Scaling up in international health: what are the key issues?
Lindsay J Mangham and Kara Hanson
Health Economics and Financing Programme, London School of Hygiene and Tropical Medicine, London, UK
Health Policy & Planning, March 2010, volume 25, no. 2
Editors' Choice Free Access paper
Available online at: http://heapol.oxfordjournals.org/cgi/content/full/25/2/85
“…….The term ‘scaling up’ is now widely used in the international health literature, though it lacks an agreed definition. We review what is meant by scaling up in the context of changes in international health and development over the last decade. We argue that the notion of scaling up is primarily used to describe the ambition or process of expanding the coverage of health interventions, though the term has also referred to increasing the financial, human and capital resources required to expand coverage.
We discuss four pertinent issues in scaling up the coverage of health interventions: the costs of scaling up coverage; constraints to scaling up; equity and quality concerns; and key service delivery issues when scaling up.
We then review recent progress in scaling up the coverage of health interventions. This includes a considerable increase in the volume of aid, accompanied by numerous new health initiatives and financing mechanisms.
There have also been improvements in health outcomes and some examples of successful large-scale programmes. Finally, we reflect on the importance of obtaining a better understanding of how to deliver priority health interventions at scale, the current emphasis on health system strengthening and the challenges of sustaining scaling up in the prevailing global economic environment. ….”
Three accompanying commentaries:
Lucy Gilson and Helen Schneider
Commentary: Managing scaling up: what are the key issues?
Susan M Cleary
Commentary: Trade-offs in scaling up HIV treatment in
Viroj Tangcharoensathien and Walaiporn Patcharanarumol
Commentary: Global health initiatives: opportunities or challenges?
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