How to scale-up: a comparative case study of scaling up a district health management strengthening intervention in Ghana, Malawi and Uganda
Image: DHMT members in a workshop in Ghana
The need to scale up public health interventions in low- and middle-income countries to ensure equitable and sustainable impact is widely acknowledged. However, there has been little understanding of how projects have sought to address the importance of scale-up in the design and implementation of their initiatives. This paper from the PERFORM2Scale team aims to gain insight into the facilitators of the scale-up of a district-level health management strengthening intervention in Ghana, Malawi and Uganda.
Despite the identification of the facilitators of the scale-up - including a shared vision, identification of champions, windows of opportunity and flexibility - full integration of the intervention into the health system has proven challenging in all countries. Approaching scale-up from a systems change perspective could be useful in future scale-up efforts, as it focuses on sustainable systems change at scale (eg improving district health management) by testing a combination of interventions that could contribute to the envisaged change, rather than horizontally scaling up and trying to embed one particular intervention in the system.