Scaling up health policies and services in low- and middle-income settings


This article is part of the supplement: 'Scaling-up health services in low- and middle-income settings', and serves as the introduction to the other papers in the supplement.

Scaling up” effective health services is high on the policy agendas of many countries and international agencies. The current concern has been driven by growing recognition both of the challenges of achieving the health-related Millennium Development Goals (MDGs) in many countries, and of the need to ensure that the increased resources for health channelled through disease-specific health initiatives are able generate health gain at scale. Effective and cost-effective interventions exist to address many of the major causes of disease burden in the developing world, but coverage of many of these services remains low. There is a substantial gap between what could be achieved and what is actually being achieved in terms of health improvement in low- and middle-income countries. A recent review article and a set of accompanying commentaries documented the origins and use of the term scaling up in international health, and identified a number of critical themes or issues in scaling up health policies and interventions: - the cost of scaling up and resources required to expand service delivery , including the trade-offs that may arise between equity and efficiency - the constraints to scaling up that operate at different levels, from the household and community level through to the service delivery, strategic and national policy, and cross-sectoral levels - the potential synergies and deleterious health system effects of global health initiatives - the opportunities afforded by novel approaches to service delivery, including making use of private sector delivery channels. However, despite increased conceptual clarity in this area, there remains relatively little empirical evidence on these themes.

In June 2009 the Consortium for Research on Equitable Health Systems, a research programme funded by the UK Department for International Development which brings together 8 health policy and systems research groups from 7 countries, hosted a writing workshop on the theme of Scaling Up Health Policies and Interventions. Workshop participants, drawn from CREHS members and collaborators, presented and discussed research they had been conducting across a variety of programmatic areas linked to this theme. The eight papers in this supplement represent a selection of the papers presented at this workshop. Together, they contribute a rich set of new evidence about the barriers to scaling up, the opportunities for overcoming these through changes in financing arrangements and service delivery innovations, and the critical importance of the processes of managing change in order to realise the promise of scaled up programmes and interventions.


BMC Health Services Research (2010), 10 (Suppl 1): I1 [doi:10.1186/1472-6963-10-S1-I1]

Scaling up health policies and services in low- and middle-income settings

Published 1 January 2010