thinking big: practical suggestions for the process...
TRANSCRIPT
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
liti
ca
l, P
oli
cy,
In
sti
tuti
on
al, L
eg
al
(v =
ve
rtic
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