Pathways to scaling up interventions: Reflections from Delivering for Success at Scale

By Rittika Brahmachari, IIHMR

“Scaling up” is considered as a pertinent and scientific pathway recognized by academia and policy makers to reduce inequalities, to achieve the Sustainable Development Goals (SDGs), and for universal health coverage. To build upon and learn from the longstanding partnership between Bangladesh Rural Advancement Committee (BRAC), International Centre for Diarrheal Disease Research, Bangladesh (ICDDR,B), and the Institute of Development Studies (IDS), a two day conference was held on 7 -8 February in Dhaka, Bangladesh to share diverse perspectives, pathways and learnings from contextual settings to achieve successful scaling up of interventions and collaborations. The conference, in addition to throwing light on the pathways of scaling up of programs through our learnings, also acted as a potential accelerator for collaboration. This blog post shares five critical reflections from the conference mentioned below.

Partnership with government is essential

The importance of collaboration with the government to achieve successful scaling up of interventions was strongly highlighted throughout the conference. An example shared during a presentation was the history of successful coverage of Oral Rehydration Solution (ORS) in Bangladesh. From the very first stage of the intervention, BRAC, ICDDR,B and the Government of Bangladesh (GoB) collaborated with the aim of successfully scaling up interventions. Without effective collaboration between these partners and the communities, this intervention would not have been the success it was. The [Bangladesh ORS Case Study][1] (2014) by The University of Washington Global Health Start Program states that “The effort was successful and benefitted hugely from a supportive, continuous and consistent communication between the stakeholders.”

[1]: http://www.shopsproject.org/sites/default/files/resources/Bangladesh ORS Case Study.pdf

Despite the obvious potential of collaboration to bring the desired results, the overuse of the term ‘collaboration’ can cause confusion due to different understandings of the term and uneven application. Many desire to be collaborative, but few actually are. Hence, skills to implement actions that may ensure effective collaboration with government are needed. Multi-stakeholder platforms can foster partnership opportunities; however the sustainability of collaboration is very much depends on the availability of funding.

Engaging everyone, not just researchers: Implementation research

"There is a difference between paper implementation and actual one"- Malabika Sarkar, James P Grant School of Public Health (JPGSPH)

There is general confusion between implementation research, traditional experimental research (e.g. randomized Control Trials) and action research. Most implementation research remains on paper (for example, in proposals) rather than actually being implemented on the ground. One session tried to cast light on implementation research through diverse experiences from health, livelihood and nutrition research and interventions. One of the speakers said that, in implementation research, the research question must be formulated by the implementer. It is all about implementation and implementer, so taking into account the perspective and engagement of the implementer is very important. Here the contribution of implementer in formulating research questions and developing strategies should be more than those of researcher. The discussion concluded with the agreement that strengthening implementation research capacity is needed for successful scale-up.

The power of qualitative enquiry

Dr Mushtaque, Chowdhury, Vice Chairperson of BRAC, highlighted the importance of community engagement. Using the ORS case study as an example, he stated that ethnographic work can reveal a lot. After the intervention, it was found that there were no observed changes in people’s behavior in their use of ORS. Ethnographic work was undertaken, which identified the key problems which needed to be addressed for higher acceptance among the communities. It was then possible to work with the communities on these issues, and this led to a successful intervention. Dr Hilary Standing, from the Institute of Development Studies, also affirmed the significance of qualitative enquiry using participatory methods for effective implementation of programs.

I feel that passionate researchers who want to use ethnography and other qualitative approaches unfortunately don’t often get support on the ‘time front’ from funders. For effective evaluation and implementation research, the research community should consider increasing the use of qualitative enquiry alongside quantitative research, to help identify the gaps in any intervention.

Engaging Community

"It is important to think how communities are changing" - Dr Sabina Faiz Rachid, BRAC

Thinking about the above statement from Dr Sabina Rachid, I feel that in order to engage communities in research and interventions, we need to capture the transition; the present situations that communities are facing after globalization. Further interactions of implementers with the communities should take place in order to bring behavioral change among beneficiaries. We need to break the glass between researchers and communities. Researchers need to work with communities to address the common thinking that exists amongst the communities - ‘researchers are outsiders, they always talk in foreign languages’.

Knowledge portal

"We should have a knowledge platform to know about the programs" – conference delegate

One conference delegate stated that ‘we always came to know about such interesting studies only in conferences and seminars’ and suggested that there should be a platform. I always feel there is a gap in knowledge dissemination from interventions and research projects, with information often staying within groups of stakeholders, geographical locations, and/or grey literature. Knowledge dissemination among different stakeholders (policy makers, researchers, academics, practitioners, and local people) could hugely benefit from a platform – 'a knowledge portal'. This could contain knowledge derived from programs, interventions and research projects arranged thematically and geographically, and would help to avoid duplication of work, saving of resources to reach untouched areas, and wide dissemination of knowledge across the different audiences. Future Health Systems India is very much eager to create such knowledge portal on Health Systems. The initiative has been already started via social media. For example- Sundarbans Health Watch Facebook Page, Future Health Systems India Google group (fhsindia@googlegroup.com) and many other stakeholder platforms. I would be happy to hear any suggestions and comments on the same.

Internationally commended conferences serve as excellent platforms to foster collaborations, contextual learning’s within the given space. Conferences such as this one are needed to bring pertinent issues to the table.