The main purpose of this concise guide is to lead you step-by-step through the process for initially implementing and then scaling up service improvements to Family Planning while providing links to relevant WHO and ExpandNet tools for more detail and specifics.



Successfully implementing and scaling up improvements to reproductive health services requires a strategic approach. The process must be participatory, listening to and learning from a wide range of stakeholders, especially the health services organization adopting the innovation and their clients, the consumers of health services. This goal can be achieved by following a concerted and deliberate process. There are five phases:

PHASE 1: Define the need for change

Step 1. Identify the problem and its causes. Turn the problem into a challenge or opportunity.

  • Establish the need for change and the reasons for making that change.
  • Establish ownership of the change process ahead.
  • Focus on causes rather than symptoms, resulting in sustainable change.
  • Turn complaints into positive spurs to change.

Step 2. Identify and agree on the desired change, its purpose, anticipated results and potential obstacles.

  • Build a consensus that all participants can work toward.
  • Reach common understanding and agreement on the desired change and the course to making it.

For further information see WHO Concise Guide to Implementing and Scaling up FPS Improvements

PHASE 2: Plan for a demonstration or pilot test of a programme innovation

Step 1. Select a change agent and a resource team to draw up the demonstration plan.

  • Put a single person in charge and gives that person authority to lead.
  • Create a team with the skills and access to resources to support the change agent and the process of change
  • Involve stakeholder groups in the resource team and builds their buy-in.

Step 2. Identify practices used elsewhere that may address the problem.

  • Identify what is likely to work
  • Confirm that change is possible.

Step 3. Choose and adapt a proven practice.

  • Decide on a cohesive set of changes – an innovation – that appears to best address the challenge.
  • Make changes to the innovation as applied elsewhere so that it fits the present needs and context.

Step 4. Design the demonstration plan and its monitoring.

  • Develop a demonstration that will convincingly test the effectiveness and feasibility of the innovation.
  • Clarify with stakeholders the purpose of testing.
  • Develop indicators to monitor progress and gauge the success and sustainability of the innovation.

Step 5. Make initial decisions about how to scale up.

  • Plan ahead for scaling up, should the demonstration succeed and decision-makers agree.

For further information see WHO Concise Guide to Implementing and Scaling up FPS Improvements

PHASE 3: Conduct the demonstration

Step 1. Help to create and maintain an environment that will encourage change.

  • Support the change agent, resource team and staff at the test sites throughout the demonstration.

Step 2. Use the change plan and indicators to continually assess, monitor, and modify the change effort.

  • Obtain evidence to inform decisions on scaling up.
  • Learn from the ongoing demonstration and adjust the innovation to improve the chances that the demonstration and, later, scale-up, will succeed.

For further information see WHO Concise Guide to Implementing and Scaling up FPS Improvements

PHASE 4: Plan for scale-up and go to scale

Step 1. Evaluate lessons from the demonstration and decide whether to scale up.

  • Reach a "Go" or "No go" decision on the basis of evidence from the demonstration..

Step 2. If the demonstration has succeeded and a decision to scale up has been made, design a scale-up strategy that best suits the country or regional programme environment.

  • Adapt scale-up to the environment.
  • Make crucial decisions about how scaling up will take place.
  • Using a systematic process, anticipate and prepare for steps and directions in the course of scaling up.

Step 3. Engage the commitment of a broad group of stakeholders and secure resources to support the scale-up strategy.

  • Build wider support for scaling up the innovation across service organizations, policy-makers, ministries, NGOs, consumers and other stakeholders.
  • Help to assure that resources are sufficient for full scale-up and then sustainability.
Both these purposes contribute to the sustainability of the innovation at full scale.

Step 4. Carry out the scale-up strategy, building the innovation into policies, systems, programmes, plans, budgets and performance expectations.

  • Mainstream the innovation and fosters its sustainability.

For further information see WHO Concise Guide to Implementing and Scaling up FPS Improvements

PHASE 5: Monitor and evaluate

M&E is not really the last phase of going to scale. Rather, it should begin early on, incorporated into the plan for the demonstration and continuing even after scale-up is completed.

  • During implementation, provide evidence to identify the need for mid-course corrections and to inform their direction.
  • After implementation, provide objective evidence of the results and impacts of the scaled-up innovation.
  • Document and make known the accomplishments and shortcomings of changed practices.
  • Learn lessons about the scale-up process for application to other scale-up efforts.

For further information see WHO Concise Guide to Implementing and Scaling up FPS Improvements