Report on reflection and learning on the use of a scale-up framework and strategy

31 May 2022
Timeline showing how the MSI and scale-up research was scheduled

The objectives of this report  - which can be downloaded here  - are:

  • To reflect on and learn about the generic PERFORM2Scale scale-up framework and strategy, and how and why this was adapted in each country during the project.
  • To produce a set of lessons on using a scale-up framework and for transferrability to similar innovation implementations in other countries.

The findings are presented according to the elements of the scale-up framework and strategy: innovation, user group, Resource Team, types of scale-up (including vertical, horizontal, diversification and spontaneous), changes in the environment, dissemination and advocacy, resources, and monitoring and evaluation.


The report found that the scale-up framework and strategy we developed, based on the ExpandNet model, was undoubtedly a useful guide to steer the scale-up of the MSI. While providing a common framework across the three study sites, it also allowed for country-specific adaptations based on the team’s experience of what seemed to work and changing contexts in each setting.  The scale-up, with initial support from the project, was relatively successful in expanding coverage of the innovation.  However, expanding the scale-up of the innovation further, supported by sustainable funding, has proved a much greater challenge. Lessons identified from this experience have been developed to assist with the future scale-up of complex health systems innovations to support UHC.