big awards, so they can achieve scale".
"You have to achieve scale before the economics will work," Mr. Allaire said.
We have to achieve momentum and velocity, and it has to achieve scale to make it sustainable".
First, most technology companies find it essential to access the large and homogenous American market in order to achieve scale.
"We think we'll soon achieve scale in the U.S. that matches some of the big chains," Mr. Low said.
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Stephen Kehoe said providing access is not enough though – usage is key to achieving scale.
One of the hurdles we are constantly coming up against is achieving scale on effective local initiatives.
Some of these are operated by multinationals, and some by emerging and maturing companies that are achieving scale.
Elliot says that policies which protect biodiversity and ecosystems can play a big role in achieving scale.
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