OVC Support Toolkit  >  Introduction  >  Responses 

Scaling Up

This section focuses on issues around increasing the scale of activities aimed at reducing the effects of HIV/AIDS on children. It examines why this is necessary, what is meant by the term 'scaling up' and issues which need to be addressed if this is to be achieved. See also examples of responses through individual projects , responses in specific countries and principles and practical tips for running a programme . Key points about scaling up are that:

1. The effects of HIV/AIDS on children are placing family and community structures under extreme strain. Although there are many examples of good responses to help support these structures, they are currently small and few in number. There is a need for a massive increase in these responses.

2. Scaling up is fundamentally about reaching more people. It may also include other elements, such as increasing impact, improving quality of services and ensuring sustainability.

3. The scale of activities can be expressed in terms of ?coverage?. This is usually expressed as a percentage. It is calculated by dividing the number of people who receive a service by the number of people who need that service.

4. Three levels have been identified which will need action if scaling up is to occur. These are the community level, the facilitating level and the policy/resources level.

5. Barriers to scaling up may exist at each of these three levels. Experience from activities that have scaled up suggests that there are some key success factors.

Engines of Change

In many countries, the situation facing children and young people as a result of HIV/AIDS is already extremely serious. The number of children orphaned and made vulnerable as a result of HIV/AIDS has risen dramatically. Traditional family and community methods of caring for such children are being put under severe strain. There are many excellent examples of projects supporting families and communities as they care for children made vulnerable by HIV/AIDS. However, these activities are very few and are often scattered across countries/regions. They have been described as a small-scale "cottage industry". What is needed are activities on a massive scale that become an "engine of change".

What is "scaling up"?

Most people use the term "scaling up" to mean that more people will be reached by particular activities. This may be by reaching more people within the geographical area served by the project (see below) or by starting activities in a new geographical area (see below).

In addition, some people use the term to mean more than just reaching more people. This may include increasing impact, improving quality of services and ensuring that services can continue. This is sometimes referred to as an expanded comprehensive response (ECR). This focuses not only on expanding geographical coverage but also on ensuring that activities are comprehensive in that they reach all vulnerable population groups and deliver a wide range of high quality services.

Coverage

A key measure of the scale of a project is the number of people it reaches with services. However, a number on its own may not be very meaningful because it does not give an idea of how many people actually need the services being offered. This is where the idea of "coverage" comes in. It is a measure of the number of people who receive a service as a proportion of the number of people in need of the service. It is usually expressed as a percentage. For example, in the case of orphans and other vulnerable children, it would be calculated by dividing the number of orphans and other vulnerable children receiving support by the total number of orphans and other vulnerable children in a particular geographical area, then multiplying by 100 to find the percentage.

Some people have concerns about the term scaling up because they fear that it is:

• Being driven by donors in developed countries.
• "Supply-driven"- that is being driven by issues in rich countries, including the availability of financial resources.
• Too focused on methods which emphasise building organisational capacity to handle financial resources.
• Leading to expectations of results in a very short time which may be unsustainable.

They have contrasted this with a process of "scaling out" which they describe as:

• Being driven by intermediary organisations. These organisations are often NGOs which work "between" international donors and communities/ community-based organisations.
• "Demand-driven" - that is responding to the needs and demands of communities rather than seeking to impose their own views and approaches.
• Focused on provision of technical assistance, including sharing experience of what has worked in other places through exchange visits and practical training.
• Based on a longer timescale which recognises that responses which support families and communities take time to grow if they are to be sustainable and locally owned.

The three levels of scaling up

Three levels have been identified where action is needed if activities are to take place on an increased scale.

The first is the community or grassroots level where activities actually take place. Several different ways of increasing activities have been identified. These include:

• Intensification - where a group or organisation reaches more people within the same geographical area.
• Expansion - where a programme is extended into another geographical area.
• Duplication - where a growing programme divides into two or more parts.
• Replication - where people start a programme based on experience gained from another geographical area. In many cases, such replication involves adapting lessons learned from one place to fit another.

At the second level, intermediary organisations have been identified as playing a role in scaling-up activities. Their role is not to deliver these scaled-up activities but to support communities and community-based organisations. This is often referred to as "facilitation". NGOs and faith-based organisations (FBOs) have a key role to play in this area.

The third level has been termed the policy/resource level . This can be seen as having two distinct but linked components. If activities for orphans and other vulnerable children are to be scaled up, they need a supportive policy environment, in the same way as plants need certain conditions to grow. Elements of this environment include supportive political leadership, an informed and enforced child welfare policy and a functioning government. Governments have a key role to play in this area. In addition, activities need adequate resources. A key issue is how resources can be effectively channelled from rich countries to the communities where the funds are needed.

Overcoming barriers to scaling up

Barriers to scaling up may exist at each of these three levels. At the community level, the main problem is lack of financial resources. Other problems include increasing the burden on overstretched people (often women); a sense of dependency and lack of ownership created by donor funding; and limited administrative capacity to deal with monitoring and reporting requirements of international donors.

At the level of intermediary organisations, the major challenge is the shift in thinking which is needed in many NGOs, away from being an implementing organisation to one which facilitates and supports community-based organisations and processes. For example, this will probably require major changes in staff roles.

At the policy/resource level, there is need for a greater understanding of how community initiatives grow and develop, in general, and, in particular, how international donors can provide funds to such initiatives without undermining them. Challenges in this area include how to bring together what donors want (quick, measurable results) with what is known about what works at community level. Another challenge is the reporting requirements of much donor funding. This is often beyond the capacity of community-based organisations.

Based on experience of successful activities, key factors have been identified in determining if a project works and can be successfully scaled up. These include:

• Leadership - the involvement and commitment of community leaders has proved vital in ensuring that activities are carried out and are owned by the local community.
• Shared values - many initiatives with orphans and other vulnerable children have a religious base. Shared values hold people together and provide social cohesion.
• Using existing structures - in general, better results are achieved by using existing structures than by seeking to establish new, uniform structures nationally. This approach also increases local ownership and the likelihood of responses being sustained. Approaches which assume that communities are a "blank sheet" onto which projects can be imposed will almost certainly fail.
• Coalitions - communities often interact with a wide range of organisations. Working cooperatively among such organisations is likely to be more beneficial to communities than if these organisations compete
• Advocates - there is a need for people who advocate for the rights and needs of orphans and other vulnerable children at each of the three levels identified.

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