Guide to Fostering Change to Scale Up Effective Health Services

“It is not the strongest of the species that survives, nor the most in­telligent, but rather the one most responsive to change.”  -Charles Darwin

The Need for a Guide to Fostering Change

This guide is based on the recognition that change is inevitable for survival and that directed and planned change has a much greater chance of success than ad hoc attempts to introduce new practices. Everyone working to improve health, including donors, researchers, technical experts, service providers and advocates at the global, national, district, community and family level is in the business of fostering, leading or implementing change. But not everyone involved in this work has a clear pathway that links proven change practices with evidence-based clinical and programmatic innovations.

Purpose of the Guide

Successful change is not an end in itself. Rather, it is a means of improving the availability and quality of services, expanding utilization and, ultimately, improving health outcomes. This guide links effective change prac­tices with proven clinical and programmatic practices to achieve results by:

  • Describing principles fundamental to effective change.
  • Increasing awareness of proven approaches to effective change.
  • Providing “how-to” steps for successful change including scale-up.
  • Describing key challenges of scaling up and recommending strategies, tools or ap­proaches for meeting those challenges.
  • Offering cases that show how the steps have been implemented in real-life situations.

Audience for the Guide

This guide is for policy makers, program managers, operations researchers or other health professionals who want to bring about change in a health practice or set of practices. Changes in health practices can originate at different levels. Sometimes an evidence-based prac­tice is introduced nationally or regionally to resolve a widespread public health concern. For example, a Minister of Health or donor might initiate the provision of insecticide-treated bed nets to reduce infant deaths from malaria or the provision of MgSO4 to prevent deaths from eclampsia.

But sometimes the change “bubbles up” from the staff of a health facility seeking to address a service delivery challenge. There are many examples of hospital directors who introduced proven practices to reduce infection rates or clinic nurses who mobilized their staff to improve counseling to increase fam­ily planning acceptors.

A range of groups can act together as a Change Coordination Team to support change, including international, regional and country members of the IBP Consortium; representatives from Ministries of Health and other government ministries; non-governmental organizations (NGOs) and faith-based organizations (FBOs); regional and country WHO, UNFPA, and IPPF offices; USAID missions; and regional and country offices of USAID cooperating agencies and other donors and decision makers. Active players in a successful change process often include representatives of national, regional or institutional organizations who are in a position to support the change as part of the coordination team, as well as those who are implementing the change on the ground at a program level, service delivery site or in the community.

Toolkit last updated: March 11, 2014