From Pilot to Practice – Planning for Scale and Sustainability from the Beginning

• In Event: Improving Effectiveness and Sustainability by Localizing Evidence: Models for Testing, Scaling, and Institutionalizing What Works

Proposal

Scale up and sustainability are the ultimate goals of most pilot projects. However, how to achieve institutionalization and sustain effective practices is typically left to each project to define for itself and chart a course independently. Successfully navigating this pilot-to-practice journey to meet scale up and sustainability goals is a critical element, yet has been a challenge for many global interventions. There is need for more evidence on what works to increase the success of scale up and sustainability.

The Improving Supply Chains for Community Case Management of Pneumonia and Other Common Diseases of Childhood (SC4CCM) was a five year learning project implemented by JSI Research & Training Institute, Inc. SC4CCM’s goal was to identify proven, simple, affordable solutions to address the unique supply chain challenges of community health workers (CHWs). Working with government integrated community case management (iCCM) programs in Ethiopia, Malawi, and Rwanda, SC4CCM tested supply chain interventions aimed at improving supply chain practices and access to medicines so CHWs can treat common childhood illnesses. The five year project was charged with both learning what practices were effective and then working with local governments and partners to institutionalize and sustain those practices in each national context.

We used a mixed-methods study design to 1) identify what approaches worked across the three implementation contexts to move the interventions from pilot to scale to practice, and 2) assess the opportunities and risks to institutionalization and sustainability. The purpose was to lay bare the process of scaling, institutionalizing, and sustaining a systems-based innovation from our specific multi-country project in the hopes of contributing to the success of the scale up, institutionalization, and sustainability of other health systems interventions.

Based on SC4CCM’s five year experience, we identified three distinguishable stages of the journey:

1. Pilot - Laying the foundation for scale and institutionalization during the pilot stage;
2. Scale- Transforming pilot successes into practice at scale using a strategy built on evidence from the pilot; and,
3. Practice - Integrating successful practices into organizational structures so that the benefits can be realized more broadly within the health system.

During this panel, SC4CCM will discuss the project’s process, the model developed, and applicability to other pilots, across sectors. We will discuss the tools developed and highlight a number of key takeaways that are relevant to projects of any type, such as:

-Pilot projects must start by deliberately intending to scale and institutionalize successful parts of the intervention, and by also explicitly planning for activities to support scale up when the project is being conceived and designed.
-Pilot projects must invest in continuous, collaborative engagement with system stakeholders from the outset, along with proving the benefits of the intervention.
-Stakeholders should recognize that there is no endpoint to the journey from pilot to sustained organizational practice; a continuous improvement process, continued political commitment, and reliable financing are all necessary ongoing investments for the process to produce sustained benefits.

Author

• Barbara Lamphere