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?

…is it about change?

…or evolution?

Gillespie, S., Menon, P., Kennedy, A (2015) Scaling Up Impact on Nutrition: What Will It Take? Advances in Nutrition, July 2015, forthcoming

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

Results:

9 key considerations

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

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”

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?

4. Drivers and barriers

• Internal and external• Actors/stakeholders– Leaders, champions, policy entrepreneurs

• Government ownership• Incentives/disincentives

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.

6. Capacity to scale up

• Defined by level…– Individual, organizational, systemic

• …..and by purpose– Strategic and operational capacities are key– Capacity to make demands

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.

Coherence: Together for nutrition

Vertical coordination

high

Strong coherence across and within sectors

low

low highHorizontal coordination

15

8. Financing scale up

• Adequacy• Stability• Flexibility

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

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

19

Why we need to come together for nutrition

Thank you

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