title: 'Scaling-up is a craft not a science': Catalysing scale-up of health innovations in Ethiopia, India and Nigeria.
abstract: Donors and other development partners commonly introduce innovative practices and technologies to improve health in low and middle income countries. Yet many innovations that are effective in improving health and survival are slow to be translated into policy and implemented at scale. Understanding the factors influencing scale-up is important. We conducted a qualitative study involving 150 semi-structured interviews with government, development partners, civil society organisations and externally funded implementers, professional associations and academic institutions in 2012/13 to explore scale-up of innovative interventions targeting mothers and newborns in Ethiopia, the Indian state of Uttar Pradesh and the six states of northeast Nigeria, which are settings with high burdens of maternal and neonatal mortality. Interviews were analysed using a common analytic framework developed for cross-country comparison and themes were coded using Nvivo. We found that programme implementers across the three settings require multiple steps to catalyse scale-up. Advocating for government to adopt and finance health innovations requires: designing scalable innovations; embedding scale-up in programme design and allocating time and resources; building implementer capacity to catalyse scale-up; adopting effective approaches to advocacy; presenting strong evidence to support government decision making; involving government in programme design; invoking policy champions and networks; strengthening harmonisation among external programmes; aligning innovations with health systems and priorities. Other steps include: supporting government to develop policies and programmes and strengthening health systems and staff; promoting community uptake by involving media, community leaders, mobilisation teams and role models. We conclude that scale-up has no magic bullet solution - implementers must embrace multiple activities, and require substantial support from donors and governments in doing so.
authors.affiliation: London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK. Electronic address: neil.spicer@lshtm.ac.uk.
authors.forename: Neil
authors.initials: N
authors.lastname: Spicer
authors.affiliation: Sambodhi Research and Communications, 0-2, 2nd Floor, Lajpat Nagar-II, New Delhi, India. Electronic address: dipankar.bhattacharya@imrbint.com.
authors.forename: Dipankar
authors.initials: D
authors.lastname: Bhattacharya
authors.affiliation: Health Hub, 564/565 Independence Avenue, Block A, 3rd Floor, Central Business District, Abuja, Nigeria. Electronic address: rasd2000@hotmail.com.
authors.forename: Ritgak
authors.initials: R
authors.lastname: Dimka
authors.affiliation: Jarco Consulting, PO Box 43107, Gofa Sefer, Addis Ababa, Ethiopia. Electronic address: feleft2@yahoo.com.
authors.forename: Feleke
authors.initials: F
authors.lastname: Fanta
authors.affiliation: London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK. Electronic address: Lindsay.mangham-jefferies@lshtm.ac.uk.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Mangham-Jefferies
authors.affiliation: London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK. Electronic address: Joanna.schellenberg@lshtm.ac.uk.
authors.forename: Joanna
authors.initials: J
authors.lastname: Schellenberg
authors.affiliation: Jarco Consulting, PO Box 43107, Gofa Sefer, Addis Ababa, Ethiopia; Federal Ministry of Health of Ethiopia, PO Box 1234, Addis Ababa, Ethiopia. Electronic address: addishoneyt@yahoo.com.
authors.forename: Addis
authors.initials: A
authors.lastname: Tamire-Woldemariam
authors.affiliation: London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK. Electronic address: gill.walt@lshtm.ac.uk.
authors.forename: Gill
authors.initials: G
authors.lastname: Walt
authors.affiliation: London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK. Electronic address: deepthi.wickremasinghe@lshtm.ac.uk.
authors.forename: Deepthi
authors.initials: D
authors.lastname: Wickremasinghe
mesh_terms: D002662:Child Health Services / Q000458:organization & administration*; D003906:Developing Countries; D005002:Ethiopia; D005260:Female; D006284:Health Plan Implementation / Q000379:methods*; D006291:Health Policy; D006801:Humans; D007194:India; D007223:Infant; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000458:organization & administration*; D009549:Nigeria; D016730:Program Development; D036301:Qualitative Research
keywords: Ethiopia; Innovations; Maternal and newborn health; Northeast Nigeria; Scale-up; Uttar Pradesh, India