Beginning with sustainable scale up in mind: initial results from a population, health and environment project in East Africa

Abstract

Small-scale pilot projects have demonstrated that integrated population, health and environment approaches can address the needs and rights of vulnerable communities. However, these and other types of health and development projects have rarely gone on to influence larger policy and programme development. ExpandNet, a network of health professionals working on scaling up, argues this is because projects are often not designed with future sustainability and scaling up in mind. Developing and implementing sustainable interventions that can be applied on a larger scale requires a different mindset and new approaches to small-scale/pilot testing. This paper shows how this new approach is being applied and the initial lessons from its use in the Health of People and Environment in the Lake Victoria Basin Project currently underway in Uganda and Kenya. Specific lessons that are emerging are: 1) ongoing, meaningful stakeholder engagement has significantly shaped the design and implementation, 2) multi-sectoral projects are complex and striving for simplicity in the interventins is challenging, and 3) projects that address a sharply felt need experience substantial pressure for scale up, even before their effectiveness is established. Implicit in this paper is the recommendation that other projects would also benefit from applying a scale-up perspective from the outset.

Systemic perspectives on scaling agricultural innovations. A review

“…3). In this perspective, research and innovation need to anticipate such adaptive (scaling) processes and therefore design with future (potential) scaling up in mind (Expandnet 2011;Ghiron et al 2014;Middleton et al 2005). This involves making scaling processes a more integral part of systemic approaches to innovation (Blesh and Wolf 2014;Foran et al 2014;Hinrichs 2014;Klerkx et al 2010).…”

Applying ExpandNet’s Systematic Approach to Scaling Up in an Integrated Population, Health and Environment Project in East Africa

“…While all of the recommendations are important, several key ones are described in further detail below that deserve special attention in this paper because they constitute areas of critical learning from the HoPE scale-up experience. Ghiron et al (2014) provide insights and critical learning that emerged from applying the ExpandNet/WHO recommendations for designing and implementing HoPE-LVB for scale up during the Stage I pilot. Additional information on specific steps the HoPE project took to address the 12 recommendations can be found in the HoPE toolkit (Pathfinder International 2017b).…”

“…HoPE's collaboration with ExpandNet represented a first opportunity to jointly apply all three stages of the systematic approach to scaling up in a hands-on way, from the earliest stages of design (Ghiron et al 2014) through to management of the early scaling-up process. While ExpandNet's initial experience grew out of supporting scale up of family planning and other reproductive health innovations, the framework and guidance provided are generic in nature and can be applied to projects addressing a wide range of thematic and technical areas.…”

From Project to Program: Tupange’s Experience with Scaling Up Family Planning Interventions in Urban Kenya

“…[1][2][3][4] However, making this transition is not easy. It requires creating ownership in the institutions that are expected to implement successful interventions on a large scale and working within existing system constraints or finding ways in which constraints can be alleviated.…”

“…1,6 The project approach refers to interventions that are focused on short-term results and not necessarily on what is needed to ensure sustainable scale up, even though large-scale impact is often stated as the ultimate goal. In this approach levels of financial, technical and human resources are unlikely to be available for subsequent implementation in routine programs and parallel structures to existing government or private sector programs tend to be created.…”