• Issues for scaling-up

Issues for scaling-up

This paper from the DFID Health Systems Resource Centre reviews current strategies for scaling up successful interventions to meet the health-related needs of the poorest in developing countries. Findings show that all mechanisms for targeting the poorest suffer from elements of leakage, as well as weak institutional and governance structures. However, these problems are outweighed by the distributive benefits of some schemes. Demand-driven financing (involving the provision of resources to supply services for a distinct group) also has potential for reaching the poorest. However, parallel interventions on the supply side are needed to ensure quality is raised in addition to coverage.

The authors identify several institutional obstacles to scaling-up small-scale interventions. These include prohibitive or unsustainable costs, problems with scaling up targeting mechanisms (which often rely on local knowledge to target the poor effectively), and the risks of capture of decentralised resources by local elites. Effective collaboration between local constituencies and local governments or agencies is also harder to replicate on a regional or national scale. Key principles for successful scaling-up are identified as: a gradualist approach, a serious commitment to shifting power to the local level, a focus on ease of replication, and working within existing structures. [adapted from author]

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