“Scale up is a craft not a science” 

Quote from the IDEAS qualitative study of scale-up in Ethiopia, Nigeria and India

Implementation projects need to use multiple methods

Unsurprisingly there is no ‘magic bullet’ approach. Implementation projects need to plan for scale-up from the start, use multiple methods – all requiring time, energy and resources – and work closely with other organisations and government to achieve scale-up.

Donors need to support scale-up

Donors need to support and fund implementers to catalyse scale-up so it is supported from the start of a project and implementaters have the resources to support scale-up work. When donors work on the ground brokering relationships with government and coordinating international organisations, scale-up is more likely.

Politics play a major role

But most importantly, the skill of achieving scale-up is a craft, not a science: support from a powerful government figure can be as important as having a good intervention and strong evidence. Country politics are very important to scale-up and implementers and donors need to work on building effective relationships with government officials.

These findings come from a paper I recently published (read a summary) based on 150 ‘qualitative interviews’ (meaning we asked respondents open ended questions and encouraged them talk in detail of about the issues they felt were important) with government, project implementers, UN agencies, experts from Ethiopia, Nigeria and Uttar Pradesh, India.

Based on this evidence, here are a few checklist tips implementers and donors can use to catalyse the scale-up of their successful innovations. We have also produced research briefs on this topic for Ethiopia, Northeast Nigeria and Uttar Pradesh, India.

Checklist: what implementers can do to catalyse scale-up

1. Design an innovation that is scalable

Designing an innovation to be scalable isn’t easy. It’s difficult to find a balance between innovations that are very effective but need a lot of money and time – and simpler, cheaper ones that governments can afford to scale-up. Ask yourself, is your innovation:

• Relevant to the needs and priorities of health workers and communities so they will accept it?
• Demonstrably effective?
• Simple for community health workers and communities to use?
• Adaptable to communities that may be different in terms of religion, wealth etc.?

2. Embed scale-up in your implementation project design

Dedicating staff, time and resources to scale-up as a central part of a project plan is important. Do research early in the project to help plan for scale-up. You may want to look at:

• The political context, e.g. what health issues does the government prioritise?
• The social context, e.g. what are the needs and priorities of communities and health workers within those communities?
• Other organisations. Are there other groups you can link with who will support your work?

3. Effectively advocate government for support

• Present strong quantitative evidence showing your innovation has a positive impact and is cost effective. Without this it’s unlikely a government with limited resources will agree to put resources in for scale-up.
• Use qualitative data to demonstrate operational lessons learned and how challenges were overcome.
• Communicate findings effectively so the government can make informed decisions. Ensure dialogue with government starts early and keeps going throughout the project (not just presenting evidence out of the blue) and try to present during the government’s decision making cycles when the evidence is more likely to be used.

4. Work closely with government and other organisations

• Get government buy-in. Make sure your innovation fits in with existing government policies and programmes and then build relationships with government officials who may be critical to getting overall government support and buy-in.
• Work with other organisations on projects, share information, and jointly communicate to government. Coordinate closely with other organisations to avoid a situation where there are lots of international organisations and implementers doing similar work in parallel – reinventing the wheel – then competing with each other for government attention.

Checklist: what donors can do to catalyse scale-up

1. Support and fund implementers to catalyse scale-up

Although donors want their innovations scaled up, work to achieve this is usually added on when a project ends. Supporting scale-up work from the start of a project and ensuring implementers have the resources they need to carry out the work will help to catalyse scale-up.

2. Be active on the ground

Broker relationships with government and help coordinate with other international organisations working in that particular country.

Not all of innovations can and will be scaled-up but these checklist tips are based on in-depth qualitative evidence which I hope will help implementers and donors to get their successful innovations scaled up to benefit more women and newborns.