Beginning with the end in mind.

Increasing access to and ensuring sustainability of an innovation that can improve people’s health at scale depends on more than a successful pilot project. The proven innovation must be scaled up—expanded from the pilot phase to nationwide coverage as well as institutionalized in national norms and systems. Yet few successfully-piloted innovations have been taken to scale, with fewer still sustained over time, due in part to gaps in understanding of how to apply a systems approach to the scale-up process and how practical, yet robust, monitoring and evaluation can support the expansion process.

IRH has multiple years of experience scaling up successful pilot programs to address unmet need for family planning and studying the process along the way. This experience suggests that monitoring and evaluation of the scale-up process and timely feedback of this information to decision makers can increase the probability of achieving sustainable, large-scale implementation. This learning process can support scale-up by helping stakeholders clearly define the innovation, maintain fidelity as the reach of the program expands, identify the need for adaptations, and ensure that the adapted innovation continues to produce the desired effect.

IRH has developed a useful kit of tools and approaches to research, monitor and evaluate scale-up of a new family planning method, and these tools can help to bridge the ‘science-to-service’ gap faced by practitioners around the world. This strategy has been guided by the ExpandNet/WHO framework which emphasizes partnering with resource organizations, involving stakeholders, working with different cadres of providers, and supporting scale-up through research, monitoring and evaluation.