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:
Step 1. Identify the problem and its causes. Turn the problem into a challenge or opportunity.
Step 2. Identify and agree on the desired change, its purpose, anticipated results and potential obstacles.
Step 1. Select a change agent and a resource team to draw up the demonstration plan.
Step 2. Identify practices used elsewhere that may address the problem.
Step 3. Choose and adapt a proven practice.
Step 4. Design the demonstration plan and its monitoring.
Step 5. Make initial decisions about how to scale up.
Step 1. Help to create and maintain an environment that will encourage change.
Step 2. Use the change plan and indicators to continually assess, monitor, and modify the change effort.
Step 1. Evaluate lessons from the demonstration and decide whether to scale up.
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.
Step 3. Engage the commitment of a broad group of stakeholders and secure resources to support the scale-up strategy.
Step 4. Carry out the scale-up strategy, building the innovation into policies, systems, programmes, plans, budgets and performance expectations.
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.