Guest Blog: 2022 Priorities for the Scaling Community of Practice

By Jenny Perlman Robinson, Nonresident Senior Fellow, Brookings Institution

Over the past six years, we’ve witnessed a marked shift in the Scaling Community of Practice (Scaling CoP) which originally came together to identify issues of common interest and to share experiences. With collective efforts, visionary leadership, and sufficient resourcing, 2022 can be a catalytic year for the CoP to tackle an array of complex development-related challenges and make significant contributions to the field.

With the vast challenges and opportunities ahead of us, I’d like to propose six priorities for the Scaling CoP to take forward in the year ahead. These are drawn from ongoing discussions and presentations from the recent Scaling CoP Annual Workshop, discussions within the Scaling CoP’s Working Groups, papers commissioned by the Scaling CoP (in particular, Richard Kohl’s cross–cutting themes paper),  and my own work through the Brookings Institution’s Center for Universal Education’s ongoing research into these issues from a global education perspective.

1. Delve deeper into the relationship between scaling and systems change

For too long, we’ve approached scaling and systems change as a false dichotomy rather than as a continuum.  The relationship between the two has been a focus of the Scaling CoP in 2021, and discussions underscored that if we’re starting from the perspective of scaling impact, the two concepts are intrinsically related and can be considered along a spectrum defined by the depth, breadth and amount of change required (see Meadows, Kohl, Sterling, among others).

What I’ve heard us discuss as a group is an appreciation that scaling involves: 1) engaging with the complexities of the real world; 2) recognizing that scaling is a political as well as a technical exercise; 3) starting with a deep understanding of locally prioritized needs and what an existing system can support and sustain; and 4) asking whether and how systemic constraints can be removed or ameliorated. All these considerations are relevant to broader systems change. Continuing to explore these and related issues would be an important contribution of the Scaling CoP that could have profound implications for how initiatives are designed, delivered and financed.

2. Measure, evaluate and learn from scaling at a systems level

The CoP—led by its Monitoring and Evaluation (M&E) Working Group—has focused on a critical gap in our collective knowledge around the use of evidence to support and assess scaling.  This has required us to move beyond measuring outputs and even outcomes at a project level to assessing progress toward achieving large-scale, sustainable delivery and results. The M&E Working Group has developed a useful framework for understanding the Information Needs for Scaling (see Fig. 1) that should be further explored. In particular, additional attention to Tier 3 (“change management”) is needed with a special focus on tools, practices, examples and guidelines for tracking and supporting efficacy at scale and for assessing longer-term, systems-level changes including continuous improvement, national financing, changes in norms, and integrating this type of M&E into government and donor structures.  

3. Explore evolving roles of various partners throughout a scaling process

A third area that warrants further exploration and consideration by the CoP concerns the evolving roles of various partners engaged in the scaling process. This includes the respective roles of those who are expected to be the “doers and payers” at large-scale (as well articulated by Kevin Starr); the innovators or originators of an initiative and how their roles necessarily shift over time; and further unpacking and understanding the role of intermediaries—third parties who play a connective and facilitative role between originators and large-scale delivers.

4. Operationalize adaptive management

There is growing recognition of the iterative nature of scaling and the need to be adaptive and flexible. As the M&E Working Group has reminded us, while this maybe intellectually clear, it remains operationally difficult. Inherent tensions exist when working with systems and institutions not known for being agile and where there are strong incentives to maintain the status quo and to comply with initial plans. It would be valuable for the CoP to deepen its work on operationalizing this principle, including what is required for encouraging systems to be more adaptive. In this regard, the CoP’s intention to develop a tool to help manage and track mainstreaming within funding organizations of a scaling mindset is a particularly welcomed endeavor.

5. Grapple with trade-offs between reach, equity, quality and sustainability

The CoP has initiated important discussions around how to determine optimal scale taking reach, equity, quality, and sustainability—dimensions sometimes at odds with one another— into account. For example, we know reaching the most disadvantaged individuals often entails higher unit costs, while expanding to new geographies, demographics and delivery platforms can risk dilution of quality. These and other trade-offs remain the proverbial “elephant in the room” and require much more research and experimentation, particularly around how decisions are made balancing these concerns.

6. Increase clarity and transparency of the funding pipeline across scaling phases

Sustainable financing across scaling phases—through domestic and external resources—is incredibly difficult and rare, and the process for securing this finance is often not well understood by practitioners and policymakers around the world. In particular, financing during the “middle stage” of scaling—the period beyond a validated pilot but before national implementation, referred to in the scaling literature as the “valley of death”—is a perennial challenge. While the financing pipeline differs by sector and by country, there remains an urgent need to understand it better, including where resources come from and how they can best be allocated and structured across funding streams and scaling phases.

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Regardless of the focus, it is critical that the CoP continues its progress in three important directions. We should consider not only what we are learning but how best to put this learning into practice. We should push ourselves to be creative, to identify what would be most impactful for those doing the work of scaling every day, and to promote necessary reforms. Secondly, we must ensure local communities and their leaders are in the drivers’ seat of change. This is a key principle behind effective scaling and should drive the scaling agenda. And third, it is critical that the CoP continues to diversify its representation, including additional geographic and linguistic diversity. This will undoubtedly have financial implications in terms of interpretation, translation, travel costs, etc.

These are just a few ideas among many for the Scaling CoP to consider tackling in the year ahead. As we push ourselves to collectively unpack and operationalize principles behind scaling impact across critical development sectors, we must also confront the realities of scaling the impact of this CoP.  This will require continued institutional capacity, committed individuals, and visionary leadership. It will also require increased financial support to sustain the important contributions to date and expand and deepen the Scaling CoP’s impact in the years ahead.

News from the Scaling Up Community of Practice

Report on the meeting of the Executive Committee (ExCom) on 22 January 2022

The ExCom reviewed a draft of the CoP position paper on “Scaling Principles and Lessons” and agreed to proceed with its finalization. It established a Resource Mobilization and Finance Committee and agreed to develop and launch a resource mobilization strategy for the CoP by the end of April, 2022.  The strategy will be developed on two tracks:  a short-term track, with a focus on raising funding for 2022-2023 based on current modalities but expanding the list of funders; and simultaneous pursuit of a longer-term track laying the groundwork for a stronger and sustainable organizational capacity for the CoP and supporting a more ambitious program of work.

Crosscutting issues

As was reported in Newsletters #20 and #21, the ExCom decided to commission thought products and convene discussions on selected issues that cut across the sectoral and thematic areas covered by our nine Working Groups. To date, we have pursued five strands of work:

• Richard Kohl’s working paper and a blog by Larry Cooley, Richard Kohl and Johannes Linn noted that a “new consensus” on scaling had emerged and identified a number of crosscutting issues for further exploration including the following four, which the ExCom decided to pursue;
• The issue of how scaling and systems change relate to each other was explored in Richard Kohl’s issues paper and considered at a plenary session of the CoP Annual Workshop in

November 2021; a blog in summarizing the results of these explorations will be prepared by April 2022;

• The topic of mainstreaming scaling in donor organizations was discussed at the 2021

Annual Workshop and in Johannes Linn’s blog, with further work expected for 2022;

• The Monitoring and Evaluation Working Group during 2021 organized five virtual events focused on methods for monitoring and evaluating the process of scaling via institutionalization of interventions in government; the topic was further explored in a plenary session during the 2021 Annual Workshop, and a paper (to be completed in April 2022) is under preparation summarizing insights and lessons based on these discussions and a review of relevant literature.
• The ExCom commissioned in early 2021 an effort to distill key principles for effective scaling, to serve as guidance for practitioners. As noted in the cover letter, a working paper by Richard Kohl and Johannes Linn pulled together scaling principles and lessons from the literature and practice.  Based on a plenary discussion at the 2021 Annual Workshop of this paper, the ExCom has prepared a short CoP position paper on scaling principles and lessons with a companion working paper by Johannes Linn applying the principles to three examples of scaling.

Posting of knowledge products on the CoP website

Members are invited to submit their knowledge products (blogs, working papers, etc.) for posting or reposting. The ExCom will provide editorial review and guidance for any knowledge products submitted for publication on the general resource page of the website. Working Group (WG) chairs will serve in the editorial capacity for knowledge products and news items to be posted on the WG pages. Note: All knowledge products to be posted should meet the following criteria: (i) focus on scaling issues, approaches or tools; (ii) report on lessons and implications of scaling experience; (iii) blogs should have 800-1000 words.

Registration on the CoP website

With the CoP Website now active, all members are strongly encouraged to register on the website and to visit the website from time to time to stay apprised of upcoming activities.  We will increasingly rely on the website to disseminate materials and to keep everyone informed.

Financial support for the CoP

The CoP depends on the financial support of its members for its effective functioning. The generous support of the following institutions for the years 2019-21 is gratefully acknowledged: GiZ, Eleanor Crook Foundation, MacArthur Foundation/Lever for Change, MasterCard Foundation, Bill and Melinda Gates Foundation, Management Systems International, and ExpandNet.

During the coming months, the Resource Mobilization and Finance Committee established by the ExCom will develop a resource mobilization strategy and seek to mobilize financial support for the next two-three years as mentioned above. Please contact ([email protected]) or Johannes ([email protected]) with any funding ideas you might have.

Working Groups of the Scaling Up Community of Practice

The CoP hosts nine Working Groups (WGs). Their recent and currently planned activities are listed below, together with the names and e-mail addresses of the chairpersons. For more information on each working group and on how to join and contribute to a working group, please visit the CoP Website (www.scalingcommunityofpractice.com) or contact the respective chairperson(s). You can also reach out to Larry ([email protected]) or Johannes ([email protected]).

Agriculture and rural development (ARD) Working Group

Lennart Woltering [email protected]

Maria Boa [email protected]

Frank Place [email protected]

Mark Huisenga [email protected]

Julie Howard [email protected]

In 2022, the ARD WG will have monthly webinars on the last Thursday of every month. Each webinar will be facilitated by one of the co-chairs, and speakers should primarily come from our membership base. Speakers are asked to refer in their presentations to one or more of the CoP ExCom scaling principles that is of particular importance (challenge or opportunity) to their case.  The first two webinars were held on 27 January 2022 and 24 February 2022. The substance of the first of these webinars focusing on scaling efforts in land restoration is described later in this Newsletter.  The second workshop on February 24^th, featuring presentations by Kate Fehlenberg and Colin Christensen, is available on the CoP website and will be summarized in the next Newsletter.

Climate Change Working Group

George Zedginize (Green Climate Fund) [email protected]

Amar Bhattacharya (Brookings) [email protected]

The climate working group is currently in the process of reorganization. Relevant news on its activities will be shared in the next newsletter.

Education Working Group

Gaelle Simon (MSI)  [email protected]

Heather Simpson ([email protected]

The Working Group will explore the following topics in webinars during 2022, building on the interests expressed by working group members, including from the survey administered during the working group’s session of the annual meeting last November. We welcome any additional feedback or suggestions related to these or other proposed themes.

• Costing and financing for scale (March 2022)
• Trade-offs between equity, effectiveness, sustainability and reach (June 2022)
• Role of intermediary organizations (September 2022)
• Teacher training and support (timing to be determined)

Additionally, group members and participants expressed an interest in using various approaches to discuss these issues. The Working Group welcomes suggestions for structuring participation to encourage more active engagement and continued dialogue between our virtual meetings. The Working Group is also seeking recommendations for continuing to expand its membership.

Fragile States Working Group

Jonathan Papoulidis (World Vision) [email protected]

Robert S Chase (World Bank) [email protected]

In 2022, the Scaling Up in Fragile States Working Group will continue to host partner/member presentations and convene dialogue around its core focus areas: a) promoting adaptive, resilient and politically-smart methods for scaling;  (b) elaborating on the obstacles to scaling in fragile states, how they have been overcome, or when scaling should not have been attempted; (c) applying scaling-up approaches to bridge the nexus between humanitarian, peace, and development interventions; and (d) examining ways to strengthen country institutions and mobilize private sector finance for durable scaling in a range of fragile contexts. The Group also plans to look for ways to stimulate wider discussions across the Community of Practice of the special needs of fragile states in the context of the Sustainable Development Goals and Leave No One Behind agenda.  We are open to serve as a sounding board for member or partner initiatives, at whatever stage, to help inform the scaling process in the hardest places.   Follow our events and updates at: https://scalingcommunityofpractice.com/groups/scaling–up–in–fragile–states/

Health Working Group

Laura J. Ghiron (ExpandNet and the Evidence to Action Project) [email protected]

The Health Working Group (HWG) is in a process of growth, bringing colleagues from the ExpandNet community together with those interested in global health who had previously participated in the CoP’s Annual Meetings, to form one common list with over 500 professionals.

Activities over the past quarter included: consolidating membership; contributing to the plenary sessions of the CoP’s November 2021 Annual Workshop (see Newsletter #22); and organizing and hosting a Health Working Group (HWG) panel for the annual meeting. Over the coming year, the HWG will invest special effort into building our membership to incorporate colleagues working across a wide variety of global public health disciplines and technical areas and providing a venue to facilitate comparative learning. The HWG is planning three events over the coming ten months to enable learning exchange.

• June: an online consultation examining through a feminist lens the scaling of public health interventions;
• September: a webinar showcasing comparative perspectives on scale up from major global health technical areas including women’s health/family planning, child health, HIV, malaria, tuberculosis, and/or others;
• December: an in-person auxiliary session as part of the proceedings of the Social and Behavioral Change Summit in Marrakech, Morocco (see link for conference information) focused on sharing scale-up experience across diverse sectors and technical areas, and drawing out lessons learned among practitioners.

Monitoring and Evaluation (M&E) Working Group

Larry Cooley (MSI) [email protected]

John Floretta (J-PAL) [email protected]

During 2021, the Working Group conducted a series of five webinars exploring issues, lessons and methodologies for using monitoring and evaluating to track and support the institutionalization within government of interventions initiated outside of government. Building on the results of these webinars, the CoP commissioned Susan Igras to write a white paper summarizing major insights and suggesting promising areas for additional attention. That paper, now in draft, will be published by the CoP in April and will form the basis for additional exploration by the Working Group in a new series of webinars beginning in late March. Watch for notice of these webinars to be held every two months on the last Thursday of the month.

Nutrition Working Group

Dylan Walters (Nutrition International) [email protected]

Following its successful contributions at the CoP Annual Workshop and the Nutrition for Growth Summit, the Nutrition Working Group (NWG) plans to continue working with its members in future events to showcase innovative projects and initiatives related to scaling in nutrition. The NWG looks forward to publishing its Retrospective Review on the state of scale of high-impact nutrition programs in the coming weeks. Details on the next NWG meeting will be shared soon.

Social Enterprise Working Group

Isabel Guerrero (IMAGO) [email protected]

Elaine Tinsley (World Bank) [email protected]

Colin Christensen (One Acre Fund) [email protected]

The Working Group will offer quarterly webinars where speakers will focus on various angles to the transformative, systems change potential of social enterprises.

• Q1: Regulatory and legal status impediments to scaling up SEs, on March 4^th; speakers: Colin Christensen (One Acre Fund) and Vincent Otieno (Ashoka)
• Q2: Partnering with government to change systems in May/June; speakers: social enterprise(s)/enabling organizations with transformative partnerships with government in the health/waste/water sector –how they succeeded in working with governments
• Q3: How Co-Impact is helping scale systems change in August/September
• Q4: Annual meeting; topic TBD (possibly the link between SEs and localization) in October/November

In addition, the Working Group plans to establish a Social Enterprise Workshopping Space where it will aim to create a space for social enterprises to brainstorm concrete solutions to real-time challenges, they are facing by leveraging the unique perspectives of the other workshop participants. At each session a few representatives from active social enterprises will present a specific work challenge they are facing, propose solutions they are considering, and get feedback from the group. The sessions will focus especially on policy and regulatory challenges, from which generalizable lessons can be distilled around what holds back social enterprises from scaling, ideally leading to useful insights on what policy changes might help governments unlock the potential of social enterprises as a force for systems change. The detailed arrangements for this initiative are currently under development.

Youth Employment Working Group

Elizabeth Vance (International Youth Foundation, IYF) [email protected]

Hisham Jabi (Consultant, World Bank) [email protected]

Jessica Ngo (MSI) [email protected]

The Working Group is scheduling dates for the following coffee and bagel sessions:

• Review of different automated career support tools;
• Scaling Agripreneurship with focus on creating attractive jobs for youth;
• The changing nature of work due to digital disruption and automation and its implications for scaling, with a special focus on digital jobs;
• Aggregating private sector partners in addressing skills gaps and financing youth employment, exploring how practitioners have brought in the private sector;
• Mainstreaming scaling within implementing agencies focusing on practical ways out of the project box.

Member News (in alphabetical order)

Agriculture and Rural Development Working Group (Agriculture)

The Working Group held its first webinar of 2022 on 27 January: Two presenters summarized the scaling approaches of their organizations in the area of land restoration. The recording of the webinar is available here:

• CRS presented an overview of their Livelihood and Landscape Restoration Strategic Change Platform with a deeper dive into Lesotho’s Integrated Catchment Management Program. CRS is scaling a common set of principles and proven land restoration models (watershed management, dryland regreening, multistory agroforestry and water-smart agriculture) that improve agricultural production, and increase food security, income and resilience. The Platform is currently operating in 8 target countries – four in a regional approach in Central America and 4 countries in Africa. All four land restoration models are represented across these countries. Besides the target countries, CRS is developing tools and methodologies for cross learning and support to a number of non-target countries in Africa and Asia. Some of the key elements of their scaling approach include building capacity and empowering local leadership, collaboration through multistakeholder platforms, supporting and catalyzing systems change, helping partners to leverage finance, and linking to national and local goals.
• The Global Evergreening Alliance (GEA) is building on the experience of thousands of small, local, land evergreening/restoration project successes that demonstrate the great potential for sequestering carbon and boosting livelihoods. The key issue is how to massively scale the thousands of small local successes. How can knowledge about local successes be shared? GEA is responding to this need for sharing knowledge on land restoration and developing more effective scaling strategies for a Global Campaign that aims to sequester 20 billion tons of CO2 annually by the year 2050 through evergreening or nature-based storage of carbon. A scaling working group was formed which identified 12 key principles and other information useful for field practitioners, and this group compiled a set of GEA “Guidelines for Scaling up Evergreening”. More information on GEA is here.
• An additional 15 minutes was reserved for a brainstorm on ideas that the ARD WG should pay more attention to. Most discussion took place about understanding tipping points that drive change at scale as well as the integration of climate change and carbon financing into programs for scaling.

Brookings Center of Universal Education (CUE) (Education)

CUE released a reflection brief under its Research on Scaling the Impact of Innovations in Education (ROSIE) titled “Scaling education innovations for impact in low– and middle–income countries during COVID: Reflections on key themes.” In this brief, CUE shares some empirical insights and practical recommendations for scaling of education innovations in low- and middle-income countries around the world. Readers are encouraged to provide feedback and to share the brief with their networks.

CUE released two additional blogs relevant to scaling education solutions:

• 4 paradoxes of global education on International Day of Education
• Adapting education innovations and their ‘knock–on effects’ in the time of COVID

Contact: Brad Olsen ([email protected])

CASE (Duke University) (Education)

Announcing F.M. Kirby Prize for Scaling Social Impact Winner – MathCorps: While each of the 5 finalists for the Fred Morgan Kirby Prize for Scaling Social Impact demonstrated innovative scaling strategies, resilience amid challenges, and powerful evidence of impact, one rose to the top of a competitive applicant pool: We are ecstatic to announce ServeMinnesota Math Corps as the winner of this year’s $100,000 F. M. Kirby Impact Prize! Math Corps delivers an evidence-based tutoring program to eligible students in grades 4-8, using community tutors who are supported through the federal AmeriCorps program. Math Corps is currently working in seven states and has served nearly 40,000 students since it began in 2008. With a robust evidence base, equity focus, and a strategy for scale that leverages the power of the AmeriCorps program, Math Corps is well-positioned to achieve outsized impact.  Read more about the winner.

Center on Gender Equity and Health (University of California San Diego) (Violence against women and children)

Lessons learned from two projects successfully scaling violence prevention interventions during COVID-19: COVID-19 has stressed health systems and communities around the world, introducing challenges to scaling evidence-based interventions.  At the same time, reports of violence against women and children have increased, furthering the need for violence prevention interventions at scale. The Uganda Ministry of Health, in partnership with the Impact & Innovations Development Center (IIDC) and the Center on Gender Equity and Health (GEH) at University of California San Diego (UCSD), is currently scaling REAL (Responsible, Engaged, and Loving) Fathers in Uganda via integration into early childhood education. REAL was designed by Save the Children and the Institute for Reproductive Health (IRH) at Georgetown University with scale in mind to capitalize on existing resources in the community, using a peer-mentorship based approach among new fathers to shift norms and behaviors around violence in the household. The team applied the ExpandNet Framework to guide scale in a systemic approach that was flexed to accommodate changing conditions and system-level barriers caused by COVID-19. A scale-up team was built, despite being locked down at home, by hosting virtual and hybrid virtual/in-person scaling workshops with interactive activities. Additionally, a scale-up plan was developed by stakeholders that responds to the current COVID-related challenges and opportunities in early childhood education such as offering programming at the household level instead of community education centers. The team also worked with the national government to adapt and endorse the REAL curriculum for early childhood education programming, developed a scale–up tool kit with training materials, trained local community service organizations in a regional strategy to build champions and capacity, and successfully incorporated REAL activities into district workplans and budgets.

 ARCHES (Addressing Reproductive Coercion in Health Settings) is a clinic-based intervention that trains providers to address reproductive coercion and intimate partner violence within routine family planning counseling. The Kenya Ministry of Health, in partnership with Population Council Kenya and GEH, is also applying ExpandNet approaches to adapt and scale ARCHES to public sector health facilities in one county in Kenya to inform a national county-by-county scale-up approach. While ARCHES is early in its journey to scale, the team has set itself up for success by aligning with government priorities and evolving system capacities during COVID-19 to develop a systematic strategy for scale-up. For example, detailed facility assessments are being undertaken now to map the resources and constraints for scale-up to inform simplifications to the intervention and required capacity building to sustain the intervention. GEH and local partners are also applying the ExpandNet framework to scale ARCHES in other LMICs through partnerships with INGOs, including Ipas and the International Planned Parenthood Federation. These initiatives offer important lessons and learnings for future work scaling health interventions during COVID-19 or other emergencies.

Contact: Jasmine Uysal ([email protected])

CIMMYT (Agriculture)

CIMMYT reports a large number of scaling examples under its activities in 2021 (for more information, see https://wheat.org/; https://maize.org/; https://www.cgiar.org/food–security–impact/results–dashboard/):

• Climate-smart innovations: Over a period of 17 years (2004-2021) in southern Africa, CIMMYT and partners focused on Conservation Agriculture-based Climate-smart Agriculture innovations in a systematic, rather than a single commodity technology approach. They generated science-based evidence and enhanced local stakeholders’ capacity, which informed policy change by several Governments towards smallholders’ sustainable intensification (see feasibility study confirming business case). MAIZE/CIMMYT was a key knowledge provider to the Government of Zimbabwe for its “Pfumvudza” concept, a scaling initiative originally developed by the Foundation for Farming, targeting 1.8 M farmers in 2020/2021 cropping season. By July 2021, the Ministry of Agriculture announced it had reached 2.2 million farmers, which made the country food secure for the first time in several decades. This success prompted the government to engage MAIZE/CIMMYT on smallholder mechanization, announcing an Alliance on Smallholder Mechanization: 1 million smallholders should access mechanization services by 2025.
• Systematic evaluation of CIMMYT’s work on climate change food system interaction: By using digital methods and machine learning techniques, scientists systematically analyzed the CIMMYT-led research portfolio within the climate change-food production nexus, including bilateral and CGIAR Research Program (2012-2021) projects. CIMMYT’s research for development efforts generated many research outputs and contributed to scaling several climate-smart technologies and practices in climatically challenged locations and production systems in Asia, Africa and Latin America. Hyperlink analysis showed that CIMMYT-led research and knowledge has been shared across thousands of websites. CIMMYT’s outputs have been distributed to more than 150 countries across both the Global North and South.
• Research on scaling: Despite a growing body of literature on how to scale innovations to contribute to the Sustainable Development Goals, there has been little attention for how scientists and programme managers engage with scaling processes in practice. Through 36 interviews MAIZE and WHEAT researchers it was found that the dominant understanding of scaling was output and beneficiary–focused, rather than outcome and society focused. This has implications for how scaling is approached in ongoing projects, and for the role of an agricultural Research for Development organization, such as CIMMYT, in bridging science and development. Authors recommend more reflection on the scaling process, and making greater use of scaling capacities and tools, to better link scientific knowledge to results on the ground.

Contact: Victor Maurice Kommerell ([email protected])

Co-Impact (General)

What we learned from our partners about deep system change – a blog post:  https://www.co–impact.org/what–we–learned–from–listening/

Co-Impact makes relatively few (until now, less than 10 per year), large-sized (US $2 to $25 million), and long-term grants (up to 6 years) focused on deep systems change. We seek to learn from program partners and other funders on how to improve grantmaking, and how to be maximally supportive to program partners. In 2021, Co-Impact engaged the Center for Effective Philanthropy (CEP) to ask our program partners and applicants to provide candid and confidential feedback on our work, approach, and relationships. We take these findings seriously and use them to improve our approach and practice to be more clear, respectful, and effective. In this blogpost we report on key features of the exercise, what we heard and learned, and the actions that we commit to take to do better. We share these here to be transparent about our thinking, to invite readers to hold us to account, and to contribute to shared learning in the philanthropic community.

Report on high-impact, systems-changing philanthropy:

https://www.co–impact.org/wp–content/uploads/2021/12/Co–Impact–PromotingHigher–Impact–Philanthropy–Nov–2021.pdf

Since our launch in November 2017, Co-Impact has brought together over 40 philanthropists and foundations from 16 countries. Contributions have totaled over USD$500 million to date. These contributions allow Co-Impact to support partners in the Global South with funding that is larger, longer- term, and more flexible. The following reflections draw from Co-Impact’s experience, research with over 1,000 global ultra-high net worth individuals and billionaires, interviews with more than 20 individuals including funders and advisors, and a comprehensive literature review of over 70 articles, reports, books, databases, and documents. We sought to understand the opportunities and limitations for high-impact, systems-changing philanthropy, focusing on individual philanthropists rather than foundations. Much of the data we use comes from the Global North as data on Global South philanthropy is scarcer. Nevertheless, we believe the overall conclusions and learnings have broad applicability.

Contact: Varja Lipovsek ([email protected])

ExpandNet (Health)

Webinar on scaling adolescent and youth sexual and reproductive health interventions: This last quarter, ExpandNet moderated a panel on scaling adolescent and youth sexual and reproductive health (AYSRH) programming hosted by FP2030 and USAID’s Knowledge SUCCESS Project. The conversation took place on November 11, 2021, as the final in a series of conversations on AYSRH topics among diverse leaders in the field. To view this recording or to learn about other recent developments in the field of scale up, we have assembled a set of videos for viewing in two places. The first is ExpandNet’s new YouTube video channel which provides recent recordings from conferences and webinars, as well as a “playlist” of additional scale-up related content uploaded by allied organizations. All of our videos are also now on a dedicated page on the ExpandNet website. During this period, Expandnet members have been working with INSPIRE and Joining Forces to develop Adaptation and Scale Guides to assist government and civil-society partnerships working on the prevention and response to violence against children. The guides are designed to support planning a systems-based strategy for adaptation and scale up of interventions.

Contact: Laura Ghiron ([email protected])

GIZ (Gesellschaft für Internationale Zusammenarbeit) (Climate change)

Bootcamp on 10 March 16.00-17.00 CET to present progress under “BMZ digilab”, which is scouting digital innovations to meet the climate change in cities:

“Innovate2030: Digital solutions for climate-smart cities” is a global innovation competition to identify the most promising digital solutions for our future in climate-resilient and sustainable cities. Cities generate some 60 per cent of global GDP and are the engines that drive economic growth, but they also account for around 70 per cent of global CO₂ emissions and consume more than 60 per cent of the world’s resources. This is why BMZ digilab is scouting the best digital innovations for climate-smart and resilient urban development to meet the challenge of climate change in cities. 23 selected solutions will be accompanied to become ready to scale within a development context. At the bootcamp, the 23 teams will get the chance to network with, and receive input from, many interesting global partners including: Leaders for Climate Action, Microsoft, Telekom TechBoost, UNCTAD, Fraunhofer Ventures, UNDP Accelerator Labs, Hack for Earth, UN Habitat, GMSA, and many more. If you are interested in participating and/or to learn more about the program, reach out to: [email protected]!

Contact: Stella Leona Stepp ([email protected])

Global Environment Facility (GEF) (Environment and climate change)

GEF support to scaling up impact – An evaluation report: This evaluation draws on the previous experiences of the GEF in scaling up to better understand and draw lessons on the processes through which scaling occurs and the conditions under which it is effectively achieved. The GEF’s Independent Evaluation Office has been tracking scaling up as one indicator of progress towards impact, reporting its prevalence in the GEF portfolio in the overall performance studies. Moreover, recent evaluations, such as those on transformational change and GEF’s support for legal and regulatory frameworks, note the importance of the scaling up process in achieving larger-scale impact. This is the first evaluation to systematically assess the scaling up process in depth, and the influencing factors and conditions. Using a purposive sampling approach, the evaluation conducted quantitative and qualitative analyses on both successful and less successful cases of GEF support to scaling up. Information was extracted from document reviews, interviews, and field visits to three countries. The evaluation provides lessons for the GEF in future support for scaling up throughout its portfolio, and for the GEF-7 Impact Programs in particular.

Contact: Jeneen Garcia ([email protected])

Florencia Guerzovich (Independent Consultant) (General)

Pathways to Scale – Blog post series by Florencia Guerzovich and Tom Aston: Scale is a complex change process that is often misunderstood. We need to better understand what it looks like in practice, including whether, how, and under what conditions (by whom, where, when) social accountability might be scaled up. Better understanding pathways to scale is the theme of this 5-part blog series.

• “Pathways to scale in social accountability” https://medium.com/@florcig/pathways–to–scale–in–social–accountability–post–1–of–540e5ff51a053
• “Introducing a resonance pathway to scale” https://thomasmtaston.medium.com/introducing–a–resonance–pathway–to–scale6cacd5163cd8
• “Contrasting alternative pathways to scale” https://thomasmtaston.medium.com/contrasting–alternative–pathways–to–scale7157b67cdd0d
• “How context shapes pathways to scale in social accountability” https://medium.com/@florcig/how–context–shapes–pathways–to–scale–in–socialaccountability–post–4–of–5–d417cfe2b4f5
• “Scale up in Time: Revisiting how we Evidence Process & Context” https://medium.com/@florcig/scale–up–in–time–revisiting–how–we–evidence–processcontext–6c53f82a1817

Harvest Plus (Agriculture, nutrition)

Pakistan is the world’s 8^th largest wheat producing country, and wheat is the main staple food in Pakistan with per capita consumption of 124 kilos per year, delivering 72% of caloric energy. Imagine if that wheat delivered more zinc what the nutritional impact would be -lower child and maternal mortality, better education outcomes, higher GDP.  In 6 years, HarvestPlus has introduced and driven the nutrient enriched zinc wheat commercial seed market share to 20%.   Accomplishing scale this quickly centered on HarvestPlus’ tried and tested delivery model – a multi component end-to-end value chain delivery plan, mobilizing experts from agricultural breeding to grain and food processing to consumer food marketing. For more information see here.

Contact: Lynn Brown ([email protected])

IDRC (General)

Evaluation of IDRC’s Strategy to Scale: To improve IDRC’s support for scaling impact, in 2019 we commissioned an external evaluation to assess the implementation of our 2015– 2020 strategic objective to” invest in knowledge and innovation for large scale positive change.” The evaluation is now complete, and we are happy to share the results. Led by independent evaluators from On Think Tanks, in partnership with Southern Hemisphere, the evaluation highlighted important insights regarding the practices, systems and processes that can support or hinder efforts to scale impact.  It is intended to make a contribution both to IDRC’s own future efforts and to the emerging science of scaling. The full report and findings briefs can be found on IDRC’s website: https://www.idrc.ca/en/research–in–action/evaluation–idrcs–strategy–scale–researchresults.

Contact: Hayley Price-Kelly ([email protected])

Institute for Reproductive Health, Georgetown University (Youth)

Learning from five Norms Shifting Interventions (NSI) going to scale: The slide document “Learning from Five Norms Shifting Interventions Going to Scale” highlights top “Passages” program lessons on scaling NSIs.  It presents the essential findings of a comparative analysis of five interventions:  Girls Holistic Development (Grandmother Project in Senegal), Growing Up GREAT! (Save the Children in DRC), Husbands’ Schools (UNFPA and SonGES in Niger), Masculinité, Famille, et Foi (Tearfund in DRC), and Terikunda Jékulu (IRH in Mali). As Passages began, there was (and still is) relatively little documented evidence on NGO experiences of scaling interventions that aim to shift community norms.  There were questions about how norms-shifting interventions could be scaled while maintaining core NSI norms-change mechanisms.  Passages comparative analysis of implementation and research findings contributes to growing evidence that it is possible to scale NSIs and achieve similar normative and behavioral shifts in new communities with new implementers.

Contact: Susan Igras ([email protected])

J-PAL (General)

Institutionalizing evidence-informed policymaking in Tamil Nadu – a case study: JPAL recently published a case study on our institutional partnership with the State Government of Tamil Nadu, India, where J-PAL South Asia has supported data and evidence use in policymaking since 2014. The objective was to partner not just on one individual research project or policy scale up, but rather to change the culture of policy and decision making itself such that rigorous evidence is one of the key factors considered when choosing and scaling programs or policies. The case study includes reflections on what it takes to form successful, longstanding partnerships between policymakers and researchers and to institutionalize a culture of evidence use.

J-PAL’s program “Evidence to Policy“ tracks down examples of where evidence from randomized evaluations has led to policy change and distills lessons on how that evidence has been applied and (in some cases) led to the scaling of different programs. The team has recently published a few new case studies found on its website.

Contact: Anna Mysliwiec ([email protected]), and Isabela Salgado ([email protected])

Lever for Change (Early Childhood Development)

Build A World of Play Challenge: The LEGO Foundation recently announced a USD 143 million (900 million Danish Kroner) global challenge to fund bold and impactful solutions focused on early childhood.

The Build A World Of Play Challenge—designed and managed by Lever for Change— celebrates the LEGO^® brand’s 90th year and reaffirms the LEGO Foundation’s commitment to supporting early learning and development of holistic skills, thereby ensuring that children thrive and reach their full potential in life, wherever they may live. The Challenge seeks evidence-based, innovative solutions to critical issues, such as access to quality early childhood education and care, adequate nutrition, eradication of toxic stress in homes and communities, reduction of violence in homes and communities, protection from pollution, and supporting the social and emotional well-being of the whole family. These solutions should make a substantial contribution to the lives of children from birth to six years old and spark a global movement to prioritize early childhood development.  

Up to ten finalists will be selected in late summer 2022. Each finalist will receive approximately USD 1 million to strengthen their proposed plan, start building their team, and scale up to successfully implement their innovation. Up to five awards will be announced by the end of 2022. Grants totaling USD 143 million will be distributed among the awardees. There will be three grants of approximately USD 30 million each and two grants of approximately USD 15 million each. All interested organizations must register to apply before 4 p.m. U.S. Central Time on April 7, 2022. Complete applications are due before 4 p.m. U.S. Central Time on May 17, 2022.

Liverpool School of Tropical Medicine (Health)

PERFORM2Scale end-of-project webinar

If you are interested in scaling-up, management strengthening or human resources for health you will be interested in the PERFORM2Scale end-of-project webinar on 16^th March 2022. Details and registration here.

Lessons from PERFORM2Scale: Experiences of district-level management strengthening at scale will outline the key findings from our five-year, EC-funded research programme.

Our team – a consortium of research institutions from Africa and Europe – has been working on the scale-up of a Management Strengthening Intervention among district health management teams (DHMTs) in Ghana, Malawi and Uganda. The intervention had previously been found to strengthen the capacity of district health managers, helping them to develop human resource management and health systems strategies to improve performance. Using an approach based on the ExpandNet model, PERFORM2Scale has explored the potential for the intervention to be scaled-up for greater and longer-lasting impact. Our findings will be revealed in this webinar.

The webinar will hear from the people directly involved in PERFORM2Scale:

• Dr Benedict Bekui, Ghana DHMT member, on the effect of the intervention on DHMT management, workforce performance and service delivery in Ghana.
• Dr Justine Namakula from the Uganda country research team at Makerere University on how the management strengthening intervention was integrated into the country’s Quality Improvement framework.
• Dr Bongani Chikwapulo from the Malawi Ministry of Health on the scale-up strategy in Malawi, how it was facilitated by the Quality Management Directorate of the Ministry of Health and its future in the country.
• Tim Martineau and Dr Joanna Raven from Liverpool School of Tropical Medicine on the research background, methodology and key findings.
• The session will be chaired by Dr Maryse Kok from KIT Royal Tropical Institute

Join us at 12-13:30 UTC on Wednesday 16^th March – Details and registration here.

Management Systems International (MSI) (General)

Training and certification in Scaling Principles, Practices and Tools: MSI has developed a semester-long certification course for practitioners and consultants in scaling principles, practices, and tools.  This multi-session course, built around MSI’s scaling framework and toolkit, and on related products of the Scaling CoP, equips participants to apply a full suite of analytical approaches and interventions to support scaling efforts across a range of sectors.  The training integrates real-time application to a range of current projects integrating scaling considerations into strategic planning, program design, scalability assessment, program implementation, evaluation, and organizational development interventions.      

Contact: Larry Cooley ([email protected])

OSEP (U.S. Department of Education Office of Special Education Programs) (Education)

New Report on improving education at scale in the United States: This 2018 report by Dean Fixsen et al. documents the culmination of ten years of development of a new approach to improving human service systems, organizations, and outcomes (State Implementation & Scaling of Evidence-based Practice). Based on the Active Implementation Frameworks, intensive support is provided to develop implementation and scaling infrastructures in state education systems to initiate and mange change processes, and to provide reliable supports for improved teacher instruction and student learning. Measures of capacity inform action planning and monitor progress in states, regions, districts, schools, and classrooms.

Contact: Dean Fixsen ([email protected])

Pumpkin Plus Agro Innovation Limited (Agriculture)

Transforming lands, transforming lives: The blog by A.Z.M Nazmul Islam Chowdhury, Innovator and Founder Pumpkin Plus Agro Innovation Limited, describes the scaling of an innovation that resulted in widespread adoption in two districts of North West Bangladesh of ‘sandbar cropping’, an innovative, simple, cost-effective technology that transforms silted barren lands created by flooding and, as a result, helps thousands of displaced, extremepoor families surviving on the edge of mighty rivers to escape from extreme poverty and hunger and climate change shocks.

Room to Learn (RTL) (Education)

A recent blog from the Learning at Scale Study recommends essential, evidence-based programmatic elements related to improved reading outcomes at scale. These elements include ensuring sufficient time for the building blocks of reading; creating supportive environments and structured guidance for teachers to practice skills they’re expected to employ; ensuring program priorities are aligned to government plans; and reinforcing the program’s focus with regular monitoring from programs and governments. The Learning at Scale Study, conducted by RTI with the Center for Global Development and funded by Bill and Melinda Gates Foundation, examines eight large-scale programs which show an impact on basic reading skills and investigates what made them successful. The study is seeking to expand to include government–led and numeracy–focused programs. The findings featured in the blog by Rita Perakis of CGD and Jonathan Stern of RTI were also disseminated at a November webinar and can be found, in full, in the Learning at Scale Interim Report.

Contact: Bidemi Carrol ([email protected])

Tiyeni (Agriculture)

Deep Bed Farming – the short upscaling story in Malawi, 2013-2021: For 10 years John Crossley worked with four villages and 38 farmers, testing out Deep Bed Farming (DBF) and adjusting it in various ways to improve it.  Farmers doubled crops and reduced their food poverty.  Colin Andrews met John by chance and on inspection of the deep bed method, John asked “why has this not spread all over Malawi?” Spreading it has since become Andrews’ goal since 2013. By 2017 17,600 farmers had adopted the method and by 2021 the number is well over 20,000.  Tiyeni only trains farming communities that request it; its methods are never imposed.  And all trustees work for free and bear all their own expenses.  In December, the Malawi Government concluded 3 years of comparative research into DBF and found that it surpassed all other methods tested against it suggesting that this is the time for a quantum leap in further scaling.

Contact: Colin Andrews ([email protected])

Udyama (Community Development)

Develop and scale community resilience through community-centered action: Founded in 1997, Udyama aims at strengthening and building capacities of local communities in India for rejuvenating ecological, economic and human capital by making optimum and sustainable use of local resources, working directly with the community and partner development organizations. The process of choice has been building ‘Community Resilience’ enhancing adaptations to vulnerability and changing the attitude from dependency to self-reliance. Udyama’s role is focused on strengthening the local community through development communication, capability building exercises, and participatory tools. Udyama’s approach to innovation and scaling builds on the following principles:

• Link to a view of poverty and poverty alleviation that goes beyond just income
• Highlight the crucial role of ‘local context’ and how this influences the asset base
• Give space to local perspectives
• Build on what exists
• Integrate the concepts of economic development and inclusion
• Facilitate risk informed development
• Catalyze agents of change

Udyama’s website contains many examples of action at various states of scale.

Contact: Pradeep Mahapatra ([email protected])

World Vision (Education)

Improving Literacy for Children Through the Support of Community Networks in Ghana, Honduras, and Nicaragua. This Global Partnership for Education and IDRC-funded project is being conducted by a learning consortium comprising World Vision (WV), Ontario Institute for Studies in Education, The School of Education and Leadership of the University of Ghana, and the Foro Social de la Deuda Externa y Desarrollo de Honduras.  The “Unlock Literacy Learning Network” (ULLN) research for girls and boys to reach their full potential’ project works with teachers, community leaders, volunteers, and administrators to adapt Unlock Literacy approaches within local learning systems. This project includes research that explores how community-based actors work together, adapt, and interact with the formal education sector to implement and support community literacy activities (including reading camps) to improve girls’ and boys’ reading fluency within distinct contexts in Ghana, Honduras, and Nicaragua. The research provides evidence on factors that enable and hinder collaborative stakeholder networks that aim to advance quality, sustainable, scalable and effective gender-responsive and inclusive education programming for early grade students (grades 1-3) to improve children’s literacy levels within vulnerable populations. To disseminate findings from its first phase of data collection, the consortium has developed a robust knowledge mobilization strategy.  WV’s Unlock Literacy model was awarded the UNESCO–Japan Prize on Education for sustainable development as an intervention with great potential for scale-up, transformation, and sustainability.  (Checkout WV’s Unlock Literacy project in Ghana here and the award here for more information.)

Contact: Miguel Moreno ([email protected])

Publications and Other Initiatives (by topic area)

General

“Scaling Programs Effectively: Two New Books on Potential Pitfalls and the Tools to Avoid Them.” By David Evans. World Bank Development Impact Blog. 9 February 2022.

https://blogs.worldbank.org/impactevaluations/scaling–programs–effectively–two–newbooks–potential–pitfalls–and–tools–avoid

Two recent books seek to add to the scaling conversation. Last year’s The Scale–Up Effect in Early Childhood and Public Policy: Why Interventions Lose Impact at Scale and What We Can Do About It (edited by List, Suskind, and Supplee) and this year’s The Voltage Effect: How to Make Good Ideas Great and Great Ideas Scale (by John List). While the first is ostensibly focused on early childhood, the principles— and even some of the chapters—have broad application to public policy programs. The books overlap in their focus (scaling effectively) but differ enormously in their tone and audience. The former is moderately technical, geared towards researchers, program implementers, and maybe a bold policymaker. The latter seeks to reach a general audience, highlighting the basic principles of scaling through stories.

The author recommends both books. For researchers, The Scale-Up Effect provides lots of practical advice and points to further resources on how to improve evaluations and policy partnerships to maximize impact at scale. Select chapters of The Scale-Up Effect will be of interest to broader groups of readers. For funders and policymakers, The Voltage Effect does more to provide intuition on the potential pitfalls and solutions in scaling. (For researchers, The Voltage Effect still adds value, both in providing simple, clear rhetoric and examples to communicate these concepts and because the range of experiences is fascinating.) These two insightful volumes both provide valuable tools to evaluate pilot programs in a way that gives the best odds for scale-up and then avoiding major pitfalls in the process of getting to scale.

Agriculture and Rural Development

“Strategies For Scaling Agricultural Technologies in Africa.” By Ajayi, T., Fatunbi. O., and Akinbamijo Y. (2018). Forum for Agricultural Research in Africa (FARA), Accra Ghana

https://research4agrinnovation.org/wp–content/uploads/2018/02/Scalingstrategies_Africa.pdf

The need to bring existing and upcoming technologies to scale has been highlighted broadly by policy makers and development practitioners in Africa. This felt need came along with the mantra that Africa has a lot of technologies on the shelf that are yet to be translated into socio-economic benefit for the stakeholders in the sector. Whether this is factual or not, Africa agriculture requires a systematic way of bringing technologies with very high potentials to scale. This book aims to bridge this gap in knowledge by reviewing the existing knowledge on scaling technologies and innovation. It provides a comprehensive review of knowledge and proposes various strategies to ensure that agricultural technologies are scaled up and scaled out for mega social and economic benefits.

“Analyzing influencing factors to scale up agroforestry systems in Colombia: A comparative ex-ante assessment of cacao farming and cattle ranching in two regions.” By Rodríguez, T., Bonatti, M., Löhr, K. et al. In Agroforest Syst (2022).

https://doi.org/10.1007/s10457–022–00730–1

Agroforestry systems (AFS) are proved to enhance sustainable land management. Thus, there is increasing demand for effective ways to scale up AFS so that more people can benefit. This study assesses the scaling-up potential of AFS using cacao farming and cattle ranching in Caquetá and Cesar, Colombia, as examples. An ex-ante assessment using the ScalA tool is conducted through interviews with AFS experts from institutions promoting AFS. Using a comparative approach, results reveal that AFS interventions have different scaling-up potential depending on the type of farming system and location characteristics. Factors hindering the scaling-up potential for both regions are including a lack of stable and differentiated markets to absorb AFS products. In contrast, the scaling-up potential in both regions is increased by factors related to the attitudes of local communities towards the organizations that promote AFS.

Climate

“Assessing the Likelihood for Transformational Change at the Green Climate Fund: An Analysis Using Self-Reported Project Data.” By Jyotsna Puri, Martin Prowse, Emma De Roy, David Huang. In Climate Risk Management (2022)

https://www.sciencedirect.com/science/article/pii/S2212096322000055?via%3Dihub

Climate finance institutions have been tasked with effectively and efficiently allocating funds to spur the transition to low-carbon, climate-resilient economies. The Green Climate Fund (GCF) is expected to assist the most vulnerable to adapt to and mitigate climate change and has an explicit mandate to contribute to a paradigm shift. To understand if the GCF’s portfolio is on track to achieve these objectives, this study reviews the project documents of GCF investments through March 2020 (N=125 projects). It examines attributes of these investments by applying a framework for potential transformational change, comprised of eight components and uses bivariate statistics and multivariate cluster analysis to examine GCF’s project portfolio of mitigation, cross-cutting, and adaptation projects. Bivariate tests find that (1) adaptation projects evidence the greatest intention to integrate policy change into national planning processes, and (2) both adaptation and cross-cutting projects manifest a greater need for and expectation of behavior change. Results from cluster analysis show that adaptation projects dominate clusters with high and medium potential for transformational change (with 47% and 78% of projects, respectively). However, even the high potential cluster only displays the highest average scores for four of the eight components in the GCF framework for transformational change.

Early Childhood Development

“What Implementation Evidence Matters: Scaling-up nurturing interventions that promote early childhood development.” By Britto, Pia R., Manpreet Singh, Tarun Dua, Raghbir Kaur, and Aisha K. Yousafzai. In Annals of the New York Academy of Sciences, vol. 1419, no. 1, 2018, pp. 5–16.

https://nyaspubs.onlinelibrary.wiley.com/doi/10.1111/nyas.13720

Research in early childhood development (ECD) has established the need for scaling-up multisectoral interventions for nurturing care.  However, key elements and processes for implementation and scale-up of such interventions are not well understood. This special series on implementation research and practice for ECD brings together evidence to inform effectiveness, quality, and scale in nurturing care programs; identifies knowledge gaps; and proposes further directions for research and practice. This paper frames the dimensions and components fundamental to the understanding of implementation processes for nurturing care interventions, factors for improving implementation of interventions, and strategies to scale by embedding interventions in delivery systems. It also discusses emerging issues in implementation research for ECD, including (1) the role of context in adaptation and implementation, (2) standardized reporting of implementation research, (3) the importance of feasibility studies to inform scale-up and capacity building, (4) fidelity and program quality improvement, and (5) intervention integration into existing systems.

Health

“COVID-19 Vaccine Development and Rollout in Historical Perspective.” By Amanda Glassman, Charles Kenny, and George Yang. Center for Global Development Working Paper 607, February 2022

https://www.cgdev.org/sites/default/files/covid–19–vaccine–development–and–rollouthistorical–perspective–paper.pdf

At the start of 2022, profound inequities in the pace of access to COVID-19 vaccines and the level of coverage of COVID-19 vaccination remain, especially with regard to the world’s poorest countries. Yet despite this inequity, we find that global COVID-19 vaccine development and diffusion has been the most rapid in history, and this rapid scale-up is evident not only in high income countries but also in upper- and lowermiddle-income countries, home to the majority of the world’s population. This paper explores the historical record in the development and deployment of vaccines globally and puts the COVID-19 vaccine rollout in that context. Although far more can be done and should be done to speed equitable access to vaccines in the COVID-19 response, it is worth noting the revolutionary speed of both the vaccine development and the diffusion process, and the potential good news that this signal for the future of pandemic preparedness and response.

“Scaling-up Normative Change Interventions for Adolescent and Youth Reproductive Health: An Examination of the Evidence.” By Nguyen, Gabrielle, Elizabeth Costenbader, Kate F. Plourde, Brad Kerner and Susan Igras, Journal of Adolescent Health, vol. 64, no. 4, 2019, S16–30.

https://www.sciencedirect.com/science/article/pii/S1054139X19300096

Adolescent and youth reproductive health (AYRH) outcomes are influenced by factors beyond individual control. Increasingly, interventions are seeking to influence community-level normative change to support healthy AYRH behaviors. While evidence is growing of the effectiveness of AYRH interventions that include normative change components, understanding on how to achieve scale-up and wider impact of these programs remains limited. We analyzed peer-reviewed and gray literature from 2000 to 2017 describing 42 AYRH interventions with community-based normative change components that have scaled-up in low/middle-income countries. Only 13 of 42 interventions had significant scale-up documentation. We compared scale-up strategies, scale-up facilitators and barriers, and identified recommendations for future programs. All 13 interventions addressed individual, interpersonal, and community-level outcomes, such as community attitudes and behaviors related to AYRH. Scale-up strategies included expansion via new organizations, adapting original intervention designs, and institutionalization of activities into public-sector and/or nongovernmental organization structures. Four overarching factors facilitated or inhibited scale-up processes: availability of financial and human resources, transferability of intervention designs and materials, substantive community and government-sector partnerships, and monitoring capacity. Scaling-up multifaceted normative change interventions is possible but not well documented. The global AYRH community should prioritize documentation of scale-up processes and measurement to build evidence and inform future programming.

“Scaling up Physical Activity Interventions Worldwide: Stepping up to larger and smarter approaches to get people moving.” By Reis, Rodrigo S., Deborah Salvo, David Ogilvie, Estelle V. Lambert, Shifalika Goenka and Ross C. Brownson. In The Lancet, vol. 388, no. 10051, 2016, pp. 1337–1348.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140–6736(16)30728–0.pdf

The global pandemic of physical inactivity requires a multisectoral, multidisciplinary public-health response. Scaling up interventions that are capable of increasing levels of physical activity in populations across the varying cultural, geographic, social, and economic contexts worldwide is challenging, but feasible. In this paper, we review the factors that could help to achieve this. We use a mixed-methods approach to comprehensively examine these factors, drawing on the best available evidence from both evidence-to-practice and practice-to-evidence methods. Policies to support active living across society are needed, particularly outside the health-care sector, as demonstrated by some of the successful examples of scale up identified in this paper. Researchers, research funders, practitioners and policymakers in culture, education, health, leisure, planning, and transport, and civil society as a whole, all have a role. We should embrace the challenge of taking action to a higher level, aligning physical activity and health objectives with broader social, environmental, and sustainable development goals.