Scaling up effective interventions in Global Health

In a discussion with a leader of a global health system, the leader said, “our system is great at everything—just not everywhere. I can name somebody who is a world-class leader in any clinical area in our system. However, I cannot say the same for every part of our system.” This reality describes many health care systems in the world where excellent practices may take place in one place but not throughout the system. Achieving excellence throughout the system requires the deliberate spread of such practices.

What do we mean by spread or scale-up? Though some people differentiate between the two, for the purposes of this presentation we will use spread and scale-up interchangeably. Spread is defined as the science of taking a local improvement (e.g. an intervention, a redesign of a process or system) that has demonstrated better results than the current method and actively disseminating it across a system, i.e. making an intervention that has proven to be more successful happen at a much larger scale than the initial location where the improvement originally took place. In this chapter, everything we will discuss will relate to an improved practice, a high-impact evidence-based intervention, a better result or a new process of care delivery that has produced a better result. We will discuss this in the context of taking the practice from the scale at which it was originally developed and actively moving it into a much larger geographic area covering a large number of facilities and patients.  This is essentially what we mean by spread or scale-up.