The broad term scale-up encompasses several different paths to expansion of a successful innovation to reach more people in more areas. There is vertical scale-up: what is needed to address the situation at the health system level, as well as horizontal scale-up: what is needed to address the situation from a service delivery level. Scaling up is more likely to succeed when it is part of the project’s goals and activities from the beginning and stakeholders have been consistently engaged and involved. For both types of scale-up it is important to develop a systematic scale-up plan in collaboration with key stakeholders.

Horizontal scale-up plans should include: 

• Stakeholder engagement at all levels, from the ministry of health to local leaders.
• A focus on the regions with the greatest need, the most support, and the necessary infrastructure. It is likely not possible, nor appropriate, to scale up to all regions of the country at the same time.
• Identification of what characteristics of the demonstration phase are critical to successful scale up. There may be more limited resources, and as the scale of implementation expands the need to streamline and simplify – while not compromising the program – will be important to address. You will need to adapt your program model over time, yet it is important not to lose the essential characteristics of the model in this process. Consider

A scale up plan must also address these critical components:

• Timeline and scope of scale up
• Costs, financing, and resource mobilization
• Advocacy and information dissemination
• Monitoring and evaluation plan with indicators
• Roles of various partners
• Role of the ministry of health
• Supervision
• Training
• Logistics management
• Selection criteria for CBFP service providers

This section of the toolkit provides information, tools, and resources to guide policymakers, program planners, and technical assistance providers through the process of horizontal scale-up to broaden the reach of CBFP programs in an effective, sustainable manner. For resources to support vertical scale-up, go to the Policy & Advocacy section.