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‘Scaling-up is a craft not a science’: Catalysing scale-up of health innovations in Ethiopia, India and Nigeria

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  • Spicer, Neil
  • Bhattacharya, Dipankar
  • Dimka, Ritgak
  • Fanta, Feleke
  • Mangham-Jefferies, Lindsay
  • Schellenberg, Joanna
  • Tamire-Woldemariam, Addis
  • Walt, Gill
  • Wickremasinghe, Deepthi

Abstract

Donors and other development partners commonly introduce innovative practices and technologies to improve health in low and middle income countries. Yet many innovations that are effective in improving health and survival are slow to be translated into policy and implemented at scale. Understanding the factors influencing scale-up is important. We conducted a qualitative study involving 150 semi-structured interviews with government, development partners, civil society organisations and externally funded implementers, professional associations and academic institutions in 2012/13 to explore scale-up of innovative interventions targeting mothers and newborns in Ethiopia, the Indian state of Uttar Pradesh and the six states of northeast Nigeria, which are settings with high burdens of maternal and neonatal mortality. Interviews were analysed using a common analytic framework developed for cross-country comparison and themes were coded using Nvivo. We found that programme implementers across the three settings require multiple steps to catalyse scale-up. Advocating for government to adopt and finance health innovations requires: designing scalable innovations; embedding scale-up in programme design and allocating time and resources; building implementer capacity to catalyse scale-up; adopting effective approaches to advocacy; presenting strong evidence to support government decision making; involving government in programme design; invoking policy champions and networks; strengthening harmonisation among external programmes; aligning innovations with health systems and priorities. Other steps include: supporting government to develop policies and programmes and strengthening health systems and staff; promoting community uptake by involving media, community leaders, mobilisation teams and role models. We conclude that scale-up has no magic bullet solution – implementers must embrace multiple activities, and require substantial support from donors and governments in doing so.

Suggested Citation

  • Spicer, Neil & Bhattacharya, Dipankar & Dimka, Ritgak & Fanta, Feleke & Mangham-Jefferies, Lindsay & Schellenberg, Joanna & Tamire-Woldemariam, Addis & Walt, Gill & Wickremasinghe, Deepthi, 2014. "‘Scaling-up is a craft not a science’: Catalysing scale-up of health innovations in Ethiopia, India and Nigeria," Social Science & Medicine, Elsevier, vol. 121(C), pages 30-38.
    • Handle: RePEc:eee:socmed:v:121:y:2014:i:c:p:30-38
    DOI: 10.1016/j.socscimed.2014.09.046
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    References listed on IDEAS

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    1. Fajans, P. & Simmons, R. & Ghiron, L., 2006. "Helping public sector health systems innovate: The strategic approach to strengthening reproductive health policies and programs," American Journal of Public Health, American Public Health Association, vol. 96(3), pages 435-440.
    2. Gavin Yamey, 2011. "Scaling Up Global Health Interventions: A Proposed Framework for Success," PLOS Medicine, Public Library of Science, vol. 8(6), pages 1-5, June.
    3. Kara Hanson & M. Kent Ranson & Valeria Oliveira-Cruz & Anne Mills, 2003. "Expanding access to priority health interventions: a framework for understanding the constraints to scaling-up," Journal of International Development, John Wiley & Sons, Ltd., vol. 15(1), pages 1-14.
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    1. Sreeja Nair & Michael Howlett, 2015. "Scaling up of Policy Experiments and Pilots: A Qualitative Comparative Analysis and Lessons for the Water Sector," Water Resources Management: An International Journal, Published for the European Water Resources Association (EWRA), Springer;European Water Resources Association (EWRA), vol. 29(14), pages 4945-4961, November.
    2. Woltering, L. & Fehlenberg, K. & Gerard, B. & Ubels, J. & Cooley, L., 2019. "Scaling – from “reaching many” to sustainable systems change at scale: A critical shift in mindset," Agricultural Systems, Elsevier, vol. 176(C).
    3. Bradley T. Hiller & Peter M. Guthrie & Aled W. Jones, 2016. "Overcoming Ex-Post Development Stagnation: Interventions with Continuity and Scaling in Mind," Sustainability, MDPI, vol. 8(2), pages 1-26, February.

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