It’s been a few weeks since the end of HSR2018. This has been time enough to reflect on the symposium and what was achieved, but not to follow up on all the contacts made or to develop the ideas hatched (which we may still be doing come HSR2020).
What we have been able to do though, is edit the recordings made of the two sessions featuring PERFORM2Scale and scale-up more broadly.
The first, on scaling-up health system interventions, featured two PERFORM2Scale project members. Susan Bulthuis of Royal Tropical Institute (KIT) spoke on factors influencing scale up in LMICs, while Dr Joanna Raven of LSTM introduced PERFORM2Scale – check it out if you need an introduction to the project.
The ‘lessons on scaling up session’ looked at projects which have been/are being scaled up – tackling TB in Viet Nam, scaling up safe surgery in Africa and PERFORM2Scale. One audience member described it as “the best session at the symposium”, but you can judge for yourself by watching the videos on YouTube.
Despite being increasingly experienced in scale up and having been immersed in the literature on the subject, the PERFORM2Scale members took a lot from these and other sessions. Reflections, in no particular order, include:
- What is scale up? Scale up is a buzzword, however, we noticed a few different definitions in use. Also, there is no common understanding of how scale up should be approached.
- Scale up is messy! Projects need a clear scale up strategy, but you also need to be opportunistic and ready to react to changing situations, both good and bad.
- Scale up is complex and there is a need for flexible funding if projects are to react to changing contexts, difficulties and opportunities.
- Advocacy is essential. Scale up has a political element, and engagement with stakeholders at all levels is essential. Ministries are especially important, and you must engage with them early in the process, providing evidence of the effectiveness of your pilot in a form they can easily absorb.
- It’s who you know. Success is not only dependent on the contacts you cultivate but also on existing relationships. If you are to really embed and institutionalise your project you will rely on your research team and implementers to make use of their contacts.
- Enthusiasm. During HSR2018 we spoke to so many people who want to learn about the scale up process, not just those working in public health but also in the clinical sciences. There is a recognition that there is a great need to scale up health interventions, which leads to our next reflection…
- Dearth of literature. There is a noticeable gap in the literature on the process of scaling up. PERFORM2Scale will help fill this as not only are we scaling-up an intervention but we are also capturing lessons learnt and documenting the process so that we, and others, might learn.
- Integration is essential. The successful projects were so partly because they integrated/embedded the intervention in the existing systems (vertical scale-up). Without this sustainability is impossible.
What do you think?
We would be keen to hear your reflections and to know your thoughts on the PERFORM2Scale and scale-up presentations. Did they reflect your experience? Is there anything we did not cover? Let us know through Twitter.