Scale-up Experiences Research Articles

Determinants and strategies for successful scale-up of health interventions in the Netherlands

Abstract Background Although many evidence-based health interventions are proven effective, the process of scaling up is often complex and challenging. Yet, some interventions have managed to achieve successful scale-up. This provides a window of opportunity to learn from those experiences to inform future scale up processes. Objectives This mixed-methods study aimed to assess determinants and scale-up strategies contributing to successful scale-up of health promotion interventions in the Netherlands. Methods Semi-structured interviews were conducted with intervention owners (i.e. the individual or team taking the responsible for several aspects related to implementation and scale-up) (N = 25) of successfully scaled interventions (implemented across various health behaviours and different settings), and other relevant stakeholders (N = 10) involved in scaling up. Additionally, a survey was distributed among interventions (N = 306) registered in a national intervention database to assess scale-up experiences. Results Scale-up is often the result of a combination of determinants, such as persistent commitment of intervention owners and stakeholders, new funding opportunities, and accreditation by institutions. Several scale-up strategies were identified related to funding (e.g. reducing costs by setting up collaborations), organizational processes (e.g. infrastructure to support implementation), monitoring and evaluation, and dissemination and advocacy. Conclusions Achieving successful scale-up does not happen automatically and continuous effort of the intervention owner is crucial. There is no such thing as one successful scaling strategy which succeeds across all contexts. The intervention owner typically takes the lead in diverse scaling pathways, where sufficient time, funding, the right moment and added value form the critical ingredients for success. Funding: This study was funded by ZonMw. Key messages • Crucial elements of achieving scale-up are the continuous effort of the intervention owner, sufficient time, funding, the right moment and added value of the intervention. • Funding should not me allocated for new initiatives but also for continuous development of interventions, ongoing evaluation and covering overhead costs.

The SMart cooperative model and scale-up experience: spreading social innovation in the cultural field across Europe

PurposeThe purpose of this paper is to explore how, in a context of economic, political, social and environmental transitions, SMart, a cultural and artistic social enterprise (CASE), has developed a relevant cooperative model to contribute to mitigate the structural labour precariousness of artists and creators.Design/methodology/approachThe research design includes a mixed-method approach that combines qualitative and quantitative methodologies with emphasis on the former. Namely, the organisation is SMartbe and its replication across nine European countries was studied as a revelatory case study. Five main types of techniques were deployed in the course of this research, including desk review, direct (participant) observation, interviews, focus group and questionnaire (Likert-scale survey).FindingsCASEs constitute a specific institutional arrangement that offers innovative labour arrangements for cultural workers and artists to fight against precariousness. Social enterprises are embedded in the social and solidarity economy and stand at the crossroads of markets, civil society and the public, which places them in a critical position: depending on the logic, actors and contexts at play, social enterprises can ensure to varying degrees the general interest through their social mission, their sustainability via the real participation of all their stakeholders and the carrying out of economic activities that are fully consistent with their mission.Originality/valueIt is within this type of sustainability and participation that transformative social innovation can emerge within CASEs. Their potential to contribute to transformative social innovation is based on its four objectives: cultural (to imagine human, participative and sustainable alternatives); social (to achieve a social –including the environment – mission and join the ecosocial transition); participatory (empowering and impacting the public sphere); and economic (being financially sustainable and fair).

Do winners pick government? How scale-up experience shapes entrepreneurs’ assessments of innovation policy mixes

AbstractHow do entrepreneurs of high-growth firms in small, open economies evaluate innovation policy mixes? In response to market consolidation by large firms, governments in such countries are using a mix of innovation policy tools to support firms with high-growth potential in digitally intensive sectors. Government objectives, however, are not being realized. Bringing actor-centric perspectives to the policy mix literature, we analyze interviews with entrepreneurs from Canadian technology firms to determine whether there is a disconnect between the objectives and instruments employed by the government. With distinct policy preferences rooted in their growth experiences specific to the country’s political economy, we find that scale-up entrepreneurs prefer a more active role of the government in the form of demand-side, direct, and targeted innovation instruments. The findings presented in this article provide a more nuanced understanding of the innovation policy landscape and the preferences of technology scale-up firms

Development and Application of the Scale-Up Reflection Guide (SRG).

Scaling up effective interventions in public health is complex and comprehensive, and published accounts of the scale-up process are scarce. Key aspects of the scale-up experience need to be more comprehensively captured. This study describes the development of a guide for reflecting on and documenting the scale-up of public health interventions, to increase the depth of practice-based information of scaling up. Reviews of relevant scale-up frameworks along with expert input informed the development of the guide. We evaluated its acceptability with potential end-users and applied it to two real-world case studies. The Scale-up Reflection Guide (SRG) provides a structure and process for reflecting on and documenting key aspects of the scale-up process of public health interventions. The SRG is comprised of eight sections: context of completion; intervention delivery, history/background; intervention components; costs/funding strategies and partnership arrangements; the scale-up setting and delivery; scale-up process; and evidence of effectiveness and long-term outcomes. Utilization of the SRG may improve the consistency and reporting for the scale-up of public health interventions and facilitate knowledge sharing. The SRG can be used by a variety of stakeholders including researchers, policymakers or practitioners to more comprehensively reflect on and document scale-up experiences and inform future practice.

Sorption enhanced gasification (SEG) of biomass for tailored syngas production with in-situ CO2 capture: Current status, process scale-up experiences and outlook

Sorption Enhanced Gasification (SEG) is being considered as a promising solid fuel conversion and carbon capture and sequestration technology since it can produce tailored syngas coupled with in-situ CO2 capture. Over the years, considerable research has been conducted with high grade biomass in laboratory and pilot scale facilities targeting technical and process scale-up viabilities of the SEG process. SEG has successfully been tested at semi industrial scale which demonstrates further scale-up potential (e.g. commercial demonstration plant) of this innovative technology. The results showed that the operation window of SEG laid at a gasification temperature ranging from 600 °C to 750 °C. By optimizing the process parameters, H2-rich syngas (>70 vol %db) and desired H2/CO ratios can be attained. Also, the total tar content of the optimized process is reported to be low compared to those obtained from classical fluidized bed gasification processes. So far, wood is mostly used as the feedstocks while tests with wastes including solid recovered fuels (SRFs) have also been conducted. Cheap and readily available natural sorbents (such as limestone) enable a satisfactory operation, however, issues associated with attrition and deactivation still need to be addressed. Accordingly, natural sorbents with improved properties, synthetic CaO-based sorbents as well as pre-treated natural sorbents are considered to overcome these limitations. This paper therefore discusses the current status of the SEG technology with an emphasis on its industrial applications for flexible syngas production with in-situ CO2 reduction. Moreover, challenges, process scale-up experiences and research gaps for the commercialization of this novel technology are identified in this review.

Clean manufacturing powered by biology: how Amyris has deployed technology and aims to do it better

Amyris is a fermentation product company that leverages synthetic biology and has been bringing novel fermentation products to the market since 2009. Driven by breakthroughs in genome editing, strain construction and testing, analytics, automation, data science, and process development, Amyris has commercialized nine separate fermentation products over the last decade. This has been accomplished by partnering with the teams at 17 different manufacturing sites around the world. This paper begins with the technology that drives Amyris, describes some key lessons learned from early scale-up experiences, and summarizes the technology transfer procedures and systems that have been built to enable moving more products to market faster. Finally, the breadth of the Amyris product portfolio continues to expand; thus the steps being taken to overcome current challenges (e.g. automated strain engineering can now outpace the rest of the product commercialization timeline) are described.

Scaling-up of membraneless microbial electrolysis cells (MECs) for domestic wastewater treatment: Bottlenecks and limitations

Microbial electrolysis cells (MECs) have the potential to become a sustainable domestic wastewater (dWW) treatment system. However, new scale-up experiences are required to gain knowledge of critical issues in MEC designs. In this study we assess the ability of two twin membraneless MEC units (that are part of a modular pilot-scale MEC) to treat dWW. Batch tests yielded COD removal efficiencies as high as 92%, with most of the hydrogen (>80% of the total production) being produced during the first 48h. During the continuous tests, MECs performance deteriorated significantly (energy consumption was relatively high and COD removal efficiencies fell below 10% in many cases), which was attributed to an inadequate configuration of the anodic chamber, insufficient mixing inside this chamber, inefficient hydrogen management on the cathode side and finally to dWW in itself. Some alternatives to the current design are suggested.

Lay Social Resources for Support of Adherence to Antiretroviral Prophylaxis for HIV Prevention Among Serodiscordant Couples in sub-Saharan Africa: A Qualitative Study.

Effectiveness of antiretroviral pre-exposure prophylaxis (PrEP) for HIV prevention will require high adherence. Using qualitative data, this paper identifies potential lay social resources for support of PrEP adherence by HIV serodiscordant couples in Uganda, laying the groundwork for incorporation of these resources into adherence support initiatives as part of implementation. The qualitative analysis characterizes support for PrEP adherence provided by HIV-infected spouses, children, extended family members, and the larger community. Results suggest social resources for support of PrEP adherence in Africa are plentiful outside formal health care settings and health systems and that couples will readily use them. The same shortage of health professionals that impeded scale-up of antiretroviral treatment for HIV/AIDS in Africa promises to challenge delivery of PrEP. Building on the treatment scale-up experience, implementers can address this challenge by examining the value of lay social resources for adherence support in developing strategies for delivery of PrEP.

Scale-up of adolescent contraceptive services: lessons from a 5-country comparative analysis.

Poor sexual and reproductive health outcomes among adolescents aged 10-19 years are indicative of the barriers this group faces in accessing health services and highlights a gap in the availability of appropriate services, including adolescent-friendly contraceptive services (AFCS). The HIV Investment Framework identifies contraceptive services as an entry point for HIV counseling, testing, and treatment, and as a component of HIV prevention. To effectively meet the needs of adolescents, greater understanding of effective scale-up strategies for adolescent-friendly services is needed. The authors conducted a retrospective analysis of AFCS scale-up experiences in Ethiopia, Ghana, Mozambique, Tanzania, and Vietnam using the ExpandNet/World Health Organization framework for systematic scale-up. The authors analyzed the type of scale (expansion or institutionalization), dissemination and advocacy, organizational process, costs and resource mobilization, and monitoring and evaluation. The analysis showed that all programs simultaneously pursued expansion and institutionalization, contributing to sustainable scale-up. Advocacy complemented by intensive capacity building at all levels of the health system contributed to adoption of AFCS in national and district work plans and budgets as well strengthening collection of age-disaggregated data. To achieve scale-up of AFCS, the authors identified the importance of institutionalization and expansion in tandem for synergy and reinforcement, empowering adolescents to be agents of change and hold government accountable to its commitments, and strengthening health systems to sustain AFCS. This article contributes to a growing body of evidence around scale-up of AFCS, which can inform the implementation and sustainable scale-up of HIV and other services for adolescents.

The 5 years scale-up experience in HIV testing and counselling (HTC) in Shiselweni, Swaziland

The 5 years scale-up experience in HIV testing and counselling (HTC) in Shiselweni, Swaziland

Systems approach to monitoring and evaluation guides scale up of the Standard Days Method of family planning in Rwanda.

There is no guarantee that a successful pilot program introducing a reproductive health innovation can also be expanded successfully to the national or regional level, because the scaling-up process is complex and multilayered. This article describes how a successful pilot program to integrate the Standard Days Method (SDM) of family planning into existing Ministry of Health services was scaled up nationally in Rwanda. Much of the success of the scale-up effort was due to systematic use of monitoring and evaluation (M&E) data from several sources to make midcourse corrections. Four lessons learned illustrate this crucially important approach. First, ongoing M&E data showed that provider training protocols and client materials that worked in the pilot phase did not work at scale; therefore, we simplified these materials to support integration into the national program. Second, triangulation of ongoing monitoring data with national health facility and population-based surveys revealed serious problems in supply chain mechanisms that affected SDM (and the accompanying CycleBeads client tool) availability and use; new procedures for ordering supplies and monitoring stockouts were instituted at the facility level. Third, supervision reports and special studies revealed that providers were imposing unnecessary medical barriers to SDM use; refresher training and revised supervision protocols improved provider practices. Finally, informal environmental scans, stakeholder interviews, and key events timelines identified shifting political and health policy environments that influenced scale-up outcomes; ongoing advocacy efforts are addressing these issues. The SDM scale-up experience in Rwanda confirms the importance of monitoring and evaluating programmatic efforts continuously, using a variety of data sources, to improve program outcomes.

Adult Male Circumcision

Voluntary medical male circumcision (VMMC) is a cost-effective HIV-prevention intervention that reduces the risk of HIV acquisition in men by 60%. Although some countries are successfully scaling up VMMC, not all are doing this. When VMMC scale-up experiences are viewed in the context of models for the diffusion of innovation, some important themes emerge. Successful VMMC programs have in common locally led campaigns, a cultural tolerance of VMMC, strong political leadership and coordination, and adequate human and material resources. Challenges with VMMC scale-up have been marked by less flexible implementation models that seek a full integration of VMMC services at public medical facilities and by struggles to achieve geographic parity in access to care. Innovation diffusion models, especially the endogenous technology model, and multiple levels of influence on diffusion--individual males and their sex partners, communities, and health systems--remind us that the adoption of a prevention intervention, such as VMMC, is expected to start out slowly and, as information spreads, gradually speed up. In addition, the diffusion models suggest that customizing approaches to different populations is likely to accelerate VMMC scale-up and help achieve a long-term, sustainable impact on the HIV epidemic.

Process Development and Scale-Up of AZD7545, a PDK Inhibitor

A brief comparison of the early manufacturing routes to AZD7545 is given. Process development of the preferred long-term manufacturing route is reported in detail, and changes from the initial kilogram-scale route are discussed. Scale-up experience from the pilot-plant manufacture is included in the discussion of each stage. Noteworthy aspects throughout the development of AZD7545 concerned chemical hazards, mechanisms, analysis, and impurities, upon which this case study will focus.

Tackling Health Workforce Shortages During Antiretroviral Treatment Scale-up—Experiences From Ethiopia and Malawi

In many sub-Saharan countries, the health workforce shortage has been a major constraint in the scale-up of antiretroviral treatment. This human resource crisis has led to profound adjustments of the antiretroviral treatment care delivery model in several countries in the region. It also inspired some governments to take swift measures to substantially increase human resources capacity. This article draws on the experience of Malawi and Ethiopia, which have been able to successfully increase their health workforce over a relatively short period, allowing scaling up of antiretroviral treatment. Additional international HIV funding and strong political commitment made possible this exceptional response. Both countries implemented a combination of measures to tackle the human resource crisis: the delegation of medical and administrative tasks to lower health cadres and lay workers, the introduction of new health cadres, the reinforcement of pre-service training, and improving health staff remuneration. In particular, the involvement of community and lay health workers in HIV-related service delivery substantially increased the health workforce. The involvement of lay cadres has important long-term implications. To sustain results, continued political commitment, ongoing training and supervision to maintain quality of care, and strategies to avoid attrition among lay cadres will be essential. Although task shifting and involvement of lay cadres allowed bridging of the human resource gap in a short time, other strategies have to be considered simultaneously, and all interventions must be maintained over a longer period to yield results.

In Situ Treatment of Acid Mine Drainage by Sulphate Reducing Bacteria in Open Pits: Scale-Up Experiences

In Situ Treatment of Acid Mine Drainage by Sulphate Reducing Bacteria in Open Pits: Scale-Up Experiences

Organizing Technology Transfer from Research to Production

AbstractAn overview of issues to be considered when organizing the transfer of technology from the research arena to the production environment will be presented. The discussion will focus on the coordination and implementation of a transfer program for a product with emphasis being given to those factors peculiar to the pharmaceutical industry. The success of any program is highly dependent on the effectiveness of the communication preceding its implementation. Therefore, the preparation and distribution of a complete document summarizing raw material and equipment requirements, manufacturing and packaging processses, process validation parameters, quality control procedures, as well as a detailed plan of action outlining expected results and time frames, must be disseminated prior to the scale-up experience. Input from the marketing and manufacturing centers must also be integrated into the plan to ensure that the right product is developed at the right price within the desired time frame. An outline en...