Scaling up in the health sector means “doing something in a big way to improve some aspect of a population’s health”. It can be applied to scaling up inputs; outputs (access, scope, quality, efficiency); outcomes (coverage, utilization) or impact (reducing morbidity or mortality). Scaling up is clearly a complex topic which raises questions on many levels. Is it best to concentrate on scaling up one intervention or technical programme at a time? What happens when there is pressure to scale up several interventions or programmes simultaneously? Why are there so many stories of relatively well-financed scale-ups encountering basic bottlenecks such as the disbursement of money or enough staff to perform simple administrative tasks? Is scaling up just about reaching as many people as fast as possible, or is there trade-offs with issues such as equity and sustainability? 

WHO Technical Brief No.3 - DRAFT 3, June 12th 2008