1. Monitoring Scale-up of Health
Practices and Interventions
Bridgit Adamou
MEASURE Evaluation Population and
Reproductive Health (PRH) Project

2. Objectives:
 Provide background information on the
monitoring scale-up initiative
 Introduce the result (the guide)
 Present what information is included in the guide
 Highlight key components of the guide

3. Background

4. Background

5. Parameters
 Succinct, but also including enough background
narrative, examples, and explanations
 Very user-friendly and applicable to a broad
audience, yet technical enough to be helpful
 FP-focused, but easily applicable to other health
practices and interventions
 Informed by ExpandNet’s work, but not
necessarily dictated by it

7. This practical “how to” resource includes:
 Rationale for monitoring scale-up
 Readiness assessment
 Ten considerations to monitoring scale-up
 Appendices including:
- Three monitoring scale-up case studies
- “Defining the Innovation” piece
- Selected frameworks and approaches for scaling-up
- Using GIS to monitor scale-up expansion

8. Rationale
Successful scale-up involves two key elements:
institutionalizing the practice and expanding or
replicating it.

9. And another way to look at scale up…

10. Readiness
Assessment

11. 10 Considerations to Monitoring
Scale-Up
1. Define objectives and
scope of scale up plan
2. Create a framework
3. Identify necessary
resources to implement
monitoring plan
4. Select indicators
5. Establish data sources
and reporting systems
6. Develop a data use and
dissemination plan
7. Collect data
8. Analyze data and
determine if scale up is
progressing on track
9. Make program adjustments
based on findings and
recommendations
10. Continue the M&E process

12. 1: Define objectives and scope of
the scale-up plan
 What do you want or need to know in order to
say your scale-up is working?
 Is the scale-up fulfilling the objectives of the
original program or pilot?
 How will you know if there are problems or that
your scale-up is not achieving its pre-determined
objectives?

13. 2: Create a
framework

15. 3: Identify necessary resources to
implement monitoring plan
 Human resources
 Financial
resources

16. 4: Select indicators
Level Indicators (by health domain) Data Sources
FINANCING
process The practice is included in the current year annual operating plan Operational plan; budget
process The budget is linked to the current year annual operational plan Budgets; chart of accounts; operational plan
ACCESS TO PHYSICAL RESOURCES
process Percent of facilities with available equipment to implement the practice Health facility audit; GIS data; specialized survey
process Availability of job aids and service protocols for the given practice Health facility audit; specialized survey
output Percent of facilities or community-based providers that experienced a stock out of
a given commodity at any point during a specified time period
Site visits, physical inventories, stock records; logistics
management information system records; supervision
records; GIS data
LEADERSHIP/GOVERNANCE
process Existence of a strategic plan for expanding coverage of the practice Review of strategic plan or strategy documents; interviews
with key staff (e.g., managers)
output Examples of practice being included and/or supported in national or subnational
policy, strategy, guidelines, curricula, or related documents and communications
Review of national or subnational policy, strategy,
guidelines, curricula, or other related documents
HEALTH MANAGEMENT INFORMATION SYSTEMS
input HMIS adapted to capture and report on key information on the implementation of
the practice
Meeting notes; HMIS
output Key information on the implementation of the practice routinely reported in the
HMIS
HMIS
HEALTH WORKFORCE
process Number of providers trained in the practice, by type of personnel Training records
output Number or percent of providers competent to provide specific services upon
completion of training
Competency tests (such as a checklist administered by the
trainers and/or external expert observer)
SERVICE DELIVERY
output Percent of trained providers performing the core components of the practice National guidelines/standards for service delivery; checklists
and notes of an expert observer
outcome Number of clients receiving the practice of interest in a given timeframe Facility records
outcome Percent of sites implementing the practice with fidelity to the model, based on
pre-determined criteria and definition of the practice/innovation
Facility records; facility audits; program records (for
community-based services); interviews with key staff
COMMUNITY INVOLVEMENT
output Community participation in and support for the practice Program records; focus groups; in-depth interviews
output Percent of audience with a favorable attitude toward the practice Sample surveys with members of the intended audience;
focus groups; in-depth interviews

17. 5: Establish data sources and
reporting systems

18. 6: Develop a data use and
dissemination plan
 Who will be responsible for analyzing and
interpreting the data?
 How will the findings be presented and
disseminated?
 Who are the internal and external audiences
for dissemination?
 Who will be using the data?

19. 7: Collect Data

20. 8: Analyze Data and Determine if
Scale-up Is Progressing On Track
 How is scale up progressing at the various
levels and within the different domains?
 Do the service delivery points have the
necessary commodities for the practice to be
properly implemented?
 Is the scale-up maintaining fidelity to the
practice?

21. 9: Make program adjustments based
on findings & recommendations
 Discuss challenges and
potential solutions to getting
the scale-up back on track or
change strategies
 Develop an action plan for
implementing each of these
solutions.

22. 10: Continue the M&E process

23. Appendices
 IRH’s Defining the Innovation, with
accompanying worksheet
 Selected frameworks and approaches for
scale-up of health interventions

24. Appendices
 Case Studies:
- PROGRESS Project: Monitoring the scale-up of
FP integration into comprehensive care centers
in Kenya
- FAM Project: Monitoring the scale-up of
standard days method in five countries
- NCP Project: Monitoring vitamin A promotion in
Niger
 Using GIS to monitor scale-up

25. "Measurement is the first step that leads to
control and eventually to improvement. If
you can't measure something, you can't
understand it. If you can't understand it, you
can't control it. If you can't control it, you
can't improve it."
- H. James Harrington

26. MEASURE Evaluation PRH is a MEASURE project funded by
the United States Agency for International Development
(USAID) through Cooperative Agreement GHA-A-00-08-00003-
00 and is implemented by the Carolina Population Center at
the University of North Carolina at Chapel Hill in partnership
with Futures Group International, Management Sciences for
Health, and Tulane University. Views expressed in this
presentation do not necessarily reflect the views of USAID or
the U.S. Government. MEASURE Evaluation PRH supports
improvements in monitoring and evaluation in population,
health and nutrition worldwide.