Scale Up

Scaling up community-based access to injectables (CBA2I) and other community-based family planning services is a promising approach to expanding access to contraceptive care on a large scale. The broad term scale-up encompasses several different paths to expansion of a successful innovation.

  • Spontaneous scale-up occurs when an innovation addresses a strongly felt need within a program or community and is unsystematically shared among individuals or adopted from the pilot community to other settings. Because effective scale-up nearly always requires careful planning and implementation, spontaneous scale-up is rarely successful.
  • Horizontal scale-up, also referred to as expansion or replication, describes instances when innovations are replicated in new geographical locations or expanded to serve larger or additional populations. A key factor in the success of horizontal scale-up efforts is balancing the need to adapt the innovation to new contexts while maintaining fidelity to the original innovation.
  • Vertical scale-up refers to the political, legal, and institutional scale-up of an innovation. Vertical scale-up involves the adoption of an innovation on a national or regional level, whereby policy change, legal action, and systemic and structural changes are made to support sustainable scale-up of the innovation.
  • Finally, functional scale-up, also termed diversification or grafting, occurs when new interventions are tested and added to an existing package of services. 
Increasingly, the global health community recognizes a growing need for systematic guidance on sustainable scale-up practices. As governments, nongovernmental organizations, researchers, and others look for ways to expand the impact of community-based access to injectables (CBA2I), comprehensive strategies which take into account the key determinants of successful scale-up and lessons learned from other scale-up experiences must be developed and implemented. This section of the toolkit provides information, tools, and resources to guide policymakers, program planners, and technical assistance providers through the process of scale-up to broaden the reach of CBA2I programs in an effective, sustainable manner.