204310 Understanding scale-up: Research and programmatic challenges

Tuesday, November 10, 2009: 12:50 PM

Rebecka Lundgren, MPH , Institute for Reproductive Health, Georgetown University, Washington, DC
Susan Igras , Institute for Reproductive Health, Georgetown University, Washington, DC, DC
Ruth Simmons, PhD , Department of Health Behavior/Health Education, University of Michigan School of Public Health, Ann Arbor, MI
To achieve the Millennium Development Goals, scale-up efforts must be multiplied several times over. However, serious gaps exist in understanding the processes by which innovations are implemented and sustained. A five-year prospective, multi-site comparative study of the process and outcomes of scaling up a family planning innovation, the Standard Days Method, is underway in Mali, India, Madagascar, Guatemala and Rwanda, drawing upon the ExpandNet/WHO scale up model. Data collection includes service statistics, household surveys, facility assessments, in-depth provider/stakeholder interviews, most-significant-change stories and process tracking. The ExpandNet model grounded development of a feasible yet rigorous methodology, and facilitated operationalization of the scale-up concept. Data from the first year of research suggest that assessment prior to engaging in scale up and throughout the process is critical to identify needed adjustments, maintain momentum and accountability and build strategic planning skills among stakeholders. Analysis of the innovation, resource team, scale-up strategy, environment and user organizations resulted in redefinition of the innovation to include not only the technology (Standard Days Method) but also supporting values such as male involvement and informed choice, as well as interventions required to make the technology available. Lessons learned will be discussed, including: adapting research methods to a rapidly shifting environment, involving multiple partners in the research, balancing competing programmatic and research needs, and producing relevant, timely data for stakeholders with diverse needs. Methodological issues such as indicator selection, use of a comparative study design, and controlling the pro-innovation bias of researchers will be discussed.

Learning Objectives:
At the conclusion of this presentation, participants will be able to: 1) assess a comparative case study methodology for studying scale up; 2) describe three key lessons learned for scale up research; 3) discuss the utility of the ExpandNet framework for research; and 4) identify three implications for scale up.

Keywords: Family Planning, Reproductive Health Research

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have over 20 years of experience in research on reproductive health. I am currently Director of Research at the Institute for Reproductive Health at Georgetown University.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.