Facilitating Large‐scale Transitions to Quality of Care: An Idea Whose Time Has Come

Abstract

In the field of reproductive health, investigation of the transfer of knowledge gained from demonstration and pilot projects to large public-sector programs typically has not been considered a relevant domain for research or other investigation. This article draws on a range of research in the social sciences and presents two frameworks for understanding the critical attributes of successful expansion of small-scale innovations. Seven key lessons are developed using examples from family planning where scaling up was an explicit objective, including the early Taichung Study of Taiwan, the Chinese Experiment in Quality of Care, the Bangladesh MCH-FP Extension Project, the Navrongo Project in Ghana, and the Reprolatina Project in Brazil. Unless small, innovative projects concern themselves from the outset with determining how their innovations can be put to use on a larger scale, they risk remaining irrelevant for policy and program development.

Scaling up Adolescent Sexual and Reproductive Health Interventions Through Existing Government Systems? A Detailed Process Evaluation of a School-Based Intervention in Mwanza Region in the Northwest of Tanzania

“…We have shown that a supported cascade training system can successfully train several teachers through existing local government systems. Other studies have identified national level endorsement or "policy windows" as important should a large-scale intervention be achieved and sustained [27][28][29]. Our research suggests that national policies relating to more frequent supervision, inclusion of behavioral and skills topics in the national examinations, and pre-service training could significantly strengthen quality and fidelity of ASRH interventions.…”

Partnering to proceed: scaling up adolescent sexual reproductive health programmes in Tanzania. Operational research into the factors that influenced local government uptake and implementation

“…However, little is known about how best to implement such programmes on a scale great enough to significantly impact on adolescent sexual and reproductive health (ASRH) on this continent. Programme scale-up is complex: it is not simply a large-scale replication of a 'blue print' but the product of an interaction between an ideal intervention and the cultures, priorities and capacities of the structures through which it is scaled up [3-6]. Simmons et al have developed models of scale-up and a series of recommendations based on an interrogation of public health case studies against diffusion of innovation and organizational development theories.…”

“…Simmons et al have developed models of scale-up and a series of recommendations based on an interrogation of public health case studies against diffusion of innovation and organizational development theories. These suggest that, in order to be sustainable, interventions must be scaled up through existing systems [3,6] and are most likely to succeed if intervention design is tailored to, and involves the structures through which scale-up is intended [6]. An integrated version of their model is presented in Figure 1.…”

“…This paper presents the results of a series of evaluations that were conducted by an operational research team, which document and explain the scale-up of an ASRH intervention through a partnership between a non-governmental organization (NGO) and local government authorities (LGAs) in Mwanza Region, Tanzania. We examine the factors affecting intervention integration into LGA activities, we discuss how these relate to recommendations for sustainability highlighted above [6] (Figure 1) and make recommendations as to ways in which these findings can support local and national health systems.…”

Moving from Research to Program: The Egyptian Postabortion Care Initiative

“…For example, Simmons and colleagues have identified seven elements of successful expansion programs, including allowing for adaptation and incremental change, working through the political process by adopting a highly pragmatic management style and engaging the support of one or more policymakers who are open to change. 8 The Egyptian postabortion care experience is an example of how these elements contributed to the successful expansion of a small-scale activity into a national program, and the lessons learned are applicable to other settings. …”