Health Economics and Financing Programme, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
Health Policy Plan. 2010 Mar;25(2):85-96. doi: 10.1093/heapol/czp066. Epub 2010 Jan 13.
The term 'scaling up' is now widely used in the international health literature, though it lacks an agreed definition. We review what is meant by scaling up in the context of changes in international health and development over the last decade. We argue that the notion of scaling up is primarily used to describe the ambition or process of expanding the coverage of health interventions, though the term has also referred to increasing the financial, human and capital resources required to expand coverage. We discuss four pertinent issues in scaling up the coverage of health interventions: the costs of scaling up coverage; constraints to scaling up; equity and quality concerns; and key service delivery issues when scaling up. We then review recent progress in scaling up the coverage of health interventions. This includes a considerable increase in the volume of aid, accompanied by numerous new health initiatives and financing mechanisms. There have also been improvements in health outcomes and some examples of successful large-scale programmes. Finally, we reflect on the importance of obtaining a better understanding of how to deliver priority health interventions at scale, the current emphasis on health system strengthening and the challenges of sustaining scaling up in the prevailing global economic environment.
“扩大规模”一词现在在国际卫生文献中被广泛使用，尽管它缺乏一个商定的定义。我们回顾了在过去十年中，国际卫生和发展方面的变化背景下，扩大规模意味着什么。我们认为，扩大规模的概念主要用于描述扩大卫生干预措施覆盖范围的雄心或过程，尽管该术语也指增加扩大覆盖范围所需的财政、人力和资本资源。我们讨论了扩大卫生干预措施覆盖范围的四个相关问题：扩大覆盖范围的成本；扩大规模的限制；公平性和质量问题；扩大服务提供规模时的关键问题。然后，我们回顾了扩大卫生干预措施覆盖范围的最新进展。这包括援助量的大幅增加，同时还出现了许多新的卫生倡议和融资机制。卫生结果也有所改善，并且有一些成功的大规模方案的例子。最后，我们反思了更好地了解如何大规模提供优先卫生干预措施、当前对加强卫生系统的重视以及在当前全球经济环境下维持扩大规模的挑战的重要性。
