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Table 3 Contrasting Meaning of Scaling Up, Resources Required, and Management Perspectives

From: Do we have the right models for scaling up health services to achieve the Millennium Development Goals?

Dimension

Scaling up to Reach the MDGs

Scaling up Innovations and Pilot Projects

Meaning of scaling up

"Becoming large": more people covered

"Expanding impact" and becoming sustainable in multiple dimensions, including quantitative, functional, organizational, and political terms

Time frame

Short to medium term

Medium to long term

Criteria for validity of scaling up strategies

Assumption of external validity of approaches. Search for easily replicable, standardized approaches

Assumption that approaches should be determined contextually. Internal validity of strategies being tested is most important. What works best depends on the particular context, time and place

Scaling up Resources

Money is a binding constraint; much money is needed

Money is necessary but not sufficient, and small amounts can go far. Money not usually the binding constraint.

Absorptive capacity

Ability to spend external funds

Ability to find a fit between:

1. Beneficiaries ability to voice concerns and how organizations that provide services make decisions

2. Requirements of programs and capabilities of organizations

3. Needs of beneficiaries and the resources and services made available

Planning Perspectives

Create better blueprints and targets that can be locally adapted

Learning by doing. Look for and embrace error, plan with key stakeholders, and link knowledge building with action

Implementation Perspectives

Range of well-defined managerial inputs, technologies, strategies and activities (often overlooking or assuming some constant quality) focused primarily on improved delivery of services

Mix of technocratic, political, social and economic activities and processes, which are not defined with specificity in advance. Service delivery outcomes alone is not the main outcome

 

Focus on "accelerating" implementation to meet well-defined goals and deadlines

Slower, phased implementation, usually from the bottom up, which allows for systematic learning to emerge through incremental expansion based on concurrent, participatory research and adaptation

 

Assumes that implementation will "occur", perhaps even spontaneous replication to new sites and beneficiaries once users see value of change

Acknowledges possibility of spontaneous replication, but strong bias towards "managed" implementation, including intensive monitoring and adaptation because of expected error and need for "champions", teamwork and capacity building

Monitoring & Evaluation

Focused on status of problem; uses formal surveys, rigor; written communication; statistical analysis; numerical presentation

Focused on problem-solving; uses observation, guided interviews, informant panels; timely feedback; oral communication; informed interpretation; narrative presentation