Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Globalization and Health
Published in: Globalization and Health 1/2018

Open Access 01-12-2018 | Research

‘The development sector is a graveyard of pilot projects!’ Six critical actions for externally funded implementers to foster scale-up of maternal and newborn health innovations in low and middle-income countries

Authors: Neil Spicer, Yashua Alkali Hamza, Della Berhanu, Meenakshi Gautham, Joanna Schellenberg, Feker Tadesse, Nasir Umar, Deepthi Wickremasinghe

Published in: Globalization and Health | Issue 1/2018

Login to get access

Abstract

Background

Donors often fund projects that develop innovative practices in low and middle-income countries, hoping recipient governments will adopt and scale them within existing systems and programmes. Such innovations frequently end when project funding ends, limiting longer term potential in countries with weak health systems and pressing health needs. This paper aims to identify critical actions for externally funded project implementers to enable scale-up of maternal and newborn child health innovations originally funded by the Bill & Melinda Gates Foundation (‘the foundation’), or influenced by innovations that were originally funded by the foundation in three low-income settings: Ethiopia, the state of Uttar Pradesh in India and northeast Nigeria. We define scale-up as the adoption of donor-funded innovations beyond their original project settings and time periods.

Methods

We conducted 71 in-depth, semi-structured interviews with representatives from government, donors and other development partner agencies, donor-funded implementers including frontline providers, research organisations and professional associations. We explored three case study maternal and newborn innovations. Selection criteria were: a) innovations originally funded by the Bill & Melinda Gates Foundation (‘the foundation’), or influenced by innovations that were originally funded by the foundation; b) innovations for which a decision to scale-up had been made, allowing us to reflect on the factors influencing those decisions; c) innovations with increased geographical reach, benefitting a greater number of people, beyond districts where foundation-funded implementers were active. Our data were analysed based on a common analytic framework to aid cross-country comparisons.

Results

Based on study respondents’ accounts, we identified six critical steps that donor-funded implementers had taken to enable the adoption of maternal and newborn health innovations at scale: designing innovations for scale; generating evidence to influence and inform scale-up; harnessing the support of powerful individuals; being prepared for scale-up and responsive to change; ensuring continuity by being part of the transition to scale; and embracing the aid effectiveness principles of country ownership, alignment and harmonisation.

Conclusions

Six critical actions identified in this study were associated with adopting and scaling maternal and newborn health innovations. However, scale-up is unpredictable and depends on factors outside implementers’ control.
Literature
1.
Araujo J, Filho R. Developing and operational framework for health policy analysis. Revista Brasileira de Saúde Materno Infanti. 2001;1(3):203–21.
2.
Atun R, de Jongh T, Secci F, Ohiri K, Adeyi O. Integration of targeted health interventions into health systems: a conceptual framework for analysis. Health Policy Plan. 2010;25:104–11.PubMed
3.
Barker P, Reid A, Schall M. A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa. Implement Sci. 2016;11(12):1–11.
4.
Bradley E, Curry L, Taylor L, Wood Pallas S, Talbert-Slagle K, Yuan C, et al. A model for scale-up of family health innovations in low-income and middle-income settings: a mixed methods study. BMJ Open. 2012;2(4):1–12.
5.
Buse K, Walt G. An unruly mélange? Coordinating external resources to the health sector: a review. Social Science and Medicine 1997;45(3):449-63.
6.
Clark J. How to review a qualitative manuscript. In: Godlee F, Jefferson T, editors. Peer review in health sciences. 2nd ed. London: BMJ Books; 2003.
7.
Cooley L, Kohl R. Scaling up from vision to large-scale change: a management framework for practitioners. Arlington: Management services international; 2006.
8.
Countdown to 2015a. The 2015 Report for Ethiopia.
9.
Countdown to 2015b. The 2015 Report for Nigeria.
10.
Dearing J. Evolution of diffusion and dissemination theory. J Public Health Manag Pract. 2008;14(2):99–108.PubMed
11.
Dixon-Woods M, Agarwal S, Jones D, Young B, Sutton A. Synthesising qualitative evidence: a review of possible methods. J Health Serv Res Policy. 2005;10(1):45–53.PubMed
12.
Greenhalgh T, Robert G, MacFarlane F, Bate P, Kyriakdou O. Diffusion of innovations in service organisations: systematic review and recommendations. Milbank Q. 2004;82(4):581–629.PubMedPubMedCentral
13.
Halcombe E, Davidson P. Is verbatim transcription of interview data always necessary? Appl Nurs Res. 2006;19(1):38–42.
14.
Hanson K, Ranson K, Oliveira-Cruz V, Mills A. Expanding access to priority health interventions: a framework for understanding the constraints to scaling up. J Int Dev. 2003;15:1–14.
15.
Hardee K, Ashford L, Rottach E, Jolivet R, Kiesel R. The Policy Dimensions of Scaling up Health Initiatives. Washington: Futures Group, Health Policy Project; 2012.
16.
Kumar V, Kumar A, Ghosh A, Samphel R, Yadav R, Yeung D, Darmstadt G. Enculturating science: community-centric design of behaviour change interventions for accelerating health impact. Semin Perinatol. 2015;39(5):393–415.PubMed
17.
Paina L, Peters D. Understanding pathways for scaling up health services through the lens of complex adaptive systems. Health Policy Plan. 2011;27(5):365e373.
18.
Pope C, Mays N. Analyzing qualitative research in health care. London: Wiley-Blackwell; 2000.
19.
Seale C. Researching Society and Culture. London: Sage; 2017.
20.
Sgaier S, Ramakrishnan A, Dhingra N, Wadhwani A, Alexander A, Bennett S, Bhalla A, Kumta S, Jayaram M, Gupta P, Piot P, Bertozzi A, Anthony J. How the Avahan HIV prevention program transitioned from the Gates Foundation to the government of India. Health Affairs. 2013;32(7):1265-1273.
21.
Shorten T, Taylor M, Spicer N, Mounier-Jack S, McCoy D. The International Health Partnership Plus: rhetoric or real change? Results of a self-reported survey in the run-up to the 4th high level forum on aid effectiveness in Busan. Glob Health. 2012;8:13.
22.
Shiffman J, Smith S. Generation of political priority for global health initiatives: a framework and case study of maternal mortality. Lancet. 2007;370:1370–79.
23.
Simmons R, Fajans P, Ghiron L, Johnson B. Managing scaling up. In: Cash R, Chowdhury A, Smith G, Ahmed F, editors. From One to Many: Scaling Up Health Programs in Low Income Countries. Bangladesh: University Press Limited of Dhaka; 2010.
24.
Spicer, N, Berhanu, D, Bhattacharya, D, Tilley-Gyado, R, Gautham, M, Schellenberg, J. ‘The stars seem aligned’: a qualitative study to understand the effects of context on scale-up of maternal and newborn health innovations in Ethiopia, India and Nigeria. Glob Health 2016;12.
25.
Spicer N, Bhattacharya D, Dimka R, Fanta F, Mangham-Jefferies L, Schellenberg J. Scaling-up is a craft not a science’: Catalysing scale-up of health innovations in Ethiopia, India and Nigeria. Soc Sci Med. 2014;121:30–8.PubMed
26.
UNICEF. The situation of children in India: a profile. In: UNICEF; 2011.
27.
World Health Organization and ExpandNet. Nine steps for developing a scaling-up strategy. Geneva: WHO; 2010.
28.
World Health Organization and ExpandNet. Beginning with the end in mind: planning pilot projects and other programmatic research for successful scaling up. Geneva: WHO; 2011.
29.
30.
Yamey G. What are the barriers to scaling up health interventions in low and middle income countries? A qualitative study of academic leaders in implementation science. Glob Health. 2012;8:11.
31.
Yin R. Case study research and applications: design and methods. London: Sage; 2018.
Metadata
Title
‘The development sector is a graveyard of pilot projects!’ Six critical actions for externally funded implementers to foster scale-up of maternal and newborn health innovations in low and middle-income countries
Authors
Neil Spicer
Yashua Alkali Hamza
Della Berhanu
Meenakshi Gautham
Joanna Schellenberg
Feker Tadesse
Nasir Umar
Deepthi Wickremasinghe
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Globalization and Health / Issue 1/2018
Electronic ISSN: 1744-8603
DOI
https://doi.org/10.1186/s12992-018-0389-y

Other articles of this Issue 1/2018

Globalization and Health 1/2018 Go to the issue

Methodology

Oppression, liberation, wellbeing, and ecology: organizing metaphors for understanding health workforce migration and other social determinants of health

Research

Does quality influence utilization of primary health care? Evidence from Haiti

Research

European Union citizens’ views on development assistance for developing countries, during the recent migrant crisis in Europe

Commentary

Wicked problems and a ‘wicked’ solution

Research

Global supermarkets’ corporate social responsibility commitments to public health: a content analysis

Debate

Strategies to integrate community-based traditional and complementary healthcare systems into mainstream HIV prevention programs in resource-limited settings