Scale Up

Scale-up is related to increasing capacity, which has implications for multiple areas, from national policy to institutional planning. This section discusses financing, strengthening professional associations/councils, and improving institutional capacity.

Financing: planning for expansion and scale-up. Address financial planning for scale-up early on, including development of a sustainable plan for financing expansion and scale-up. The Innovative Financing for Pre-Service Education provides practical guidance on financing pre-service education. Strengthening existing and establishing new pre-service education programs must include long range plans for funding the development of institutions that provide high quality education for the country’s midwives and other health workforce providers. The Nine steps for developing a scale- up strategy provide practical guidance on planning for scale-up.

Strengthen related professional councils or associations. Develop and strengthen professional associations (Fullerton and Leshabari 2010; Dal Poz, et al. 2009). Twinning, one way of strengthening professional councils or associations, is a “mutually beneficial exchange between two member midwives associations. It is a formal and substantive collaboration between two organizations” (International Confederation of Midwives (ICM), 2010). Twinning can be used to collaborate, develop, or improve regulatory frameworks or curricula, or support infrastructure investment. The Technical Briefs on Strengthening Professional Associations outline additional approaches and activities.

Improve capacity of institutions to increase uptake. The scale-up of health care workers requires additional infrastructure, faculty, and clinical instructors, which are often in shortage (Mullan et al. 2010). Creating additional clinical sites and preparing clinical instructors or preceptors to provide clinical supervision are essential components of increasing the quantity of health care workers (Mullan, et al. 2010). Gain efficiencies—consider ‘hubs’ at institutions with satellite learning centers and build more instruction into clinical practice.

Involve stakeholders in monitoring of infrastructure requirements for scale up. The demand for additional health care workers is constrained by human and materials resources. Involve key stakeholders in reviewing numbers of projected workers against quality standards related to infrastructure, for example, ratio of tutors to students, student lodging, clinical site requirements, etc. Having the involvement of key stakeholders in this process may help mobilize additional resources and political support needed.


Lessons Learned: Support Scale-Up

 The relevant professional council is a key stakeholder that should be intimately involved in your program planning, evaluation and any plans for scale-up. Although this type of collaboration may delay program implementation at times, for long-term sustainability and scalability, their partnership is one of the most important programmatic goals. Successful and sustained pre-service programs are built on a strong working relationship with the related professional council.

 Involve and use regional expertise throughout your program to help ensure program interventions are relevant and ensure continued support from regional bodies.