Phase 7: Scale Up -- Spreading Your Success

Scaling up community mobilization means going beyond a single or limited number of communities to have greater impact at the regional, national or even multinational level. The challenge for communities is to expand their effective participatory approaches beyond a relatively small population without diminishing the quality and impact.

BEFORE YOU SCALE UP

STEP 1: Have a vision to scale up from the beginning of the project

From the start of a CM program, your team needs to envision how this approach could be expanded if it is successful. The team should discuss the potential and possible steps for achieving scale. Identify point people and provide them with adequate time and resources to ensure that these steps are followed.

STEP 2: Determine the effectiveness of the approach

It is important to establish that the technical intervention, methodology or approach that is being considered for scaling up leads to desired results through carefully evaluated and documented research. The demand for innovative and new approaches to involving communities in improving their health is, in some cases, leading to scaling up some approaches too quickly, without proof that the new approaches really do improve health or lead to other positive results.

STEP 3: Assess the potential to scale up

Not all programs have the potential to scale up, or at least not in their existing form. It's important, then, to assess the possibilities for scaling up and the potential barriers.

STEP 4: Consolidate, define and refine

The program design and/or interventions should be simplified as much as possible and written documents should be accessible in user-friendly language. Documenting and refining successful approaches is the first step.

STEP 5: Build a consensus to scale up

You will need to lay a foundation for scaling up. Principally, this means building consensus for scaling up among decision makers, implementers and leaders of those who participate in the program. You will have to introduce the intervention and make the case for its added value to key individuals and groups.

STEP 6: Advocate for supportive policies

Before expanding a community mobilization program, you will need to look at the existing policies in the country and determine whether or not they present any barriers to effective large-scale program implementation. If there are policies that will seriously restrict the ability of the program to function, you should consider whether these policies could or should be changed

AS YOU SCALE UP

STEP 7: Define the roles, relationships and responsibilities of implementing partners

All of the partners will need to determine who will be responsible for program training, supervision, monitoring and evaluation, resource allocation, funding procurement, management and information systems and other functions.

STEP 8: Secure funding and other resources

The amount of funding needed for large-scale programs is often not available through only one donor. You will probably need to negotiate contracts, budgets, and work plans both with partners and donors.

STEP 9: Develop the partners' capacity and capability to implement the program

An organization that chooses to adopt a new approach to community mobilization is not usually able to effectively implement it without orientation, training and technical assistance. You will, therefore, need to prepare training and technical assistance teams and materials for use at the regional or other levels depending on organizational structure.

STEP 10: Establish and maintain a monitoring and evaluation system

Program implementers need to meet regularly on the local, regional and national levels to monitor progress, identify problems, develop innovative solutions, strengthen skills and build the team. It is important to establish participatory systems that provide for regular monitoring of process and outcome indicators. Instruments and tools to help program teams monitor their progress should be developed and used to synthesize information and detect trends over time.

STEP 11: Support institutional development for scale

For community action to be sustained over the long term on a larger scale, it needs to depend not on individuals but on organizations and/or networks dedicated to the issue-in this case, health. Advocacy groups and coalitions can build support for ongoing assistance to communities as they learn to better identify and address their health needs.

SCALING UP-LESSONS LEARNED

  • To scale up successfully, management and coordination systems must be carefully designed so that information, human and financial resources can be used most effectively to reach greater numbers of families in need.

  • Inter-institutional coordination is key to the success of the scaling-up effort. The coordination with the Ministry of Health is not just at the executive level, but negotiation and action takes place at the regional, district, sector and area levels as well.

  • Training and technical assistance in program methods must be provided and a variety of media used to spread the methodology, tools and lessons learned on a regional, national level or international level. Establish a small team that will provide technical assistance and training to other organizations or communities that choose to implement the program.

  • The technical personnel in charge of coordinating with partner agencies should possess the following characteristics: high level of skill in non-formal education methodologies, speak the regional language, exceptional interpersonal skills so that they are capable of obtaining the acceptance of the communities, and commitment to stay with the project for at least two years.

  • Work with communities that participated in the successful initial pilot sites to establish them as "living universities" where others who want to learn the methodology can go to get hands-on training and experience in the field.

  • Spread the use of successful methods and tools through regional or international workshops or conferences. Training tools can be introduced at workshops where participants can practice using them. Support groups of trainees can be established so that they can learn from each other's experiences and provide assistance when implementation does not go exactly as planned.

  • Organizations will learn what works and does not work through their own experience in the field. The benefit of having on-the-ground technical assistance from organizations that have successfully implemented the methodology is that these lessons have often already been learned and could have been shared with new partners. This also points to the need for very detailed documentation, not only of the methods used, but the rationale behind them.

  • Develop mechanisms to aid communities that are interested in replicating or adapting the methodology or using the tools. Contact information at the end of the television or radio programs or print stories can lead the audience to a web site or contact address for more information. Media centers and clearinghouse experience will prove invaluable in this effort.

  • Define the parameters of the partnership at the beginning. If possible, make the terms as clear to both parties as possible by forging a written Memorandum of Agreement or Understanding

  • Partners need to work from the same paradigm. Both organizations should operate on the principle that workable and sustainable community health activities should be designed within the context of a community-managed health system, and not just from the point of view of the health providers.

  • Partners must have a mutual trust for and be open and honest with each other to survive. They should recognize mutually beneficial strengths and help each other overcome weaknesses, and they should seize every opportunity to strengthen the partnership through other activities or projects even if they are outside the bounds of the partnership.

  • Look beyond linear or one-on-one partnerships. Inter organizational learning involves not only sharing each other's special skills, but also the pool of technical resources that may be made available through each other.