scholarly journals Assessing scalability of an intervention: why, how and who?

2019 ◽  
Vol 34 (7) ◽  
pp. 544-552 ◽  
Author(s):  
Karen Zamboni ◽  
Joanna Schellenberg ◽  
Claudia Hanson ◽  
Ana Pilar Betran ◽  
Alexandre Dumont
Keyword(s):  
Early Stage ◽  
Scale Up ◽  
Complex Interventions ◽  
Scaling Up ◽  
Outcome Evaluation ◽  
Assessment Tools ◽  
Assessment Process ◽  
Optimal Timing ◽  
Middle Income ◽  
Rigorous Research

Abstract Public health interventions should be designed with scale in mind, and researchers and implementers must plan for scale-up at an early stage. Yet, there is limited awareness among researchers of the critical value of considering scalability and relatively limited empirical evidence on assessing scalability, despite emerging methodological guidance. We aimed to integrate scalability considerations in the design of a study to evaluate a multi-component intervention to reduce unnecessary caesarean sections in low- and middle-income countries. First, we reviewed and synthesized existing scale up frameworks to identify relevant dimensions and available scalability assessment tools. Based on these, we defined our scalability assessment process and adapted existing tools for our study. Here, we document our experience and the methodological challenges we encountered in integrating a scalability assessment in our study protocol. These include: achieving consensus on the purpose of a scalability assessment; and identifying the optimal timing of such an assessment, moving away from the concept of a one-off assessment at the start of a project. We also encountered tensions between the need to establish the proof of principle, and the need to design an innovation that would be fit-for-scale. Particularly for complex interventions, scaling up may warrant rigorous research to determine an efficient and effective scaling-up strategy. We call for researchers to better incorporate scalability considerations in pragmatic trials through greater integration of impact and process evaluation, more stringent definition and measurement of scale-up objectives and outcome evaluation plans that allow for comparison of effects at different stages of scale-up.

scholarly journals Cost of scaling up mental healthcare in low-and middle-income countries

2007 ◽  
Vol 191 (6) ◽  
pp. 528-535 ◽  
Author(s):  
Dan Chisholm ◽  
Crick Lund ◽  
Shekhar Saxena
Keyword(s):  
Low Income ◽  
Scale Up ◽  
Mental Healthcare ◽  
Scaling Up ◽  
Psychosocial Treatment ◽  
Economic Evaluations ◽  
Middle Income ◽  
Middle Income Countries ◽  
Per Capita ◽  
Low And Middle Income

BackgroundNo systematic attempt has been made to calculate the costs of scaling up mental health services in low-and middle-income countries.AimsTo estimate the expenditures needed to scale up the delivery of an essential mental healthcare package over a 10-year period (2006–2015).MethodA core package was defined, comprising pharmacological and/or psychosocial treatment of schizophrenia, bipolar disorder, depression and hazardous alcohol use. Current service levels in 12 selected low-and middle-income countries were established using the WHO–AIMS assessment tool. Target-level resource needs were derived from published need assessments and economic evaluations.ResultsThe cost per capita of providing the core package attarget coverage levels (in US dollars) ranged from $1.85 to $2.60 per year in low-income countries and $3.20 to $6.25 per year in lower-middle-income countries, an additional annual investment of $0.18–0.55 per capita.ConclusionsAlthough significant new resources need to be invested, the absolute amount is not large when considered at the population level and against other health investment strategies.

scholarly journals Scale up of behaviour change interventions: A rapid review of evidence and practice

2021 ◽  
Author(s):  
Alexander K Saeri ◽  
Peter Slattery ◽  
Morgan James Tear ◽  
Chiara Varazzani ◽  
Daniel Epstein ◽  
...  
Keyword(s):  
Research Design ◽  
Behaviour Change ◽  
Scale Up ◽  
Scaling Up ◽  
Rapid Review ◽  
Behavioural Science ◽  
Overview Of Reviews ◽  
Behaviour Change Interventions ◽  
Public Purpose ◽  
Rigorous Research

Behaviour science has been applied for public value by more than 100 government and public purpose organisations worldwide. Much of this work has focused on evidence production through rigorous research design and theories of behaviour change.However, successfully tested interventions are not always scaled up to an entire population of interest, a new setting, or adapted to new target behaviours. Scaling up effective behaviour change interventions is often the true goal and often represents a challenge for government and research end-users working in behavioural science. We conducted a systematic search for an overview of reviews of scholarly evidence on scale up, and 11 practice interviews with behaviour science researchers and practitioners to identify the factors and activities that influence the scale up of behaviour change interventions. This work is aimed not only at uncovering the effectiveness of these activities but also at increasing the reach and impact of behaviour change interventions at scale.

scholarly journals ASHA-Led Community-Based Groups to Support Control of Hypertension in Rural India Are Feasible and Potentially Scalable

2021 ◽  
Vol 8 ◽  
Author(s):  
Michaela A. Riddell ◽  
G. K. Mini ◽  
Rohina Joshi ◽  
Amanda G. Thrift ◽  
Rama K. Guggilla ◽  
...  
Keyword(s):  
Program Implementation ◽  
Scale Up ◽  
Complex Interventions ◽  
Implementation Process ◽  
Rural India ◽  
Supportive Supervision ◽  
Culturally Appropriate ◽  
Clinical Trial Registry ◽  
Community Based ◽  
Middle Income

Background: To improve the control of hypertension in low- and middle-income countries, we trialed a community-based group program co-designed with local policy makers to fit within the framework of India's health system. Trained accredited social health activists (ASHAs), delivered the program, in three economically and developmentally diverse settings in rural India. We evaluated the program's implementation and scalability.Methods: Our mixed methods process evaluation was guided by the United Kingdom Medical Research Council guidelines for complex interventions. Meeting attendance reports, as well as blood pressure and weight measures of attendees and adherence to meeting content and use of meeting tools were used to evaluate the implementation process. Thematic analysis of separate focus group discussions with participants and ASHAs as well as meeting reports and participant evaluation were used to investigate the mechanisms of impact.Results: Fifteen ASHAs led 32 community-based groups in three rural settings in the states of Kerala and Andhra Pradesh, Southern India. Overall, the fidelity of intervention delivery was high. Six meetings were delivered over a 3-month period to each of the intervention groups. The mean number of meetings attended by participants at each site varied significantly, with participants in Rishi Valley attending fewer meetings [mean (SD) = 2.83 (1.68)] than participants in West Godavari (Tukeys test, p = 0.009) and Trivandrum (Tukeys test, p < 0.001) and participants in West Godavari [mean (SD) = 3.48 (1.72)] attending significantly fewer meetings than participants in Trivandrum [mean (SD) = 4.29 (1.76), Tukeys test, p < 0.001]. Culturally appropriate intervention resources and the training of ASHAs, and supportive supervision of them during the program were critical enablers to program implementation. Although highly motivated during the implementation of the program ASHA reported historical issues with timely remuneration and lack of supportive supervision.Conclusions: Culturally appropriate community-based group programs run by trained and supported ASHAs are a successful and potentially scalable model for improving the control of hypertension in rural India. However, consideration of issues related to unreliable/insufficient remuneration for ASHAs, supportive supervision and their formal role in the wider health workforce in India will be important to address in future program scale up.Trial Registration: Clinical Trial Registry of India [CTRI/2016/02/006678, Registered prospectively].

scholarly journals An implementation model for scaling up oral pre-exposure prophylaxis in Kenya: Jilinde project

2021 ◽  
Vol 5 ◽  
pp. 113
Author(s):  
Daniel Were ◽  
Abednego Musau ◽  
Mary Mugambi ◽  
Marya Plotkin ◽  
Mark Kabue ◽  
...  
Keyword(s):  
Scale Up ◽  
Scaling Up ◽  
Policy Coordination ◽  
Middle Income ◽  
Implementation Model ◽  
Middle Income Countries ◽  
Community Ownership ◽  
Exposure Prophylaxis ◽  
Oral Prep ◽  
Low And Middle Income

Oral pre-exposure prophylaxis (PrEP) is an efficacious way to lower the risk of HIV acquisition among high-risk individuals. Despite the World Health Organization’s 2015 recommendation that all persons at substantial risk of HIV infection be provided with access to oral PrEP, the rollout has been slow in many low- and middle-income countries. Initiatives for national rollout are few, and subtle skepticism persists in several countries about the feasibility of national PrEP implementation. We describe the conceptual design of the Jilinde project, which is implementing oral PrEP as a routine service at a public health scale in Kenya. We describe the overlapping domains of supply, demand, and government and community ownership, which combine to produce a learning laboratory environment to explore the scale-up of PrEP. We describe how Jilinde approaches PrEP uptake and continuation by applying supply and demand principles and ensures that government and community ownership informs policy, coordination, and sustainability. We describe the “learning laboratory” approach that informs strategic and continuous learning, which allows for adjustments to the project. Jilinde’s conceptual model illustrates how the coalescence of these concepts can promote scale-up of PrEP in real-world conditions and offers critical lessons on an implementation model for scaling up oral PrEP in low- and middle-income countries.

scholarly journals The impact of the timely birth dose vaccine on the global elimination of hepatitis B

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Margaret J. de Villiers ◽  
Shevanthi Nayagam ◽  
Timothy B. Hallett
Keyword(s):  
Hepatitis B ◽  
Horizontal Transmission ◽  
Scale Up ◽  
Scaling Up ◽  
World Health ◽  
Birth Cohorts ◽  
Middle Income ◽  
Hbv Vaccine ◽  
Birth Dose ◽  
The Impact

AbstractIn 2016 the World Health Organization set the goal of eliminating hepatitis B globally by 2030. Horizontal transmission has been greatly reduced in most countries by scaling up coverage of the infant HBV vaccine series, and vertical transmission is therefore becoming increasingly dominant. Here we show that scaling up timely hepatitis B birth dose vaccination to 90% of new-borns in 110 low- and middle-income countries by 2030 could prevent 710,000 (580,000 to 890,000) deaths in the 2020 to 2030 birth cohorts compared to status quo, with the greatest benefits in Africa. Maintaining this could lead to elimination by 2030 in the Americas, but not before 2059 in Africa. Drops in coverage due to disruptions in 2020 may lead to 15,000 additional deaths, mostly in South-East Asia and the Western Pacific. Delays in planned scale-up could lead to an additional 580,000 deaths globally in the 2020 to 2030 birth cohorts.

scholarly journals Factors influencing the scale-up of public health interventions in low- and middle-income countries: a qualitative systematic literature review

2019 ◽  
Vol 35 (2) ◽  
pp. 219-234 ◽  
Author(s):  
Susan E Bulthuis ◽  
Maryse C Kok ◽  
Joanna Raven ◽  
Marjolein A Dieleman
Keyword(s):  
Public Health ◽  
Scale Up ◽  
Scaling Up ◽  
Health Interventions ◽  
Public Health Interventions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Factors Influencing ◽  
Low And Middle Income ◽  
The Way

Abstract To achieve universal health coverage, the scale-up of high impact public health interventions is essential. However, scale-up is challenging and often not successful. Therefore, a systematic review was conducted to provide insights into the factors influencing the scale-up of public health interventions in low- and middle-income countries (LMICs). Two databases were searched for studies with a qualitative research component. The GRADE-CERQual approach was applied to assess the confidence in the evidence for each key review finding. A multi-level perspective on transition was applied to ensure a focus on vertical scale-up for sustainability. According to this theory, changes in the way of organizing (structure), doing (practice) and thinking (culture) need to take place to ensure the scale-up of an intervention. Among the most prominent factors influencing scale-up through changes in structure was the availability of financial, human and material resources. Inadequate supply chains were often barriers to scale-up. Advocacy activities positively influenced scale-up, and changes in the policy environment hindered or facilitated scale-up. The most outstanding factors influencing scale-up through changes in practice were the availability of a strategic plan for scale-up and the way in which training and supervision was conducted. Furthermore, collaborations such as community participation and partnerships facilitated scale-up, as well as the availability of research and monitoring and evaluation data. Factors influencing scale-up through a change in culture were less prominent in the literature. While some studies articulated the acceptability of the intervention in a given sociocultural environment, more emphasis was placed on the importance of stakeholders feeling a need for a specific intervention to facilitate its scale-up. All identified factors should be taken into account when scaling up public health interventions in LMICs. The different factors are strongly interlinked, and most of them are related to one crucial first step: the development of a scale-up strategy before scaling up.

scholarly journals Implementation outcomes and strategies for depression interventions in low- and middle-income countries: a systematic review

2020 ◽  
Vol 7 ◽  
Author(s):  
Bradley H. Wagenaar ◽  
Wilson H. Hammett ◽  
Courtney Jackson ◽  
Dana L. Atkins ◽  
Jennifer M. Belus ◽  
...  
Keyword(s):  
Early Stage ◽  
Scale Up ◽  
Sub Saharan Africa ◽  
Future Research ◽  
Middle Income ◽  
Middle Income Countries ◽  
Hybrid Type ◽  
Implementation Outcomes ◽  
Low And Middle Income

Abstract Background We systematically reviewed implementation research targeting depression interventions in low- and middle-income countries (LMICs) to assess gaps in methodological coverage. Methods PubMed, CINAHL, PsycINFO, and EMBASE were searched for evaluations of depression interventions in LMICs reporting at least one implementation outcome published through March 2019. Results A total of 8714 studies were screened, 759 were assessed for eligibility, and 79 studies met inclusion criteria. Common implementation outcomes reported were acceptability (n = 50; 63.3%), feasibility (n = 28; 35.4%), and fidelity (n = 18; 22.8%). Only four studies (5.1%) reported adoption or penetration, and three (3.8%) reported sustainability. The Sub-Saharan Africa region (n = 29; 36.7%) had the most studies. The majority of studies (n = 59; 74.7%) reported outcomes for a depression intervention implemented in pilot researcher-controlled settings. Studies commonly focused on Hybrid Type-1 effectiveness-implementation designs (n = 53; 67.1), followed by Hybrid Type-3 (n = 16; 20.3%). Only 21 studies (26.6%) tested an implementation strategy, with the most common being revising professional roles (n = 10; 47.6%). The most common intervention modality was individual psychotherapy (n = 30; 38.0%). Common study designs were mixed methods (n = 27; 34.2%), quasi-experimental uncontrolled pre-post (n = 17; 21.5%), and individual randomized trials (n = 16; 20.3). Conclusions Existing research has focused on early-stage implementation outcomes. Most studies have utilized Hybrid Type-1 designs, with the primary aim to test intervention effectiveness delivered in researcher-controlled settings. Future research should focus on testing and optimizing implementation strategies to promote scale-up of evidence-based depression interventions in routine care. These studies should use high-quality pragmatic designs and focus on later-stage implementation outcomes such as cost, penetration, and sustainability.

scholarly journals Towards a more nuanced global mental health

2014 ◽  
Vol 204 (6) ◽  
pp. 415-417 ◽  
Author(s):  
Ross G. White ◽  
S. P. Sashidharan
Keyword(s):  
Mental Health ◽  
Global Mental Health ◽  
Scale Up ◽  
Scaling Up ◽  
World Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Gap ◽  
Action Programme ◽  
Health Organization

SummaryThe World Health Organization has made concerted efforts to scale up mental health services in low- and middle-income countries through the Mental Health Gap Action Programme (mhGAP) initiative. However, an overreliance on scaling up services based on those used in high-income countries may risk causing more harm than good.

scholarly journals Health systems strengthening to optimise scale-up in global mental health in low- and middle-income countries: lessons from the frontlines. A re-appraisal

2020 ◽  
Vol 29 ◽  
Author(s):  
I. Petersen ◽  
A. van Rensburg ◽  
S. G. Gigaba ◽  
Z. B. P. Luvuno ◽  
L. R. Fairall
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Health Systems ◽  
Scale Up ◽  
Scaling Up ◽  
Health Systems Strengthening ◽  
Middle Income ◽  
Middle Income Countries ◽  
Policy Window

Abstract Against the backdrop of mounting calls for the global scaling-up of mental health services – including quality care and prevention services – there is very little guidance internationally on strategies for scaling-up such services. Drawing on lessons from scale-up attempts in six low- and middle-income countries, and using exemplars from the front-lines in South Africa, we illustrate how health reforms towards people-centred chronic disease management provide enabling policy window opportunities for embedding mental health scale-up strategies into these reforms. Rather than going down the oft-trodden road of vertical funding for scale-up of mental health services, we suggest using the policy window that stresses global policy shifts towards strengthening of comprehensive integrated primary health care systems that are responsive to multimorbid chronic conditions. This is indeed a substantial opportunity to firmly locate mental health within these horizontal health systems strengthening funding agendas. Although this approach will promote systems more enabling of scaling-up of mental health services, implications for donor funders and researchers alike is the need for increased time commitments, resources and investment in local control.

scholarly journals Public health nutrition capacity: assuring the quality of workforce preparation for scaling up nutrition programmes

2016 ◽  
Vol 19 (11) ◽  
pp. 2090-2100 ◽  
Author(s):  
Roger Shrimpton ◽  
Lisanne M du Plessis ◽  
Hélène Delisle ◽  
Sonia Blaney ◽  
Stephen J Atwood ◽  
...  
Keyword(s):  
Public Health ◽  
Child Nutrition ◽  
Task Force ◽  
Scale Up ◽  
Scaling Up ◽  
Public Health Nutrition ◽  
Middle Income ◽  
Nutrition Training ◽  
Service Training ◽  
Hybrid Distance

AbstractObjectiveTo describe why and how capacity-building systems for scaling up nutrition programmes should be constructed in low- and middle-income countries (LMIC).DesignPosition paper with task force recommendations based on literature review and joint experience of global nutrition programmes, public health nutrition (PHN) workforce size, organization, and pre-service and in-service training.SettingThe review is global but the recommendations are made for LMIC scaling up multisectoral nutrition programmes.SubjectsThe multitude of PHN workers, be they in the health, agriculture, education, social welfare, or water and sanitation sector, as well as the community workers who ensure outreach and coverage of nutrition-specific and -sensitive interventions.ResultsOvernutrition and undernutrition problems affect at least half of the global population, especially those in LMIC. Programme guidance exists for undernutrition and overnutrition, and priority for scaling up multisectoral programmes for tackling undernutrition in LMIC is growing. Guidance on how to organize and scale up such programmes is scarce however, and estimates of existing PHN workforce numbers – although poor – suggest they are also inadequate. Pre-service nutrition training for a PHN workforce is mostly clinical and/or food science oriented and in-service nutrition training is largely restricted to infant and young child nutrition.ConclusionsUnless increased priority and funding is given to building capacity for scaling up nutrition programmes in LMIC, maternal and child undernutrition rates are likely to remain high and nutrition-related non-communicable diseases to escalate. A hybrid distance learning model for PHN workforce managers’ in-service training is urgently needed in LMIC.

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