Thinking Big: Practical Suggestions for the Process of

Going to Scale

Leslie Elder

Sr. Nutrition Specialist

Health, Nutrition and Population

Human Development Network

The World Bank

What is the problem?

Pilot projects and interventions being tested in research studies show impressive results

BUT Their impact often remains small-scale and

unsustainable

WHAT IS MISSSING?

Thinking big….

1. Definition of scaling up

2. ExpandNet approach and key tools http://www.expandnet.net/tools.htm

3. Planning for scaling up from the start of pilots/research design

4. Developing a strategy for scaling up an innovation

Definition of scaling up

“Deliberate efforts to increase the impact

of health service innovations

successfully tested in pilot or

experimental projects so as to benefit

more people and to foster policy and

program development on a lasting basis.”

(ExpandNet)

Scale-up: IYCF services/interventions

• Increased coverage of available IYCF services and implementation of optimal care practices

• Improved quality of infant and young child feeding care and services

• Improved equity in coverage and utilization of IYCF services

• Sustainability of scaled-up delivery of IYCF services and use of improved IYCF care practices in the

context of broader health systems

Setting the stage for successful scale-up

1. Engage in a participatory process involving key stakeholders

2. Ensure the relevance of the proposed intervention

3. Reach consensus for

expectations of scale-up

Setting the stage for successful scale-up

4. Tailor the innovation to the sociocultural and institutional settings

5. Keep the innovation as simple as possible

6. Test the innovation in the variety of settings where it will be scaled up

Setting the stage for successful scale-up

7. Test the innovation under the routine operating conditions and existing resource constraints of the health system

8. Develop plans to assess and document the process of implementation

9. Advocate with donors and other sources of funding for financial support beyond the pilot stage

Setting the stage for successful scale-up

10. Prepare to advocate for necessary changes in policies, regulations and other health-system components

11. Develop plans for promoting learning and disseminating information

12. Be cautious about initiating scale-up before the required evidence is available

Sometimes, good ideas

just spread on their own……

ExpandNet/WHO Conceptual Framework for Scaling Up

Types of scaling up

• Spontaneous diffusion – reduced costs/effort but important to ensure that essence of innovation remains intact

• Guided scaling up – Replication/expansion (horizontal)

– Political/legal institutionalization (vertical)

– Diversification

Can occur in combination

Pathways to scale-up

High h

High v

Low h

Low v

High h

Low v

Replication/Expansion

(h = horizontal)

Time

Po

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l, P

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In

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al, L

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(v =

ve

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al)

Courtesy of Ruth Simmons

Strategic choices depending on type of scaling up

Principles underpinning the scale up process

• Systems thinking

• Focus on sustainability

• Enhancing scalability

• Grounded in participatory/client-based approaches with a focus on equitable access

CORRECT attributes of scalability

Credible

Observable

Relevant

Relative advantage

Easy to install and understand

Compatible with established values, norms

Testable at small-scale prior to large-scale adoption

Apply the nine step process for

developing a scaling-up strategy

• Balance what is desirable with

what is feasible

• A scale-up strategy is never static and will change as soon as implementation is underway

• Scaling up is a learning process based on systematic use of evidence generated through M&E

• Strategic thinking should continue with the process of moving from planning to management of scaling up

Thank you for your kind attention