by Ruth Simmons, ExpandNet Secretariat; Peter Fajans, RHR/WHO and ExpandNet Secretariat; and Suzanne Reier RHR/WHO and ExpandNet Over the next 12 months, project Optimize will be collecting final data from its demonstration projects and transitioning management of these projects to government partners. Recognizing the challenges inherent in such transitions, Optimize solicited assistance from ExpandNet, a global network of public health professionals and scientists with expertise and tools for scaling up successful health innovations. In October 2011, ExpandNet members traveled to Senegal to help the team there develop a scale-up strategy. ExpandNet has fine-tuned an approach to scaling up that employs a nine-step process. Using a participatory approach, key stakeholders from the project team and government as well as other relevant colleagues start by visiting the project sites together and then participate in a workshop. During the workshop, stakeholders analyze the demonstrated innovations; evaluate the capacity of organizations that will implement them; review the larger institutional and social, cultural, economic, and political context which influences the scale-up process; and assess the availability of resource people who can facilitate the wider introduction of the innovations. Discussions produce specific actions that will facilitate scaling up. Participants also make strategic choices about how to advocate for and disseminate the innovation, how to organize, monitor and evaluate the scale-up process, and how to mobilize resources. Scale up requires two key efforts: the first is to integrate new approaches into existing policies and service delivery institutions so they are sustainable over time; the second is to expand the innovations to new geographic areas, population groups, or service-delivery sites. The first is often the most difficult, as it requires moving an innovation from a project approach—where innovations are typically funded and supported by external resources and technical experts—to a program approach where they become part of the routine way in which service delivery systems are funded and function. Such a transition requires policy commitment to implement the new approach and government commitment to assume financial costs, assign which agency will be responsible for the implementation, and determine how it will be supervised, monitored, and supported over time. One of the key lessons ExpandNet has learned is that scaling up is not the same as routine program operations. Scaling up requires an intense effort over a period of time in which resources are mobilized, decisions are made, trainings and other forms of capacity building are implemented, and monitoring systems are established before innovations are fully functioning within established service systems. Unless there is a team of individuals dedicated to supporting the process, scaling up is unlikely to succeed. Because scale-up is lengthy and challenging, many organizations are beginning to recognize that scale-up strategies and discussions should be initiated right from the start of any demonstration or pilot project. ExpandNet’s tool for organizations that are still designing interventions is aptly named “Beginning with the end in mind.” This tool is comprised of 12 recommendations that help project people think ahead to scaling up. Among the recommendations are to involve key public sector decision-makers in the design stage of the intervention and to test the demonstration with “real-life” resources in “real-life” scenarios. This means providing not only a proof of concept but also a proof of implementation to determine whether the innovation can succeed with the type of resources it is likely to have after the demonstration ends. Designing a demonstration with scaling up in mind will provide country partners the critical information they need for decision-making at the end of the project. For Optimize in Senegal, a key conclusion of the workshop was to focus the remaining project year not only on completing the demonstrations, but also on securing government agreement on key issues and making arrangements to integrate the new delivery systems and technologies into relevant public-sector institutions. A key step in this process is to ensure the continuity of the demonstration in the Saint Louis Region as well as the availability of a small team of dedicated resource people who will commit time and effort toward facilitating the institutionalization of the demonstration project, as well as its expansion to new geographic areas of the country. “We tried to think about scale up from the beginning of the project,” says Modibo Dicko, Optimize project manager for Senegal, “and ExpandNet’s expertise and resources have made the steps very obvious. We are now on a clear path toward scale-up and have the resources and expertise to move forward in a common direction.” To learn more about ExpandNet, download their tools, or seek technical assistance, please visit the website. Photo: Ruth Simmons To comment, click reply.
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