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It is a common story in low- and middle-income countries across the world. A donor funds a pilot project to develop an innovative practice, for example in the health sector, hoping that national governments will see the potential benefit and take the innovative practice to scale in the longer term.

In reality however, in more cases than not, once donor funding dries up, the project comes to an end, thereby limiting the project’s longer term benefits in countries with weak health systems and pressing health needs.

A new paper published by researchers at the London School of Hygiene & Tropical Medicine in the journal Globalization and Health titled: ‘The development sector is a graveyard of pilot projects!’ Six critical actions for externally funded implementers to foster scale-up of maternal and newborn health innovations in low and middle-income countries’ asks what it takes to keep an innovative practice going once donor funding ends. The qualitative study, led by Neil Spicer, Yashua Hamza, Della Berhanu, Meenakshi Gautam, Professor Joanna Schellenberg, Feker Tadesse, Nasir Umar and Deepthi Wickremasinghe looks at maternal and newborn health innovations funded by the Bill & Melinda Gates Foundation.

Conducting 71 interviews with representatives from government, donors and implementers and exploring three case studies from India, Ethiopia and Nigeria, the research team identified six critical steps that implementers had taken to enable the adoption and scale-up of maternal and newborn health innovations funded by the Bill & Melinda Gates Foundation.

Results point to the importance of: designing innovations for scale from the get-go; generating multiple forms of evidence to influence and inform scale-up; harnessing the support of powerful individuals; being prepared for scale-up and responsive to change; ensuring continuity by being part of the transition to scale; and embracing the aid effectiveness principles of country ownership, alignment and harmonisation.

However, even where these six steps are taken success is not guaranteed: scale-up is unpredictable and often depends on factors outside implementers’ control.



Profile picture of Dr Neil Spicer
Dr Neil Spicer

Associate Professor

Profile picture of Dr Della Berhanu
Dr Della Berhanu

Assistant Professor

Profile picture of Dr Meenakshi Gautham
Dr Meenakshi Gautham

IDEAS India Country Coordinator and Research Fellow

Profile picture of Professor Joanna Schellenberg
Professor Joanna Schellenberg

IDEAS Co-Principal Investigator and Professor

Profile picture of Dr Nasir Umar
Dr Nasir Umar

IDEAS Nigeria Country Coordinator and Assistant Professor

Profile picture of Deepthi Wickremasinghe
Deepthi Wickremasinghe

Research Fellow

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