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Table 1 Review of frameworks for scaling up health interventions

From: A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa

Frameworks Sequential scale-up plan Adoption influences and infrastructure
Implementing Best Practices Consortium (15,16) Preliminary setup phase, a test-of-concept phase, further testing in different environments, and an implementation scale-up phase to get to full scale; theory-based approach that tests the applicability of the intervention in different contexts before scaling Outlines eight principles that support change including perception of benefits, change agent, resource support for the change agent, leadership support, staff motivation, small-scale testing using success to motivate, clear implementation ownership, and getting going by not delaying first steps
Expandnet (17–19) Alignment to the local practices and contexts in the setup phase, and testing and learning from different contexts as the intervention starts to scale up, feeding the information learned into the final scale-up plan; theory-based approach that tests the applicability of the intervention in different contexts before scaling Emphasis on understanding attributes of the innovation, the organization, the resource team and the larger social, political, economic, and institutional environment
WHO/Massoud (20) Preliminary setup phase, a test-of-concept phase in a representative “slice” of the system, and exponential increase of these slices to fill out the areas of full scale through further testing in different environments; theory-based approach that tests the applicability of the intervention in different contexts before scaling; a major contribution from Massoud is the notion of planning from the outset with scale in mind and initial testing in a network of facilities across multiple layers of the system Use of evidence of success as a mechanism for advocacy and will building, and creating a receptive environment for taking an intervention to full scale; suggest using leaders from successful early test phases of the work to become the advocates and local champions to drive the scale-up phases of the work
Management Systems International (21) Planning, establishing pre-conditions for scaling up, and implementation; accounts for, and anticipates the needs of, different contexts through deep inquiry into local conditions Highlights the need for pre-work, stage setting, and engagement that will support successful scaling up, especially in terms of attaining necessary resources and buy-in through advocacy methods
Consolidated Framework for Implementation Research (22) Planning, engaging, executing, and reflecting/evaluating; accounts for, and anticipates the needs of, different contexts through deep inquiry into local conditions Five areas to consider: intervention characteristics, inner setting, outer setting, individual characteristics, and the implementation process
Yamey (23) Phased delivery strategy as one of six success factors that needs to account for and anticipate needs of different contexts through deep inquiry in to local conditions as well as using a phased approach Outlines six areas that influence successful scale-up, including attributes of the tool/service being scaled up, of the implementers, of the community, of the socio-political environment, of the research environment, and the delivery strategy