Best Practices in Scaling Up

In 2006, JSI launched a new series of case studies that look at successful processes for scaling up health services. By December 2008, there were nine published case studies in the series that examine how various health services have been successfully scaled up.

Two monographs examine the functional scale up of integrated family planning services in Romania and Turkey. JSI's groundbreaking work with the government of Egypt to implement a diarrheal control program nationwide is featured, as is Health Population and Environmental activities in Madagascar. Two case studies look at scaling up logistics systems and commodity supply chains, one in Nepal and one focuses on the DELIVER project's work in three country programs. Expanding the use of the Lot Quality Assurance Survey methodology in Uganda is reviewed, and another looks at both the political and organizational scaling up of HIV programs in workplaces in Zambia. Finally, one monograph focuses on geographical scale up of primary health care services in the rural highlands of Guatemala. An Introduction to the series defines scale up and ties the papers together.

These are the first nine studies in an on-going series designed to delineate the process for scaling up successful programs, so that these examples may be of use to others implementing programs. Look for future editions on scaling up programs in Russia, Djibouti and Nepal, others.

We hope you will find these case studies beneficial as you move your programs forward and prepare to scale up critical public health interventions that will improve the lives of those in your countries who are the most vulnerable. If you are interested in receiving hard copies in a special Best Practices in Scaling Up binder, please email jsinfo@jsi.com.

DELIVER Project: Scaling up Logistics Management Information Systems in Health Commodity Supply Chains (1,048 KB)

This case study, developed as part of JSI's Best Practices in Scaling Up series, examines the process that three country programs have used to scale up commodities supply chains to increase the number and types of products they provide. The case study highlights why commodity scale up is important, how logistics management information systems must be developed to support expended services, steps in the scale-up process and results from three country programs. Also included are highlights of what JSI staff learned along the way as scale up processes were implemented. Gregory Roche and Barbara Felling, John Snow, Inc., 2006.

Egypt: Control of Diarrheal Disease Goes National (PDF, 336 KB)

This case study, developed as part of JSI's 'Best Practices in Scaling Up' series, describes the national implementation of JSI's oral rehydration therapy (ORT) program to treat diarrheal disease in Egypt. Prior to this intervention, dehydration due to diarrhea was the leading cause of death in Egyptian children under five-years-old; meanwhile, ORT was emerging as a simple and sustainable option that could help reverse this trend. The case study delineates the course of this mass life-saving effort in the 1980s and 1990s, including steps in scale-up, the role of media in bringing about behavior change, and results of the efforts. As a result, virtually all mothers in Egypt understand and practice the preparation and use of ORT, and diarrheal disease control is now integrated into the Ministry of Health's activities. Susan Klein and Elizabeth Burleigh, John Snow, Inc., 2008.

Guatemala, Pro Redes Salud: Rapid Scale Up of Primary Health Care through NGOs (1,056 KB)

This case study, developed as part of JSI's Best Practices in Scaling Up series, examines the process used to scale up primary health care programs in the Guatemalan highlands under JSI's Pro Redes Salud (NGO Networks) project. The case study highlights how high quality services can be extended to thousands of rural residents through NGO networks. The case study also includes steps used to scale-up as well as a review of what worked and what JSI staff learned along the way as scale-up processes were implemented. Elizabeth Burleigh, John Snow, Inc., 2006.

Madagascar: Scaling Up Across Sectors: The Growth of the Population-Health-Environment Program (PDF, 376 KB)

This case study, produced as part of JSI's 'Best Practices in Scaling Up' series, describes the collaboration of population, health, and environmental (PHE) interventions to strengthen development efforts in Madagascar. Prior to JSI's PHE program, Madagascar's high population growth rate was a significant stressor both on its inhabitants and environment. In the early 2000s, JSI collaborated with various partners to apply PHE initiatives to address inhabitants' limited access to health care, family planning services, and agricultural extension services. The PHE program noticeably improved key health indicators and land-use practices during its span, and is now a model for other countries seeking to link health and environmental initiatives. G. Yvette Ribaira and Elaine E. Rossi, John Snow, Inc., 2008.

Nepal: Scaling Up an Integrated Health Logistics System (1,665 KB)

This case study, developed as part of JSI's Best Practices in Scaling Up series, explores the implementation of an effective and sustainable integrated health logistics system. The paper delineates the steps used to design the integrated system, the training process, coordination and resource generation, and implementation. The logistics system now enables health staff nationwide to monitor drugs and supplies at each service delivery point and throughout the system to ensure that resources are used efficiently. Janardin Lamichhane and Heem Shayka, John Snow, Inc., 2007.

Romania: Reaching the Poor—Scaling Up Integrated Family Planning Services (4,247 KB)

This case study, developed as part of JSI's Best Practices in Scaling Up series, maps out how the Romanian Family Health Initiative (RFHI) has expanded family planning coverage nationwide to over 2000 rural communities. This case study highlights the process JSI's project used to integrate family planning into existing primary health services, including creating a favorable policy environment, training health care professionals, and implementing an effective logistics management system. Also included are highlights of what JSI staff learned along the way as scale-up processes were implemented. Merce Gasco, Diane Hedgecock and Christopher Wright, John Snow, Inc., 2007.

Turkey: Scaling Up Nationwide Access to Integrated Family Planning through the Turkish Social Insurance Organization (SSK) (1,007 KB)

This case study, developed as part of JSI's Best Practices in Scaling Up series, reviews the successful introduction and expansion of family planning services through the Turkish government's social services agency, SSK. The paper maps out the results and sustainability of the program as well as the process used to introduce and scale up services, including contraceptive security, collaboration and quality assurance. Also included are highlights of what JSI staff learned along the way as scale up processes were implemented. Nancy Pendarvis Harris, Nilgun Kircalioglu, Diane Hedgecock, John Snow, Inc., 2007.

Uganda: Using a Simple Survey Method to Scale Up Evidence-Based Decision Making at the District Level—The UPHOLD Project (1,418 KB)

This case study, developed as part of JSI's Best Practices in Scaling Up series, examines how JSI's Uganda Program for Human and Holistic Development (UPHOLD) expanded use of the Lot Quality Assurance Sampling (LQAS) methodology for data collection and analysis. Because of the program, districts now have accurate data available for their planning, budgets more accurately reflect districts' specific needs, and district performance can be measured and health services thus improved. The case study also looks at the steps used to scale-up LQAS in Uganda and explores what worked and what was learned as the methodology was implemented broadly. Xavier Nsabagasani, Joseph Mabirizi, Samson Kironde, Nosa Orobaton, John Snow, Inc., 2007.

Zambia: When Scaling Up is the Only Alternative: Experience with Workplace HIV Programs in Zambia (1,186 KB)

This case study, developed as part of JSI's Best Practices in Scaling Up series, examines the process used to scale up workplace-based HIV programs under JSI's Zambia Integrated Health Project (ZIHP) and the Support to the HIV/AIDS Response in Zambia (SHARe) Projects. The case study highlights how workplace-based programs matter, strategies and steps used to scale-up and results from Zambia. Also included are highlights of what JSI staff learned along the way as scale up processes were implemented. Mutinta Nyumbu, Rose Musumali Lungu, Simon Mutonyi and Chilufya Mwaba, John Snow, Inc., 2006.