Scale-up is not always a strategic or deliberate process but can occur somewhat opportunistically as available funding increases, country and donor priorities change, or societal norms and behaviors adjust, among other changes.
Gain a better understanding of what it takes to scale up the main elements of the practice or intervention Identifies if there is essential information for continued replication and sustainability M&E helps to systematically plan for and manage scale-up beyond routine program management and implementation Determine if the core components of the practice are being maintained Point to where more attention is needed in the scale-up efforts Identify if scale-up is proceeding on a path toward country ownership and sustainability
This resource is not meant to be a tool for measuring the achievement of outcomes, such as changes in knowledge, attitudes, beliefs, and behaviors among the scale up beneficiaries, nor is it meant to be a guide for conducting an outcome evaluation. It is to help monitor scale-up processes of practices for which scale-up is already underway, even if the scale-up was not initially well-planned or monitored. The idea is that this guide will help to unlock that “black box” and assist with understanding how you got to where you are in the process of scaling up.
Introduction to scale-up and rationale for monitoring scale-up Readiness assessment, or an assessment of the practices currently being scaled up and strategically deciding where to focus monitoring resources Ten considerations to monitoring scale-up A “Defining the Innovation” guidance and worksheet developed by the Institute for Reproductive Health Selected frameworks and approaches for scale-up of health interventions Three monitoring scale-up case studies Using geographic information systems to monitor the geographic aspect of scale-up
Expanding or replicating the process includes moving it from one geographic area to more areas or from one level of health service to other levels. Expanding involves training, increasing staffing or service delivery providers, task-shifting and/or task sharing, additional technical assistance and supervision, modifying or upgrading facilities, procuring supplies, equipment, and commodities, distributing materials, and adapting data collection methods or tools, among other steps. Expansion/replication is also referred to as “horizontal scale up”. Institutionalization is more the “systems” piece of scale up and is sometimes referred to as “vertical scale up”. It includes buy-in from leaders and stakeholders which translates into legal, political, and institutional changes. This piece includes: norms and procedures, training curricula, supervision, health information systems, supply distribution, and budget lines. It is generally more time-consuming with long-term results. This is the heart of scale up, which is not really technical, but is more of an organizational, political, and managerial exercise. This is why systematic, well-planned scale up is not quick; to do it well, these more challenging pieces must be monitored consistently to make sure they are working, keeping up momentum, and moving ahead.
The institutional aspect of scale up is more top-down and the expansion/replication piece is more bottom-up.
In any given country, there are typically multiple health practices in the process of being scaled up. However, not all of these practices are high priority or have an equal chance of becoming sustainable practices fully integrated into existing health programs. The Readiness Assessment checklist and accompanying flowchart will help determine which practices being scaled up would benefit from a more concerted and strategic look at how the scale-up process is progressing. Thus, the following criteria will assist in the process of systematically reviewing the practices currently being brought to scale in a particular country or context to identify which one(s) to focus monitoring efforts on for success in scale up and long-term sustainability.
Although program implementers may be familiar with the steps to monitoring, drawing from various M&E resources, the emphasis here is on monitoring through a scale-up lens, addressing the challenges and specific considerations that come with this process. These were initially called “Ten Steps to Monitoring Scale Up”, but in recognition of the fact that these steps are not always linear, they are now being called “considerations”.
In 2008-2009, a successful pilot project integrating family planning (FP) into HIV Comprehensive Care Centers (CCCs) was conducted in Kenya’s the Rift Valley and Coast provinces. Following the pilot, the MoH decided to scale up this integrated practice to all HIV CCCs in Kenya. A couple of years later, FHI 360’s PROGRESS Project began working with stakeholders to monitor the progress and pace of scale-up. This case study focuses on data collection methods and indicators. IRH conducted a five year (2007-2012) prospective study to assess and document the process and effects of large-scale integration and scale-up of SDM in FP and reproductive health systems in 5 countries. So the FAM case study looks more at the process of how they monitored the scale-up. The Nutrition Communication Project (NCP) Vitamin A Promotion Project was implemented in Tahou Region from 1991-1994. It was USAID-funded and implemented by AED and Helen Keller International. Although the MoH had actively distributed vitamin A capsules, it had no experience with behavior change programs encouraging the consumption of vitamin A-rich foods. A two year pilot study was successfully conducted and reached approximately 26,000 people. The project was then scaled up and reached approximately 250,000 people. This case study looks at key monitoring issues and lessons learned during that scale up in a difficult and unique environment.
GIS tools help to break down the complexity of the data while adding an additional component — space. By linking different data sources together to see how variables interact and relate to one another in space, we are better able to understand and make sense of our data.
Monitoring the Scale-up of Family Planning Practices and Interventions
Monitoring the Scale-up of
Family Planning Practices and
MEASURE Evaluation Population and
Reproductive Health (PRH) Project
Discuss the concept of scale-up and the importance
of monitoring and evaluating it
Introduce the monitoring scale-up guide
Present what information is included in the guide
Highlight key components of the guide
What does “scale-up” mean?
ExpandNet’s definition: ““deliberate efforts to increase
the impact of health service innovations successfully
tested in pilot or experimental projects so as to benefit
more people and to foster policy and program
development on a lasting basis”
Scale-up entails the process of reaching more
people with a proven practice, more quickly, and more
effectively in a particular context.
Benefits of M&E of Scale-up
Gain a better understanding of what it takes to scale up
the main elements of the practice
Identify if there is essential information for continued
replication and sustainability
Help to systematically plan for and manage scale-up
beyond routine implementation
Determine if the core components of the practice are
Point to where more attention is needed
Identify if the country ownership is being established
Guide to Monitoring Scale-up of
Health Practices and Interventions
Goal: To assist country
stakeholders with identifying
if scale-up is happening as
intended and if the scale-up
efforts can be sustained to
achieve the desired impact.
The guide is a practical “how to”
resource which includes:
Rationale for monitoring scale-up
Ten considerations to monitoring scale-up
“Defining the Innovation” guidance and worksheet
Selected frameworks and approaches for scale-up
Monitoring scale-up case studies
GIS for monitoring expansion
The two key elements for successful scale-up:
institutionalizing the practice and replicating it
Evidence exists that the scaled-up practice will likely
have a positive impact on health outcomes
Experience from an evaluation of a local or comparable
pilot is available
The scale-up adheres, to the extent possible, to existing
health system structures, processes, and practices
The costs of scaling up have been identified and can be
There is a strong level of interest/commitment
There is a commitment to monitoring the scale-up
Ten Considerations to Monitoring
1. Define objectives and
scope of scale-up plan
2. Create a framework
3. Identify necessary
resources to implement
4. Select indicators
5. Establish data sources
and reporting systems
6. Develop a data use and
7. Collect data
8. Analyze data and
determine if scale-up is
progressing on track
9. Make program adjustments
based on findings and
10. Continue the M&E process
IRH’s Defining the Innovation, with accompanying
- PROGRESS Project: Monitoring the scale-up of
FP/CCC integration in Kenya
- FAM Project: Monitoring the scale-up of
standard days method in five countries
- Nutrition Communication Project: Monitoring vitamin
A promotion in Niger
Using GIS to Monitor Scale-up
GIS tools help to add an additional
component to data analysis — space.
The expansion aspect of scale-up is
inherently geographic in scope, and
therefore most any data that contains
a geographic component can be
imported into a GIS and mapped
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.