Scaling-Up Methodologies Three different approaches for different settings Plenary session on scaling up Reconvening Bangkok 2007 – 2010

A common understanding of what is meant by scaling up Deliberate efforts to guide the spread, institutionalization and sustainability of successfully tested interventions for which there is local evidence

Scaling up is predominantly a political, managerial and organizational task It requires commitment from those with authority and power to implement

Scaling up requires systematic nurturing and support Not the same as routine program implementation A committed change agent supported by a team of multi-disciplinary stakeholders increases success

We must begin with the end in mind Planning for scale up should start with planning for the pilot and not just be an afterthought

We need to know two things: Whether interventions: 1) 1)are acceptable and improve health; 2) 2)can be implemented not only in a pilot but in a large-scale program

Focus must be on strengthening health systems capacity Scaling up should not detract from the implementation of existing programs

Complex innovations are not easy to scale up More resources are needed The pace of spread/expansion may have to be slower

Scaling up benefits from participatory approaches Change must matter to those who are making change They must see clear benefits

A learning process Scaling up involves: Building local capacities for innovation Flexibility Ability to adapt interventions to local settings

Results from monitoring must influence decision making… … to allow learning, adaptation and strategic management

Do not lose central values during scaling up Introducing best practices is grounded in a philosophy of reproductive health, equity, and quality of care These values require special monitoring during scale up as they are most easily lost