Understanding Scaling Up: Research and Programmatic Challenges

Editor's Notes

• #5: These slides summarize findings from a review that Rebecka did on scaling up research for class last year.
• #6: Concerns cited in the literature: Point 1: Practices spread if interpretive process renders them salient, familiar, compelling – e.g. if the idea of the SDM makes sense culturally. Point 3: Researchers tend to underemphasize rejection/discontinuance/re-invention of innovations because they are frequently part of the scale-up process.
• #8: A big program challenge is defining scale up and its attributes. It has become a jargon term with many meanings. People often say that a FP method is ‘scaled up’ once it is found in the MOH’s FP norms and procedures and when providers have been trained in offering the method. But full scale integration of a new method (or any other kind of new service) touches on many systems elements in order to be sustained. As the slide shows, systems and services are interlinked. Political support and technical leadership provide the forward momentum. When you think of what is the innovation – many elements go into the package that makes up the innovation. It is not just the technology being introduced.
• #10: For program management and decision making Also for understanding SU processes
• #12: As opposed to the null hypothesis – Scale-up efforts which focus primarily on integration of SDM into norms and training will not lead to sustainable quality SDM services.
• #13: And we are trying to integrate these aspects into both our planning and M&E and research
• #14: Yin, R. (1994). Case study research: Design and methods (2nd ed.). Thousand Oaks, CA: Sage Publishing.
• #15: Purpose: Describe the process and outcomes of SDM scale-up using the ExpandNet framework in selected FAM project countries. Specific objectives: Compare and contrast similarities and differences in the innovation and the process and outcomes of SDM scale-up across countries. To assess the usefulness of application of the ExpandNet framework (using a systems approach) to the scale-up process. To explore how each element of the framework evolves during the scale-up process and what contribution it makes. To describe the unique contributions of SDM scale-up to RH at the organizational and individual level To identify the facilitating and constraining factors that are specific to SDM scale-up Adapted from RL Presentation at IRH (2009) and Clear Horizon Presentation (2006)
• #16: Some people call a logic model their “roadmap”. OUTPUTS are the activities a program undertakes. WHAT WE DO OUTCOMES are the changes or benefits that result from our program activities. “ What gets measured, gets done” [Osborne and Gaebler, 1992)] OUTCOMES = SO WHAT!! This is a great looking logic model, but is this what we “should” be doing? A logic model expresses your “theory of action” or “theory of change”. Process and Output - (Country, Partner Tracking Reports) Routine process tracking (what was key achievement; how/when/where/who involved in achievement Routine output tracking (e.g.. number of: FAM acceptors, people trained by type, and different SDPs by type) - collected bi-annually Household surveys (Knowledge, attitudes and use) Service Delivery Points Assessment (readiness of delivery points, quality of services) In-depth stakeholder interviews (Extent of integration, attitudes, readiness, constraints of integration
• #17: Operationalizing scale up indicators – so that it could be evaluated/researched
• #18: Maybe we don’t need this much detail. (This and the next slide)
• #20: Adapted from RL Presentation at IRH (2009) and Clear Horizon Presentation (2006)
• #24: Overview from different countries of the different kind of data being collected to inform scale up in the different countries. Multiple sources will provide ways to validate information as well as inform program planning and monitoring scale up progress.
• #25: This are indicators collected by our semiannual reporting. I put Mali as an example Shows year 2 or a five year plan. Shows that scale up is not really measured by yes/no.
• #26: Information from policy makers/program managers for stakeholder interviews in Guatemala Teasing out at central and other levels factors influencing scale up of the SDM. Questions reflect elements of the scaling up model of Expandnet – looking at system capability, political factors, resource factors.
• #27: Scale up barriers/successes seen at level of service delivery – provider interviews and facility assessments – Rwanda example
• #28: Another info source from which to monitor / evaluate / inform strategies of scale up is household surveys – of women and men. Findings of women respondents in Mali capturing attitudes towards the SDM. Also look at traditional FP indicators such as method mix and SDM contribution. Really important info for policy makers and program managers since HMIS is not yet capturing SDM users.
• #31: Shifts in partners, donors, intervention areas, unanticipated events result in issues with design/data collection
• #32: Operationalization of scale up (indicators) critical for planning, monitoring and evaluation Need to pay attention to interpretation of meanings of indicators Definitions of scaling up, integration, introduction, availability Advantages/disadvantages of comparative design Relational database has facilitated management of diverse info/data