Scaling up nutrition: what will it take?
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Transcript of Scaling up nutrition: what will it take?
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Scaling up nutrition: what will it take?
Stuart GillespieInternational Food Policy Research Institute
Addis Ababa, 15 June 2015
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Is it about making something bigger?....
….or about generating greater impact?
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…is it about change?
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…or evolution?
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Gillespie, S., Menon, P., Kennedy, A (2015) Scaling Up Impact on Nutrition: What Will It Take? Advances in Nutrition, July 2015, forthcoming
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Methods• Literature search
– Google Scholar, PubMed, Expandnet and Brookings bibliographies (2000-2014)
• Keywords: – scaling up, going to scale, diffusion, expansion, mainstreaming, nutrition,
health, agriculture, development.
• Active consultation with key experts• Condensed to 55 papers
– Theoretical frameworks (36)– Program experiences (19)
• In-depth case studies of 4 scaled up programs
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Results:
9 key considerations
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1. Vision: where are we going?
• Has the vision been clearly and collectively articulated with a compelling narrative that explains why it’s important, and how it can be attained?
• “Beginning with the end in mind” (WHO/Expandnet 2011)
• Appropriate indicators of impact and success are needed to crystallize the vision, as well as to ensure accountability
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2. What is being scaled?• A process, principle, project, technology,
innovation, or methodology?• Is there evidence of efficacy? Of large-scale
effectiveness?• Interventions differ in “scalability”
– relative advantage over existing products and practices– compatibility with existing values and practices– simplicity and ease of use– visibility of results– adaptability and “communicability”
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3. Under what conditions?
• Social, economic, cultural, political and historical• Institutional arrangements• Community and household contexts• Implementation context– Stand-alone projects vs. integrated programs
• Are these conditions enabling or disabling?• Can an enabling environment be created?
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4. Drivers and barriers
• Internal and external• Actors/stakeholders– Leaders, champions, policy entrepreneurs
• Government ownership• Incentives/disincentives
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5. Scaling up strategy• What will be done, and how will it be done?• Theory of change• Processes and pathways:
– Quantitative: intervention expands in size, geographical base, or budget (also referred to as ‘scaling out’);
– Functional: increases in the types of activities and integration with other programs;
– Political: increases in political power and engagement;
– Organizational: increases in organizational strength/capacity.
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6. Capacity to scale up
• Defined by level…– Individual, organizational, systemic
• …..and by purpose– Strategic and operational capacities are key– Capacity to make demands
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7. Governance
• Structures and systems underpinning scale up• Horizontal (cross-sectoral)• Vertical (national to local) coherence• “Scaling down” (of central power, resources) often
needed for sustainable scale up.
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Coherence: Together for nutrition
Vertical coordination
high
Strong coherence across and within sectors
low
low highHorizontal coordination
15
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8. Financing scale up
• Adequacy• Stability• Flexibility
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9. M&E, learning, accountability
• Limited evaluations of large-scale programs– Coverage, quality, equity, sustainability and
outcomes– Impact pathways (how was it achieved)
• Even fewer evaluations of scaling up processes
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9 elements
1. Vision2. What is being scaled?3. Enabling environment4. Drivers and barriers5. Strategy (what and how)6. Capacity 7. Governance8. Finance9. M&E, learning, accountability
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19
Why we need to come together for nutrition
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Thank you
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