The document outlines lessons on scaling up interventions from the ExpandNet initiative, emphasizing that it is primarily an organizational and political task rather than just technical. It presents a strategic framework consisting of three stages: assessment, testing, and scaling up, while also discussing the complexities involved, such as system characteristics and sociocultural influences. Key components for successful scaling include resource mobilization, monitoring, and the strategic choice of areas for innovation.

1. Contextualizing Scaling Up: Lessons from ExpandNet Ruth Simmons ExpandNet and the University of Michigan School of Public Health

2. Polity Society Economy People Services Technology Policies, program structure Personnel, facilities, management Availability and accessibility Quality Available technologies Technology characteristics Barriers including cost Needs and rights People’s perspectives Medical profile Sociocultural and gender influences The systems framework guiding the Strategic Approach Source: Adapted from Simmons et al. “The Strategic Approach to Contraceptive Introduction: Lessons from Eight Countries.”, Studies in Family Planning 1997 Vol 28, no 2 .

3. Strategic Approach: Three Stages of Work Stage I: Strategic Assessment Stage II: Testing Interventions Stage III: Scaling up and Expansion

4. Scaling up is predominantly … … an organizational, managerial and policy or political task, rather than a narrowly technical one.

5. ExpandNet/WHO Guidance Materials www.expandnet.net

6. The Innovation User Organization(s) Resource Team ORGANIZATIONAL PROCESS COSTS/RESOURCE MOBILIZATION MONITORING AND EVALUATION TYPE OF SCALING UP Environment Scaling-up Strategy DISSEMINATION AND ADVOCACY The elements of scaling up Strategic choice areas

7. Three Examples Testing innovations with scaling up in mind Need for caution with rapid scale up Engaging with opportunities and constraints in the environment