Beginning with Sustainable Scale up in Mind: Initial results from an integrated population, health and environment project in East Africa
Small-scale pilot projects have demonstrated that integrated population, health and environment approaches can address the needs and rights of vulnerable communities. However, these and other types of health and development projects rarely influence larger policies and programmes. ExpandNet, a network of health professionals working on scaling up, argues this is because projects are often not designed with sustainability and scaling up in mind. This paper shows how this new approach is being applied and the initial lessons from its use in the Health of People and Environment in the Lake Victoria Basin Project (HoPE-LVB) currently underway (2011-2017) in Uganda and Kenya. Specific emerging lessons are: 1) ongoing, meaningful stakeholder engagement has significantly shaped the design and implementation, 2) multi-sectoral projects are complex and striving for simplicity in the interventions is challenging, and 3) projects that address a sharply felt need experience substantial pressure for scale up, even before their effectiveness is established. This paper recommends that other projects would also benefit from applying a scale-up perspective from the outset.