Open Access Highly Accessed Research article

Do we have the right models for scaling up health services to achieve the Millennium Development Goals?

Savitha Subramanian1, Joseph Naimoli2, Toru Matsubayashi1 and David H Peters1*

Author Affiliations

1 Johns Hopkins University Bloomberg School of Public Health, Department of International Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA

2 U.S. Agency for International Development GH/AA, Rm 5.07-101 RRB 1300 Pennsylvania Ave., NW Washington, DC, 20523, USA

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BMC Health Services Research 2011, 11:336  doi:10.1186/1472-6963-11-336

Published: 14 December 2011

Abstract

Background

There is widespread agreement on the need for scaling up in the health sector to achieve the Millennium Development Goals (MDGs). But many countries are not on track to reach the MDG targets. The dominant approach used by global health initiatives promotes uniform interventions and targets, assuming that specific technical interventions tested in one country can be replicated across countries to rapidly expand coverage. Yet countries scale up health services and progress against the MDGs at very different rates. Global health initiatives need to take advantage of what has been learned about scaling up.

Methods

A systematic literature review was conducted to identify conceptual models for scaling up health in developing countries, with the articles assessed according to the practical concerns of how to scale up, including the planning, monitoring and implementation approaches.

Results

We identified six conceptual models for scaling up in health based on experience with expanding pilot projects and diffusion of innovations. They place importance on paying attention to enhancing organizational, functional, and political capabilities through experimentation and adaptation of strategies in addition to increasing the coverage and range of health services. These scaling up approaches focus on fostering sustainable institutions and the constructive engagement between end users and the provider and financing organizations.

Conclusions

The current approaches to scaling up health services to reach the MDGs are overly simplistic and not working adequately. Rather than relying on blueprint planning and raising funds, an approach characteristic of current global health efforts, experience with alternative models suggests that more promising pathways involve "learning by doing" in ways that engage key stakeholders, uses data to address constraints, and incorporates results from pilot projects. Such approaches should be applied to current strategies to achieve the MDGs.