Step 4

Scaling up a policy or intervention


An approach to working with country teams to scale-up strategies has been developed by ExpandNet in collaboration with WHO.

This approach entails a nine step guide for developing a scaling-up strategy:

  1. Planning actions to increase the scalability of the innovation
  2. Increasing the capacity of the user organization to implement scaling up
  3. Assessing the environment and planning actions to increase the potential for scaling-up success
  4. Increasing the capacity of the resource team to support scaling up
  5. Making strategic choices to support vertical scaling up (institutionalization)
  6. Making strategic choices to support horizontal scaling up (expansion/replication)
  7. Determining the role of diversification
  8. Planning actions to address spontaneous scaling up
  9. Finalizing the scaling-up strategy and identifying next steps

Please refer to the guide for further information.

ExpandNet is a global network of representatives from international organizations, nongovernmental organizations, academic and research institutions, ministries of health and specific projects who seek to advance the science and practice of scaling up.

Case study 6: Scaling up – Physical activity interventions, Brazil

Sustainability planning tools

Some other useful sustainability planning tools can be found here:

Program Sustainability Assessment Tool developed by the Centre for Public Health Systems Science at George Warren Brown School of Social Work:
(accessed 14 October 2016).

Ontario Health: Implementing and sustaining changes:
(accessed 14 October 2016).

NHS: Sustainability Model and Guide:
(accessed 14 October 2016).

McGrath KM, Bennett DM, Ben-Tovim DI, Boyages SC, Lyons NJ, O’Connell TJ. Implementing and sustaining transformational change in health care: lessons learnt about clinical process redesign. Med J Aust. 2008; 188 (6):32.

Guidelines for reporting of health interventions using mobile phones: mobile health (mHealth) evidence reporting and assessment (mERA) checklist:(102)