Spicer Neil, Bhattacharya Dipankar, Dimka Ritgak, Fanta Feleke, Mangham-Jefferies Lindsay, Schellenberg Joanna, Tamire-Woldemariam Addis, Walt Gill, Wickremasinghe Deepthi
London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK.
Sambodhi Research and Communications, 0-2, 2nd Floor, Lajpat Nagar-II, New Delhi, India.
Soc Sci Med. 2014 Nov;121:30-8. doi: 10.1016/j.socscimed.2014.09.046. Epub 2014 Sep 28.
Donors and other development partners commonly introduce innovative practices and technologies to improve health in low and middle income countries. Yet many innovations that are effective in improving health and survival are slow to be translated into policy and implemented at scale. Understanding the factors influencing scale-up is important. We conducted a qualitative study involving 150 semi-structured interviews with government, development partners, civil society organisations and externally funded implementers, professional associations and academic institutions in 2012/13 to explore scale-up of innovative interventions targeting mothers and newborns in Ethiopia, the Indian state of Uttar Pradesh and the six states of northeast Nigeria, which are settings with high burdens of maternal and neonatal mortality. Interviews were analysed using a common analytic framework developed for cross-country comparison and themes were coded using Nvivo. We found that programme implementers across the three settings require multiple steps to catalyse scale-up. Advocating for government to adopt and finance health innovations requires: designing scalable innovations; embedding scale-up in programme design and allocating time and resources; building implementer capacity to catalyse scale-up; adopting effective approaches to advocacy; presenting strong evidence to support government decision making; involving government in programme design; invoking policy champions and networks; strengthening harmonisation among external programmes; aligning innovations with health systems and priorities. Other steps include: supporting government to develop policies and programmes and strengthening health systems and staff; promoting community uptake by involving media, community leaders, mobilisation teams and role models. We conclude that scale-up has no magic bullet solution - implementers must embrace multiple activities, and require substantial support from donors and governments in doing so.
捐助者和其他发展伙伴通常会引入创新做法和技术，以改善低收入和中等收入国家的健康状况。然而，许多在改善健康和生存方面有效的创新举措，在转化为政策并大规模实施方面进展缓慢。了解影响扩大规模的因素很重要。2012/13年，我们开展了一项定性研究，对埃塞俄比亚、印度北方邦以及尼日利亚东北部六个州的政府、发展伙伴、民间社会组织、外部资助的实施机构、专业协会和学术机构进行了150次半结构化访谈，这些地区孕产妇和新生儿死亡率负担较高，该研究旨在探讨针对孕产妇和新生儿的创新干预措施的扩大规模情况。访谈采用了为跨国比较而制定的通用分析框架进行分析，并使用NVivo对主题进行编码。我们发现，这三个地区的项目实施者需要采取多个步骤来推动扩大规模。倡导政府采用并资助卫生创新需要：设计可扩展的创新；在项目设计中融入扩大规模的内容并分配时间和资源；建设实施者推动扩大规模的能力；采用有效的宣传方法；提供有力证据以支持政府决策；让政府参与项目设计；借助政策倡导者和网络；加强外部项目之间的协调；使创新与卫生系统及优先事项保持一致。其他步骤包括：支持政府制定政策和项目并加强卫生系统及工作人员能力；通过让媒体、社区领袖、动员团队和榜样参与来促进社区采用。我们的结论是，扩大规模没有万灵药式的解决方案——实施者必须开展多项活动，并且在此过程中需要捐助者和政府的大力支持。
