Promoting Scale-Up Across a Global Project Platform: Lessons from the Evidence to Action Project

Laura Ghiron,Alexis Ntabona,Peter Fajans,Eric Ramirez-Ferrero,Regina Benevides,Ruth Simmons,Rita Badiani

doi:10.1007/s43477-021-00013-4

Abstract

The USAID-funded flagship family planning service delivery project named Evidence to Action (E2A) worked from 2011 to 2021 to improve family planning and reproductive health for women and girls across seventeen nations in sub-Saharan Africa using a “scaling-up mindset.” The paper discusses three key lessons emerging from the project’s experience with applying ExpandNet’s systematic approach to scale up. The methodology uses ExpandNet/WHO’s scaling-up framework and guidance tools to design and implement pilot or demonstration projects in ways that look ahead to their future scale-up; develop a scaling-up strategy with local stakeholders; and then strategically manage the scaling-up process. The paper describes how a scaling-up mindset was engendered, first within the project’s technical team in Washington and then how they subsequently sought to build capacity at the country level to support scale-up work throughout E2A’s portfolio of activities. The project worked with local multi-stakeholder resource teams, often led by government officials, to equip them to lead the scale-up of family planning and health system strengthening interventions. Examples from project experience in the Democratic Republic of the Congo, Kenya, Nigeria, and Uganda illustrating key concepts are discussed. E2A also established a community of practice on systematic approaches to scale up as a platform for sharing learning across a variety of technical agencies engaged in scale-up work and to create learning opportunities for interacting with thought leaders around critical scale-up issues.

Highlights

Several decades of investment by global donors to improve health and other areas of development have not succeeded in ensuring that interventions proven on a small scale become part of national systems (Simmons et al, 2007; Hartmann & Linn, 2008; ExpandNet & World Health Organization, 2009)
Applications of the ExpandNet approach in several countries has shown that when scale-up was intended to take place within government systems, as was often the case in E2A activities, it was critical that government played a leading role in the resource team (Simmons et al, 2007; Keyonzo et al, 2015; Mai et al, 2019; Benevides et al, 2019; Oku et al, 2019)
The Democratic Republic of the Congo (DRC) saw numerous scale-up successes associated with the work of a newly established, government-led, multi-stakeholder resource team who guided the process of instituting community-based access to family planning services in three project provinces (Mai et al, 2019)

Summary

Introduction

Several decades of investment by global donors to improve health and other areas of development have not succeeded in ensuring that interventions proven on a small scale become part of national systems (Simmons et al, 2007; Hartmann & Linn, 2008; ExpandNet & World Health Organization, 2009). Prepared by members of ExpandNet and the E2A project’s technical leadership team, the paper provides key learning from this process with the hope that other initiatives can benefit and in turn help countries more rapidly achieve their ambitious Sustainable Development Goals targets and commitments (United Nations, 2015).

Results

Conclusion