How to scale-up: a comparative case study of scaling up a district health management strengthening intervention in Ghana, Malawi and Uganda

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dc.contributor.authorBulthuis, S.
dc.contributor.authorKok, M.
dc.contributor.authorOnvlee, O.
dc.contributor.authorO’Byrne, T.
dc.contributor.authorAmon, S.
dc.contributor.authorNamakula, J.
dc.contributor.authorChikaphupha, K.
dc.contributor.authorGerold, J.
dc.contributor.authorMansour, W.
dc.contributor.authorRaven, J.
dc.contributor.authorBroerse, J.E W.
dc.contributor.authorDieleman, M.
dc.date.accessioned2023-02-08T14:36:01Z
dc.date.available2023-02-08T14:36:01Z
dc.date.issued2023
dc.descriptionResearch Articleen_US
dc.description.abstractBackground The need to scale up public health interventions in low- and middle-income countries to ensure equitable and sustainable impact is widely acknowledged. However, there has been little understanding of how projects have sought to address the importance of scale-up in the design and implementation of their initiatives. This paper aims to gain insight into the facilitators of the scale-up of a district-level health management strengthening intervention in Ghana, Malawi and Uganda. Methods The study took a comparative case study approach with two rounds of data collection (2019 and 2021) in which a combination of different qualitative methods was applied. Interviews and group discussions took place with district, regional and national stakeholders who were involved in the implementation and scale-up of the intervention. Results A shared vision among the different stakeholders about how to institutionalize the intervention into the existing system facilitated scale-up. The importance of champions was also identified, as they influence buy-in from key decision makers, and when decision makers are convinced, political and financial support for scale-up can increase. In two countries, a specific window of opportunity facilitated scale-up. Taking a flexible approach towards scale-up, allowing adaptations of the intervention and the scale-up strategy to the context, was also identified as a facilitator. The context of decentralization and the politics and power relations between stakeholders involved also influenced scale-up. Conclusions Despite the identification of the facilitators of the scale-up, full integration of the intervention into the health system has proven challenging in all countries. Approaching scale-up from a systems change perspective could be useful in future scale-up efforts, as it focuses on sustainable systems change at scale (e.g. improving district health management) by testing a combination of interventions that could contribute to the envisaged change, rather than horizontally scaling up and trying to embed one particular intervention in the system.en_US
dc.identifier.otherhttps://doi.org/10.1186/s12913-023-09034-1
dc.identifier.urihttp://ugspace.ug.edu.gh:8080/handle/123456789/38569
dc.language.isoenen_US
dc.publisherBMC Health Services Researchen_US
dc.subjectScale-upen_US
dc.subjectBarriers and facilitatorsen_US
dc.subjectDistrict health management strengthening interventionen_US
dc.subjectLMICsen_US
dc.subjectComparative case-studyen_US
dc.titleHow to scale-up: a comparative case study of scaling up a district health management strengthening intervention in Ghana, Malawi and Ugandaen_US
dc.typeArticleen_US

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