Local ownership, strong documentation, and quality assurance are key to scaling up, say experts at meeting convened by E2A-IBP Community of Practice on Scale-Up

Seventy-five reproductive health and family planning practitioners with vast and nuanced expertise in scaling up high-impact practices met in Washington, DC on December 5 to advance the science and practice of scale-up. Through presentations, panel discussions and hands-on learning sessions, participants enriched their knowledge about applying systematic approaches to scale-up and made valuable connections with other global health experts committed to effective and evidence-based scale-up.

Led by the community of practice managed by the Evidence to Action (E2A) Project with support from the IBP Initiative—Systematic Approaches for Scale-Up of Family Planning/Reproductive Health Best Practices—the meeting focused on the merits and process of scaling up as well as challenges and gaps related to sustainable scale-up. Carina Stover, E2A’s Project Director, opened the meeting, highlighting the value of the community of practice to scaling up high-impact practices around the globe.

USAID Perspectives on Scale-Up

Ellen Starbird, Director of USAID’s Office of Population and Reproductive Health, offered keynote remarks, affirming that scaling up high-impact practices in reproductive health contributes to USAID’s goals of 'Ending Preventable Child and Maternal Deaths' and achieving an 'AIDS-Free Generation.'

She said that if we want our work to be lasting, we need to take best practices to scale at country level and internationally, while continuing to ensure quality, equity, human rights, and voluntary informed choice in the interventions and practices we scale. 

Echoed throughout the meeting were Ellen Starbird’s calls for sound and detailed documentation of scale-up efforts and application of a strong evidence base. She reminded participants that we need to learn more quickly from our successes and failures, and rapidly apply findings and replicate successes.

Following Starbird, Rhea Bright of USAID spoke on behalf of James Heiby, Medical Officer with USAID’s Office of Health Systems. Bright pressed for a learning agenda that allows programs to monitor results, including both quantitative and qualitative indicators that fully tell the story of how interventions have been scaled up. 

She emphasized the importance of sharing stories about the process of scale-up, including the value of country-to-country information exchange. Bright specifically examined efforts in West Africa to reduce postpartum hemorrhage, highlighting how Niger was able to share its experience with  Mali in a way that allowed Mali to ensure Active Management of the Third Stage of Labor was applied at standard 100 percent of the time. 

Both keynote speakers and sessions throughout the day emphasized leadership, quality assurance, and institutionalization as essential to the success of scale-up.

Presentations

Following keynote remarks, several presenters told success stories about their experiences with scaling up best practices, including the Standard Days Method in Rwanda; a Population, Health and Environment program in the Lake Victoria Basin; Active Management of the Third Stage of Labor in Mali; and one domestic example concerning housing the homeless in the United States. 

Scale-up experts then gave short presentations that set the stage for interactive learning sessions, held later in the day, on systematic approaches to scale-up. Themes addressed during the presentations include the theory of change and diffusion of innovation and how they can be applied to scaling up, as well as an overview of the multiple systematic approaches to scaling up. Presenters pointed out that there are multiple systematic approaches, and choosing the right one to apply depends on context. Joe McCannon of the Billions Institute also talked about how to effectively engage a target audience and support rapid learning and behavior change, through things like human connections and passion, as well as evidence-based literature, campaigns, and grassroots organization. Other presenters included Suzanne Reier of the World Health Organization and IBP Initiative; Rashad Massoud of University Research Co., LLC; and Ruth Simmons of ExpandNet.

Knowledge Cafés

Each of the aforementioned presenters, along with colleagues, then led Knowledge Cafés covering differing aspects of scale-up and approaches to systematic scale-up. Rashad Massoud led a session where participants learned how to apply the Wave Sequence Approach for Scale-up.Kate Wilson of Management Sciences for Health and Ados May of the IBP Initiative led a session that allowed participants to use The Guide to Fostering Change to Scale Up Effective Health Services during a case-study exercise. Ruth Simmons and her colleague Laura Ghiron of ExpandNet also led a case-study exercise that allowed participants to practice applying several steps of ExpandNet’s Nine Steps for Developing a Scaling-up Strategy. Regina Benevides, E2A’s Senior Youth Advisor and Stembile Mugore, E2A’s Senior Advisor for Clinic Performance Improvement, assisted with ExpandNet’s session. During the session led by Joe McCannon, participants heard an overview of the campaign approach to mobilizing large-scale change that was applied to end chronic homelessness in the United States. They reflected on how they could use a similar approach in their work. 

Evidence Gaps, Discussion with Experts

Luigi Jaramillo of the EVIDENCE Project gave a brief recap of a meeting co-hosted earlier this year by EVIDENCE, E2A, and other partners, where research gaps related to scaling up family planning and reproductive health best practices were identified. He presented several imminent research gaps, including the need to identify and document bottlenecks in the process of scale-up, assess system readiness for scale-up, and implement monitoring and evaluation systems linked to research.

Following Jaramillio, a panel of experts and discussants addressed what they had learned at the meeting as well as what they still don’t know in terms of scaling up high-impact practices. They mentioned salient points related to scale-up including leadership being integral and advocacy as an important mechanism for achieving local ownership of the practice being scaled. They also pointed out continued challenges related to adapting scale-up approaches to different contexts, ensuring resources are available for scale-up, and limited flexibility related to donor and research timelines, among others. Salwa Bitar, E2A’s Senior Advisor for Scale-Up, moderated the discussion, adding valuable insights on the real-world challenges of scaling up high-impact practices. 

You can download presentations and other supporting materials from the meeting here.

Please stay tuned for a meeting report.

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