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Scaling Up of pilot Programmes
Scaling up – the concept
Over the last decade, the concept of scaling up has been gaining importance among governments, donors, international
agencies and NGOs. Scaling up can be described as a process of adaptation and expansion of programmes to make
quality services more widely accessible to larger number of people over a wider geographic area quickly, equitably
and in a sustainable manner1. Scaling up contributes to increase something in size, amount and extent. It could be
in terms of numbers – reaching more people; geographic area - reaching a greater geographic or political area;
demographic profile - reaching different types of beneficiaries; and coverage - reaching a greater percentage of a
given population. These different dimensions of scaling up are mostly interrelated.
Relevance of Scaling up
Scaling up health services was a central theme behind the slogan Health for All at the World Health Organization’s
landmark primary health care conference in Alma Ata over 40 years ago (WHO, 1978). Since then, scaling up of
expanded packages of health services continues to be at the core of efforts to reach national health and Millennium
Development Goals (MDGs) targets. Global and Indian experiences, however, show that very few innovative projects
go all the way to effective implementation at large scale with impact. One of the reasons for this is the implicit
assumption that scaling up happens spontaneously and actual implementation at large scale is taken for granted.
What is often missing is the adoption of a systematic approach to scale up proven interventions, including at the
planning stage of a project.
The Scaling Up Management framework
Population Foundation of India (PFI) in partnership with Management Systems International (MSI) adopted the Scaling
Up Management (SUM) Framework2 in 2006 and has since been applying it to NGO and government-led pilots for scaling
up of innovations in health and nutrition in India. The initiative is supported by The John D and Catherine T MacArthur
Foundation. The SUM framework is an operational framework that enables a systematic approach to scaling up.
The SUM framework has three steps:
Step 1 is intended to clarify WHAT is being scaled up, WHO will do the scaling up, WHERE the scaling up will
occur, and HOW the scaling up will be done.
Step 2 is aimed at creating an enabling environment through advocacy and resource mobilization.
Step 3 is meant to guide implementation at scale.
Specific tasks to be undertaken within each step are:
Step 1: Developing a Scaling up plan
Task 1: Creating a vision for scaling up
Task 2: Defining the model and assessing scalability
Task 3: Filling in the gaps/Modifying the model
Task 4: Developing a scaling up strategy
Step 2: Establishing the preconditions for scaling up
Task 5: Legitimization: Advocating for the general issue
Task 6: Advocacy for adoption of a particular model
Task 7: Realigning and mobilizing resources
Step 3: Implementing the scaling up process
Task 8: Modifying and strengthening organizations
Task 9: Coordinating action
Task 10: Tracking performance and maintaining momentum
1 National Conference, Scaling Up in India : Lessons Learnt and the Way Forward, Population Foundation of India, 2010
2 Cooley, L, and Kohl, R, Scaling Up-From Vision to Large Scale Change, A Management Framework for Practitioners, Management Systems International, 2006
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Principles and lessons learnt in Scaling up
One of the key challenges to universal health care in India is scaling up of models or innovations that have been
tested in a variety of contexts. Findings from several evaluations and reviews, especially of the National Rural Health
Mission, highlight bottlenecks in rapid and effective scaling up. Key factors that need to be addressed are the lack of a
scaling up strategy, poor knowledge management, and little attention to technology transfer and capacity building.
Identifying and assessing models for scalability, designing sustainable and context-specific scaling up strategies,
undertaking advocacy with policy makers and implementers, capacity building and transfer of knowledge and skills,
and monitoring and evaluation to ensure outcomes are the key steps of the scaling up process. Scaling up, is therefore,
a systematic process and requires multiple skills, which needs partnerships between multiple actors and institutions
from civil society and government.
PFI’s support to Scaling up
PFI and MSI have worked with several promising models that met the scalability assessment criteria and provided
need-based support in systematically planning for scaling up.
These include:
Home Based Neo-Natal Care (Society for Education, Action and Research in Health)
Increasing Age of First Conception/Child Spacing (The Institute of Health Management, Pachod)
Community-based Health Insurance (Self Employed Women’s Association)
NGO Management of Public Primary Health Care Centres (Karuna Trust)
Training of District Medical Officers in Emergency Obstetric Care (The Federation of Obstetric and
Gynaecological Societies of India)
Improving maternal health through improving decentralized governance (Community Health Care
Management Initiative)
Community Based Planning and Monitoring (Advisory Group on Community Action)
PFI has also developed a Monograph on Adolescent Reproductive and Sexual Health Programmes in India.
PFI has trained various NGOs, funding organizations and government representatives on the SUM framework to
enable them to systematically apply the scaling up management principles to their programmes. PFI, with support of
the Planning Commission, organized a National Conference on Scaling Up: Lessons Learnt and Way Forward in 2010
to share experiences from health and other social sectors on scaling up, and to develop the vision and strategy for
scaling up social sector programmes in India. PFI and MSI have developed a tool kit and offer training workshops
for practitioners and researchers on Scaling Up. Details can be accessed at: http://populationfoundation.in/news/
pfi-conducts-training-programme-trainers-scaling
1. Scalability Assessment
2. Identifying the Model
3. Stakeholder Analysis
4. Policy Mapping
The Scaling Up Tools
5. Force Field Analysis
6. Advocacy Strategy Profile
7. Institutional Development Framework
8. Monitoring and Evaluation
About PFI
Population Foundation of India (PFI) is a national non-governmental organization, established in 1970 by a group
of socially committed industrialists led by the late Mr JRD Tata and Dr Bharat Ram. PFI promotes and advocates the
effective formulation and implementation of gender sensitive population and development policies, strategies, and
programmes. Scaling up successful pilots in public health is a vital component of our work.
Population Foundation of India
B- 28, Qutab Institutional Area, New Delhi - 110 016
Phone: +91-11-43894100 Email: info@populationfoundation.in Website: www.populationfoundation.in