title: Beginning with sustainable scale up in mind: initial results from a population, health and environment project in East Africa.
abstract: Small-scale pilot projects have demonstrated that integrated population, health and environment approaches can address the needs and rights of vulnerable communities. However, these and other types of health and development projects have rarely gone on to influence larger policy and programme development. ExpandNet, a network of health professionals working on scaling up, argues this is because projects are often not designed with future sustainability and scaling up in mind. Developing and implementing sustainable interventions that can be applied on a larger scale requires a different mindset and new approaches to small-scale/pilot testing. This paper shows how this new approach is being applied and the initial lessons from its use in the Health of People and Environment in the Lake Victoria Basin Project currently underway in Uganda and Kenya. Specific lessons that are emerging are: 1) ongoing, meaningful stakeholder engagement has significantly shaped the design and implementation, 2) multi-sectoral projects are complex and striving for simplicity in the interventins is challenging, and 3) projects that address a sharply felt need experience substantial pressure for scale up, even before their effectiveness is established. Implicit in this paper is the recommendation that other projects would also benefit from applying a scale-up perspective from the outset.
authors.affiliation: Vice President, Partners in Expanding Health Quality and Access, Davis, CA, USA. Electronic address: ljghiron@gmail.com.
authors.forename: Laura
authors.initials: L
authors.lastname: Ghiron
authors.affiliation: Country Representative and Project Director, Health of People and Environment in the Lake Victoria Basin Project (HoPE-LVB), Pathfinder International - Uganda, Kampala, Uganda.
authors.forename: Lucy
authors.initials: L
authors.lastname: Shillingi
authors.affiliation: Programs Manager, Ecological Christian Organization, Kampala, Uganda.
authors.forename: Charles
authors.initials: C
authors.lastname: Kabiswa
authors.affiliation: HoPE-LVB Project Manager for Kenya, Pathfinder International - Kenya, Kisumu, Kenya.
authors.forename: Godfrey
authors.initials: G
authors.lastname: Ogonda
authors.affiliation: Deputy Director of Programs, OSIENALA (Friends of Lake Victoria), Kisumu, Kenya.
authors.forename: Antony
authors.initials: A
authors.lastname: Omimo
authors.affiliation: Consultant, Partners in Expanding Health Quality and Access, Kinshasa-Ngaliema, DR of Congo.
authors.forename: Alexis
authors.initials: A
authors.lastname: Ntabona
authors.affiliation: President, Partners in Expanding Health Quality and Access; and Professor Emerita, University of Michigan School of Public Health, Inverness, CA, USA.
authors.forename: Ruth
authors.initials: R
authors.lastname: Simmons
authors.affiliation: Consultant, Partners in Expanding Health Quality and Access, Gex, France.
authors.forename: Peter
authors.initials: P
authors.lastname: Fajans
mesh_terms: D000351:Africa, Eastern; D003247:Conservation of Natural Resources; D003299:Cooperative Behavior; D004782:Environmental Health; D014943:Global Health; D006291:Health Policy; D007407:Interviews as Topic; D010865:Pilot Projects; D016730:Program Development; D015980:Public Health Practice; D014944:World Health Organization
keywords: Kenya; Uganda; WHO Strategic Approach; development; health and environment; health policy and programmes; pilot projects; population; scale; scaling up of services