Scaling up success to improve health: Towards a rapid assessment guide for decision makers

Abstract

Introduction

Evidence-based health interventions exist and are effectively implemented

throughout resource-limited settings. The literature regarding scale-up strategies

and frameworks is growing. The purpose of this paper is to identify and

systematically document the variation in scale-up strategies to develop a rapid

assessment tool for decision-makers looking to identify the most appropriate

strategy for their organizational and environmental contexts.

Methods

A list of scale-up strategies and frameworks were identified through an in-depth

literature review and conversations with scale-up and quality improvement

leaders. The literature search included a broad range of terms that might be used

interchangeably with scale-up of best practices. Terms included: implementation research, knowledge

translation, translational research, quality improvement research, health systems improvement, scale-up,

best practices, improvement collaborative, and community based research. Based on this research, 18

strategies and frameworks were identified, and nine met our inclusion criteria for scale-up of health-related

strategies. We interviewed the key contact for four of the nine strategies to obtain additional information

regarding the strategy’s scale-up components, targets, underlying theories, evaluation efforts, facilitating

factors, and barriers. A comparative analysis of common elements and strategy characteristics was completed

by two of the authors on the nine selected strategies. Key strategy characteristics and common factors that

facilitate or hinder the strategy’s success in scaling up health-related interventions were identified.

Results

Common features of scale-up strategies include: 1) the development of context-specific evidence; 2)

collaborative partnerships; 3) iterative processes; and 4) shared decision-making. Facilitating factors include

strong leadership, community engagement, communication, government collaboration, and a focus on

human rights. The analysis informed the development of a two-step rapid assessment tool that can be used

to guide decision-makers in identifying the most appropriate scale-up strategy given their political

environment, leadership styles, and program characteristics.

Conclusion

The rapid assessment proposed in this paper can be used to help bridge the gap in bringing evidence-based

health interventions to communities that need them the most. The purpose of the assessment tool is to

decrease the time required to scale effective interventions by identifying and applying a strategy appropriate

to the innovation, organizational capacity, and social and political environment.