Scaling Up
What do we mean by ‘scaling up'?
The term ‘scaling up' is used to encompass different strategies to expand the scope, reach and impact of our responses to HIV. In the Code we use the term to refer to expanding the geographical or population reach of HIV-specific programmes and integrating HIV-specific interventions within other health programming, such as sexual and reproductive health and child and maternal health programmes, as well as mainstreaming HIV within development and humanitarian programming.
Giving the devastating impact of HIV in many developing countries, the need for sustained responses of a sufficient scale to affect the dynamics of the epidemic is abundantly clear. The scaling up of responses needs to be as significant a priority for countries where prevalence is low and where it is still possible to prevent epidemics from spiralling out of control as it is in countries where HIV is having a more visible impact.
The challenges associated with scaling up are one of the primary motivations for the development of this Code. While considerable expertise and knowledge exist about what works to prevent HIV transmission and meet the range of needs of PLHIV and affected communities, many programmes have yet to become comprehensive in their coverage. There is also much more to be done in mainstreaming HIV in order to respond more effectively to the causes and consequences of HIV.
The good practice principles in this section concerning how to scale up can be more readily applied to existing HIV programmes and to integrating HIV work into other health and related programming, as efforts to mainstream HIV are relatively underdeveloped. The Code also considers mainstreaming HIV within development and humanitarian programmes and draws on experience to date to guide these emerging approaches to the HIV response.
There is much that can be learned from smaller-scale initiatives that has wider relevance and application. However, scaling up NGO programmes is complex. It is critical to recognise and address the new challenges involved in the process of scaling up. Resources need to be made available in a manner that supports the complexity of the process. Careful planning is needed to determine what programmes are capable of being scaled up, given the nature of the epidemic in a given context. Pressures to meet government and/or donor expectations in order to secure continued resources for scaling up must be balanced with the need to maintain community ownership and a realistic assessment of the capacity of organisations to scale up.
There are numerous different strategies for scaling up, including:
- expanding organisational size and/or scope
- applying cascading and multiplication models, which involve the provision of intensive training to groups who can subsequently provide training to others
- adapting concepts and models so that effective programme approaches can be adapted andreplicated
- building practical working partnerships to develop joint initiatives to increase the reach and impact of programming through combined efforts
- catalysing and supporting others by providing technical support
- decentralising services by transferring decision-making and programme coordination from a central location to a more local level, and
- influencing laws and policy that affect the effectiveness of HIV programming.
The strategies employed will vary depending on NGO implementing programmes and whether the organisation concerned is a Supporting NGO. Supporting NGOs are likely to play a role in catalysing and supporting others to scale up programmes. This section provides both good practice principles in scaling up for NGOs generally, as well as outline good practice principles in scaling up that are specific to Supporting NGOs.
THE PRINCIPLES:
We work to scale up appropriate programmes while ensuring their quality and sustainability.
We monitor and evaluate programmes that are scaled up.