Table 2 Synthesis of public health scaling up models and frameworks

Scalability considerations

Scalability with a focus on the following:

Health promotion: generic

Literature review and expert Delphi process

High-income country

[25]

➢ Effectiveness

➢ Reach and adoption

➢ Human, technical and organisational Resources

➢ Costs

➢ Intervention delivery

➢ Contextual factors

➢ Appropriate evaluation approaches

Scaling up population health interventions: guide, New South Wales Ministry of Health

A 4-step process for scaling up interventions:

Public health: generic

Literature review and expert Delphi process

High-income country

[26]

➢ Step 1. Scalability assessment: to assess the suitability of the intervention/s for scaling up

➢ Step 2. Develop a scaling up plan: create a vision of what scaling up will look like and a compelling case for action

➢ Step 3. Prepare for scaling up: securing resources and building a foundation of legitimacy and support for the scaling up plan

➢ Step 4. Scale up: the main tasks that should be addressed during scale up

9 steps to scaling up, WHO ExpandNet

ExpandNet framework involves 9 steps:

Health services and public health: generic

Literature review and interviews

Global health

[7, 39]

➢ Planning actions to increase the scalability of the innovation

➢ Increasing the capacity of the user organisation to implement

➢ Assessing the environment and planning actions to increase the potential for success

➢ Increasing the capacity of the resource team to support scaling up

➢ Making strategic choices to support vertical scaling up (institutionalisation)

➢ Making strategic choices to support horizontal scaling up (expansion/replication)

➢ Determining the role of diversification

➢ Planning actions to address spontaneous scaling up

➢ Finalising the scaling-up strategy and identifying next steps

Scaling up management (SUM) framework

Includes 3 key steps:

Health services and public health: generic

Literature and interviews

Global health

[24]

➢ Step 1: developing a scaling up plan

➢ Step 2: establishing the preconditions for scaling up

➢ Step 3: implementing the scaling up process based on the identification of factors that can promote extension and sustainability

Scale up of exclusive breastfeeding

Involves the following steps:

Health services and public health: breastfeeding

Systematic review

Global health

[23]

➢ Assess situation, create a policy environment conducive to action

➢ Define roles, relationships and responsibilities of all partners

➢ Establish agreements

➢ Review technical support

➢ Define programme strategy

➢ Mobilise resources

➢ Provide training and technical assistance

➢ Develop and use monitoring and evaluation systems

➢ Monitor coverage and quality

➢ Measure impact and cost

➢ Provide for testing novel approaches and continuing innovation

Scaling up global health interventions: framework for success

Describes 6 components of the scaling up process:

Health services and public health

Literature review and interviews with experts

Global health

[9]

➢ Attributes of the specific tool or service being scaled up

➢ Attributes of the implementers

➢ Chosen delivery strategy

➢ Attributes of the ‘adopting’ community

➢ Socio-political context and research context

Breastfeeding gear model

Eight interrelated elements:

Health services and public health

Literature review, interviews and focus groups

Global health

[27]

➢ Advocacy

➢ Political will

➢ Legislation and policies

➢ Funding and resources

➢ Training and delivery

➢ Promotion

➢ Research and evaluation

➢ Coordination and goals monitoring

The framework suggests successful multiple feedback loops and several potential paths are required to achieve intended innovation