Small-scale pilot and demonstration projects often are used to test the feasibility and effectiveness of innovative interventions to strengthen and expand the reach of reproductive health programs. These are frequently proved successful because they are well-planned, well-resourced, and well-implemented. The critical challenge, however, is whether and how an intervention can be scaled up. For example, an intervention proven successful within a few facilities in a district will first need to be institutionalized within that district’s health program so that it is funded and implemented routinely. Its implementation may then be expanded to other district programs in the same province, and then to other provinces. If appropriate, it may then be replicated in another program or country.
Population Council focus
Scaling up a service-delivery intervention that has proven effective on a small scale requires a phased approach during which the procedures and resources for implementation at increasing levels within a health system are developed, proven functional, and then institutionalized. The Council supports programs to develop organizational capacity to deliver interventions at increasing scale, through intensive technical assistance that leads to sustainable increases in access, quality, and use of reproductive health services.
Population Council impact
- Following demonstration of an effective family planning and child health intervention in one district of Ghana, the Council then supported the Ghana Health Service in first testing the intervention’s replicability in another district and then expanding its implementation nationwide through the Community Health Planning and Services Initiative.
- In Bangladesh, the Council first demonstrated the acceptability and feasibility of public-sector delivery of emergency contraception (EC) through small-scale studies. It then supported a two-phased nationwide expansion by first introducing EC into the country’s largest division, then expanding introduction into all remaining districts.
- In Kenya and Senegal, the Council supported the pilot-testing of public-sector models at the subdistrict level for coordinating multisectoral responses that addressed the reproductive health needs of adolescents. These models were then scaled up through a phased approach by which coordinating mechanisms were developed at increasingly higher levels of the public sector.
Projects
Developing Capacity for Targeted, Evidence-based Programming and Asset Building for Adolescent Girls (more)
The Council is helping to build the capacity of NGOs, UN country teams, and government agencies to develop effective health, social, and economic asset-building programs for adolescent girls.
(1/2008 - ongoing)
Global, Kenya, Liberia
Comprehensive Condom Programming in West Africa (more)
This Council project identified strategies for re-integrating the female and male condom in the national reproductive health and HIV and AIDS programs of Burkina Faso, Democratic Republic of Congo, Liberia, Mauritania, Senegal, and Sierra Leone.
(1/2008 - 12/2008)
Burkina Faso, Congo, DRC, Liberia, Mauritania, Senegal, Sierra Leone
Scaling Up the Community-based Health Planning and Services Initiative in Nkwanta District (more)
Nkwanta District has pioneered the implementation of a national program based on the Navrongo Community Health and Family Planning Project.
(7/2001 - 8/2008)
Ghana
Institutionalizing a Successful Adolescent Reproductive Health and HIV Intervention Program: Expanding the Kenya Adolescent Reproductive Health Program Experience in Kenya (more)
Council researchers identified selected activities from the Kenya Adolescent Reproductive Health Program and institutionalized them within the study sites.
(9/2003 - 5/2008)
Kenya
Sharing Experiences with Comprehensive Responses to Adolescent Reproductive Health Needs in Africa (more)
In francophone West Africa, Council research is promoting the utilization of multisectoral approaches for improving adolescent reproductive health programming by governments, donors, and national and international agencies.
(10/2007 - 3/2008)
Africa
Scaling Up Utilization of the Quality Assurance (QA) Checklist in India (more)
Council researchers helped create a manual to enable district-level managers to systematically monitor the quality of reproductive health services in India.
(5/2007 - 2/2008)
India
Extending Operations Research to the Problems of Scale Up: Costs, Compliance, and Effectiveness of Systematic Screening (more)
Council researchers with the FRONTIERS program worked to combine support for scaling up systematic screening with research on specific aspects of the scaling-up process.
(9/2005 - 12/2007)
Bolivia, India, Mali, Senegal
Enhancing Utilization of the Findings from the Youth Reproductive Health Project (more)
The Council provided technical assistance to Senegal’s MOH to implement programs to improve adolescent reproductive health.
(1/2004 - 8/2007)
Senegal
Scaling Up Emergency Contraceptive Pills to the National Level in Bangladesh (more)
Council researchers with the FRONTIERS program worked the Ministry of Health in Bangladesh to introduce emergency contraceptive pills into the National Family Planning Program.
(7/2003 - 2/2007)
Bangladesh
Scaling Up Reproductive Health Services for Men (more)
Council researchers collaborated in Bangladesh to expand and document the integration of male family planning and reproductive health services from eight to 40 Health and Family Welfare Centers.
(9/2005 - 1/2007)
Bangladesh
Resources
APHIA II Operations Research Project in Kenya Newsletter, October 2010 (PDF)
Publication date: 2010
Creating conditions for scaling up access to life skills based sexual and reproductive health education and condom services: Strengthening safe sex decision-making
Bhuiya,Ismat; Rob,Ubaidur; Zahiduzzaman,K.M.; Chowdhury,Asiful Haider; Sarma,Haribondhu
Publication date: 2009
Introduction and scaling-up of emergency contraception: Lessons learned from three regions (abstract)
Fernandez-Cerdeno,Araceli; Vernon,Ricardo; Hossain,Sharif Mohammed Ismail; Keesbury,Jill; Khan,M.E.
Population Review 48(1): 119-134
Publication date: 2009
An assessment of the Positive Partnership Project in Thailand: Key considerations for scaling-up microcredit loans for HIV-positive and negative pairs in other settings (abstract)
Viravaidya,Mechai; Wolf,R.C.; Guest,Philip
Global Public Health 3(2): 115-136
Publication date: 2008
Comparing the effectiveness and costs of alternative strategies for improving access to information and services for the IUD in Ghana (PDF)
Osei,Ivy; Voetagbe,Gertrude; Aikins,Moses; Gyapong,John; Nyarko,Philomena; Birungi,Harriet; Asare,Gloria Quansah; Odoi-Agyarko,Henrietta; Aglah,Olivia
FRONTIERS Final Report
Publication date: 2008
Creating the conditions for scale-up of the Men in Maternity intervention in India (PDF)
Caleb-Varkey,Leila; Mishra,Anurag; Khan,M.E.
FRONTIERS Final Report
Publication date: 2008
Creating the conditions for scaling up the integration of reproductive health services for men in health and family welfare centers in Bangladesh (PDF)
Mannan,M.A.; Hakim,Jafar Ahmad; Waris,Syeda Tazneen; Ali,Ashraf; Hakim,AKM Nurul; Hannan,Abdul; Chowdhury,Sameena; Tasnim,Saria; Islam,Saiful; Karim,AQM Rezaul; Hossain,Sharif Mohammed Ismail; Rob,Ubaidur; Khan,M.E.
FRONTIERS Final Report
Publication date: 2008
Development of a quality assurance procedure for reproductive health services for district public health systems: Implementation and scale-up in the state of Gujarat (PDF)
Khan,M.E.; Mishra,Anurag; Sharma,Vivek; Caleb-Varkey,Leila
FRONTIERS Final Report
Publication date: 2008
Institutionalization of quality assurance within district health management: Experiences from Maharashtra and Karnataka (PDF)
Khan,M.E.; Mishra,Anurag; Sharma,Vivek; Ahmad,Jaleel; Joseph,Jose; Srinivasan,Venkatesh; Sathyanarayana,K.M.; Vargees,Viji; Maiti,K.D.; Sharma,Rashmi
FRONTIERS Final Report
Publication date: 2008
Introducing and scaling up emergency contraceptive pill in the National Family Planning Program of Bangladesh: Enhancing utilization of operations research results and lessons learned from program implementation
Khan,M.E.; Hossain,Sharif Mohammed Ismail
FRONTIERS Final Report
Publication date: 2008
Multisectoral youth RH interventions: The scale-up process in Kenya and Senegal (PDF)
Joyce,Stephanie; Askew,Ian; Diagne,Anta Fall; Diop,Nafissatou J.; Evelia,Humphres
FRONTIERS Program Brief (no. 13)
Publication date: 2008
Taking critical services to the home: Scaling-up home-based maternal and postnatal care, including family planning, through community midwifery in Kenya (PDF)
Mwangi,Annie; Warren,Charlotte
FRONTIERS Final Report
Publication date: 2008
Using systematic screening to integrate health services in India and Senegal: Pilot study versus scale-up results (PDF)
Foreit,James R.
FRONTIERS Final Report
Publication date: 2008
Assessing the equitable distribution of essential medicines for rural maternal and child health care: Baseline report, Nkwanta District, Ghana (PDF)
GEMI (Ghana Essential Medicines Initiative) Progress Report, (June)
Publication date: 2007
Evidence-based scaling up of health and family planning service innovations in Bangladesh and Ghana (PDF)
Phillips,James F.; Nyonator,Frank K.; Jones,Tanya C.; Ravikumar,Shruti; Simmons,Ruth; Fajans,Peter; Ghiron,Laura
from Scaling Up Health Service Delivery: From Pilot Innovations to Policies and Programmes, pp. 113-134
Publication date: 2007
Expanding contraceptive choice and improving quality of care in Zambia's Copperbelt: Moving from pilot projects to regional programmes (PDF)
Skibiak,John P.; Mijere,Peter; Zama,Mary; Simmons,Ruth; Fajans,Peter; Ghiron,Laura
from Scaling Up Health Service Delivery: From Pilot Innovations to Policies and Programmes, pp. 71-88
Publication date: 2007
How much will it cost to scale up a reproductive health pilot project? (PDF)
Janowitz,Barbara; Bratt,John H.; Homan,Rick; Foreit,James R.
FRONTIERS Program Brief (no. 8)
Publication date: 2007
Innovative program dramatically lowers child mortality in Ghana (PDF)
Population Briefs 13(2)
Publication date: 2007
Introducing and scaling up emergency contraception in the National Family Planning Program: Experience from Bangladesh
FRONTIERS Asia and Near East Region OR Summary (no. 21)
Publication date: 2007
Mainstreaming and scaling up the Kenya Adolescent Reproductive Health Project (PDF)
Askew,Ian; Evelia,Humphres
FRONTIERS Report
Publication date: 2007
Rapid achievement of the child survival Millennium Development Goal: Evidence from the Navrongo experiment in Northern Ghana (abstract)
Binka,Fred N.; Bawah,Ayaga A.; Phillips,James F.; Hodgson,Abraham; Adjuik,Martin; MacLeod,Bruce
Tropical Medicine and International Health 12(5): 578-583
Publication date: 2007
Scaling up experimental project success with the Community-based Health Planning and Services initiative in Ghana (PDF)
Nyonator,Frank K.; Akosa,Agyeman Badu; Awoonor-Williams,John Koku; Phillips,James F.; Jones,Tanya C.; Simmons,Ruth; Fajans,Peter; Ghiron,Laura
from Scaling Up Health Service Delivery: From Pilot Innovations to Policies and Programmes, pp. 89-112
Publication date: 2007
Scaling up family planning service innovations in Brazil: The influence of politics and decentralization (PDF)
Diaz,Juan; Simmons,Ruth; Diaz,Margarita; Cabral,Francisco; Chinaglia,Magda; Fajans,Peter; Ghiron,Laura
from Scaling Up Health Service Delivery: From Pilot Innovations to Policies and Programmes, pp. 135-156
Publication date: 2007
The effect of community nurses and health volunteers on child mortality: The Navrongo Community Health and Family Planning Project (abstract)
Pence,Brian Wells; Nyarko,Philomena; Phillips,James F.; Debpuur,Cornelius
Scandinavian Journal of Public Health 35(6): 599-608
Publication date: 2007
Accelerating reproductive and child health programme impact with community-based services: The Navrongo experiment in Ghana
(abstract)
Phillips,James F.; Bawah,Ayaga A.; Binka,Fred N.
Bulletin of the World Health Organization 84(12): 949-953
Publication date: 2006
Costs and financial burden of care and support services to PLHA and households in South India (abstract)
Duraisamy,P.; Ganesh,A.K.; Homan,Rick; Kumarasamy,N.; Castle,Christopher; Sripriya,P.; Mahendra,Vaishali Sharma; Solomon,Suniti
AIDS Care 18(2): 121-127
Publication date: 2006
India: Scaling up of quality assurance measure in district level management in Gujarat state
Asia and Near East OR Summary (no. 15)
Publication date: 2006
Scaling up a reproductive health curriculum in youth training courses (PDF)
Rahman,Laila; Islam,M.Mazharul; Rob,Ubaidur; Bhuiya,Ismat; Khan,M.E.
FRONTIERS Final Report
Publication date: 2006
Scaling up: Reproductive health curriculum in vocational training centers for youth
Asia and Near East Region OR Summary (no. 12)
Publication date: 2006
TB baseline survey in 30 districts implementing CHPS in seven southern regions of Ghana
Final report
Publication date: 2006
Accelerating reproductive and child health program development: The Navrongo initiative in Ghana (PDF)
Phillips,James F.; Bawah,Ayaga A.; Binka,Fred N.
Policy Research Division Working Paper (no. 208)
Publication date: 2005
Building national capacity to deliver emergency contraceptive services in Bangladesh (PDF)
Khan,M.E.; Hossain,Sharif Mohammed Ismail; Nizamuddin Bhuiyan,Md
FRONTIERS Research Update (no. 3)
Publication date: 2005
Emergency Contraceptive Pills: South East Asia Regional Training Manual (PDF)
Rahman,Md.Moshiur; Khan,M.E.; Hossain,Sharif Mohammed Ismail; Sebastian,Mary Philip
Publication date: 2005
Expanding a successful health care initiative (PDF)
Population Briefs 11(3)
Publication date: 2005
Guiding the Ghana Community-based Health Planning and Services approach to scaling up with qualitative systems appraisal (abstract)
Nyonator,Frank K.; Jones,Tanya C.; Miller,Robert A.; Phillips,James F.; Awoonor-Williams,John Koku
International Quarterly of Community Health Education 23(3): 189-213
Publication date: 2005
Review of antenatal-linked voluntary counseling and HIV testing in sub-Saharan Africa: Lessons and options for Ghana (abstract)
Baiden,Frank; Baiden,Rita; Williams,John; Akweongo,Patricia; Clerk,Christine; Debpuur,Cornelius; Phillips,James F.; Hodgson,Abraham
Ghana Medical Journal 39(1): 8-13
Publication date: 2005
The effect of community nurses and health volunteers on child mortality: The Navrongo Community Health and Family Planning Project (PDF)
Pence,Brian Wells; Nyarko,Philomena; Phillips,James F.; Debpuur,Cornelius
Policy Research Division Working Paper (no. 200)
Publication date: 2005
The Ghana Community-based Health Planning and Services Initiative for scaling up service delivery innovation (abstract)
Nyonator,Frank K.; Awoonor-Williams,John Koku; Phillips,James F.; Jones,Tanya C.; Miller,Robert A.
Health Policy and Planning 20(1): 25-34
Publication date: 2005
Transferring Ghana's system of evidence-based health program development: Program for an initial exchange with Sierra Leone and Burkina Faso (PDF)
FRONTIERS Report
Publication date: 2005
What works? What fails? Compendium of newsletters from the Navrongo Community Health and Family Planning Project 2001-2004
Publication date: 2005
Bridging the gap between evidence-based innovation and national health-sector reform in Ghana (abstract) (PDF)
Awoonor-Williams,John Koku; Feinglass,Ellie S.; Tobey,Rachel; Vaughan-Smith,Maya; Nyonator,Frank K.; Jones,Tanya C.
Studies in Family Planning 35(3): 161-177
Publication date: 2004
Bridging the gap between evidence-based innovation and national health-sector reform in Ghana (PDF)
Awoonor-Williams,John Koku; Feinglass,Ellie S.; Tobey,Rachel; Vaughan-Smith,Maya; Nyonator,Frank K.; Jones,Tanya C.; Phillips,James F.
Policy Research Division Working Paper (no. 191)
Publication date: 2004
Expanding care and support in South India: Scaling up YRG CARE's patient-centered approach (PDF)
YRG CARE; Horizons Program; International HIV/AIDS Alliance
Horizons Final Report
Publication date: 2004
Maximizing resources to meet client needs: Evaluation of a comprehensive HIV/AIDS care and support model in India (PDF)
YRG CARE; Horizons Program; International HIV/AIDS Alliance
Horizons Final Report
Publication date: 2004
Scaling up a multi-sectoral pilot project
FRONTIERS Research Update
Publication date: 2004
Scaling up a successful counseling model in Guatemala (PDF)
Guatemalan Association of Female Physicians (AGMM)
FRONTIERS Final Report
Publication date: 2004
The effects of outreach on perceived quality of care in two rural areas of Bangladesh (abstract)
Hossain,Mian Bazle; Barkat-e-Khuda; Phillips,James F.
Journal of Biosocial Science 36(5): 507-522
Publication date: 2004
Demographic surveillance systems
Phillips,James F.; Demeny,Paul; McNicoll,Geoffrey
from Encyclopedia of Population, pp. 204-206
Publication date: 2003
Evidence-based development of health and family planning programs in Bangladesh and Ghana (PDF)
Phillips,James F.; Jones,Tanya C.; Nyonator,Frank K.; Ravikumar,Shruti
Policy Research Division Working Paper (no. 175)
Publication date: 2003
Innovative strategies reduce fertility in Ghana (PDF)
Population Briefs 9(2)
Publication date: 2003
Social interaction and contraceptive change in northern Ghana (abstract)
Feyisetan,Bamikale J.; Phillips,James F.; Binka,Fred N.
African Population Studies 18(2): 47-67
Publication date: 2003
The Ghana Community-based Health Planning and Services Initiative: Fostering evidence-based organizational change and development in a resource-constrained setting (PDF)
Nyonator,Frank K.; Awoonor-Williams,John Koku; Phillips,James F.; Jones,Tanya C.; Miller,Robert A.
Policy Research Division Working Paper (no. 180)
Publication date: 2003
YRG CARE base model report: Integrated prevention, care, and support services (PDF)
Castle,Christopher
Horizons Project Report
Publication date: 2003
Community-Based Health Planning and Services (CHPS) in Ghana: A multi-level, qualitative assessment in the Volta Region
Nyonator,Frank K.; Agbadja,Comfort; Gbeddy,Dennis; Nyarko,George; Jones,Tanya C.; Miller,Robert A.; Phillips,James F.
Publication date: 2002
The impact of the Navrongo project on contraceptive knowledge and use, reproductive preferences, and fertility (abstract) (PDF)
Debpuur,Cornelius; Phillips,James F.; Jackson,Elizabeth F.; Nazzar,Alex; Ngom,Pierre; Binka,Fred N.
Studies in Family Planning 33(2): 141-164
Publication date: 2002
A Question of Scale? The Challenge of Expanding the Impact of Non-Governmental Organisations' HIV/AIDS Efforts in Developing Countries (PDF)
DeJong,Jocelyn
Publication date: 2001
Comment promouvoir l'utilisation des résultats d'une analyse situationnelle à l'échelle nationale: Expérience du Sénégal [Promoting utilization of results from the national situation analysis in Senegal] (PDF)
Ndoye,Adama; Mbow,Bineta; Diop,Cheikh Bamba; Cisse,Mady; Thiam,Macoumba; Sanogo,Diouratie; Niang,Mbacke
FRONTIERS Final Report
Publication date: 2001
Demographic surveillance and health equity in sub-Saharan Africa (abstract)
Ngom,Pierre; Binka,Fred N.; Phillips,James F.; Pence,Brian Wells; MacLeod,Bruce
Health Policy and Planning 16(4): 337-344
Publication date: 2001
Honduras: Postpartum and postabortion patients want family planning (PDF)
FRONTIERS OR Summary (no. 25)
Publication date: 2001
Immunization status and child survival in rural Ghana (PDF)
Nyarko,Philomena; Pence,Brian Wells; Debpuur,Cornelius
Policy Research Division Working Paper (no. 147)
Publication date: 2001
Assessing population dynamics in a rural African society: The Navrongo Demographic Surveillance System (abstract)
Binka,Fred N.; Ngom,Pierre; Phillips,James F.; Adazu,Kubaje; MacLeod,Bruce
Journal of Biosocial Science 31(3): 375-391
Publication date: 1999
Lessons from community-based distribution of family planning in Africa (PDF)
Phillips,James F.; Greene,Wendy L.; Jackson,Elizabeth F.
Policy Research Division Working Paper (no. 121)
Publication date: 1999
The changing nature of adolescence in the Kassena-Nankana District of northern Ghana (abstract) (PDF)
Mensch,Barbara S.; Bagah,Daniel; Clark,Wesley H.; Binka,Fred N.
Studies in Family Planning 30(2): 95-111
Publication date: 1999
The changing social environment for adolescents in Kassena-Nankana District of northern Ghana: Implications for reproductive behavior (PDF)
Mensch,Barbara S.; Bagah,Daniel; Clark,Wesley H.; Binka,Fred N.
Policy Research Division Working Paper (no. 110)
Publication date: 1998
Scaling-up improved postabortion care in Egypt: Introduction to University and Ministry of Health and Population Hospitals (PDF)
Nawar,Laila; Huntington,Dale; Hassan,Ezzeldin Osman; Youssef,Hala; Abdel-Tawab,Nahla
Asia and Near East OR/TA Project Final Report
Publication date: 1997
Scaling-up improved postabortion care in Egypt: Introduction to University and Ministry of Health and Population Hospitals [Arabic] (PDF)
Research Summary
Publication date: 1997
The determinants of contraceptive innovation: A case-control study of family planning acceptance in a traditional African society
Phillips,James F.; Binka,Fred N.; Adjuik,Martin; Nazzar,Alex; Adazu,Kubaze Frank
Policy Research Division Working Paper (no. 93)
Publication date: 1997
Developing a culturally appropriate family planning program for the Navrongo experiment (abstract)
Nazzar,Alex; Adongo,Philip B.; Binka,Fred N.; Phillips,James F.
Studies in Family Planning 26(6): 307-324
Publication date: 1995
The Navrongo Community Health and Family Planning Project (abstract)
Binka,Fred N.; Nazzar,Alex; Phillips,James F.
Studies in Family Planning 26(3): 121-139
Publication date: 1995
What's New
- FRONTIERS Legacy Themes: Results and lessons learned from ten years of operations research have been synthesized and grouped into eight major legacy themes. (more)
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