Overview of concept of scaling-up

1. Overview of concept of scaling-up George Laryea-Adjei UNICEF 21 July 2005

2. Focus of presentation • The programming stage of policy process • For PRSs that provide detailed information on the “how” – at the level of “strategies” and “actions” in PRSs + MTEF • For PRSs that provide just a development framework - level of sector planning and MTEF

3. The case • Several reforms to enhance delivery of basic services since 1990s: SWAPs, MTEF • Protection/increase of expenditures on poverty reduction • Earmarking/targeted approaches • Decentralization (hybrid type in most cases) • Yet, evidence of stagnating/worsening outcomes in several sectors/countries. E.g. under five mortality has gone up in some star Health SWAP countries with increased budgets; same for underweight, etc.

4. Expenditure tracking studies also show that bulk of resources does not always reach the intended beneficiaries • Benefit-incidence studies show that the poor still receive disproportionately less public investment • Many UN agencies with proven interventions are trapped in the pilot/small scale mode • Therefore, greater focus on type + combination of interventions and how they are delivered • Serious challenges with spending effectiveness and efficiency

5. Points to note • Scaling up means reaching more people through national policy processes and mechanisms • Scaling up does not mean reaching all at the same time • The principles of strategic planning (not comprehensive planning) are most relevant: • Have a “starting point” • Develop a sequencing plan for other interventions • Address all aspects of “starting point” (recurrent+development)

6. The approach For Goals/targets address: • Policy issues • Financing issues • Better targeting of resources • Scaling up (some) public investments: • Scaling up (some) services • Scaling up (some) systems development

7. Within public investments focus on: • Within services/interventions: • Proven high impact interventions/ cost-effective interventions • Quick wins offer a starting point (MP identifies some; best if country and context specific) • Within systems development: • Consider institutional pluralism (community IMCI; ITNs) • Greater decentralization (longer term)

8. Safe water • Scaling up safe water provision in rural districts when there was no Agency for rural water: • Service: out-door, small scale service • Institutions: combination of local government teams, NGOs, CBOs, private contractors, women’s groups, national agency • Capacity building was tied to specific products • Result: dramatic increase in access to safe water in rural districts; pluralism reduced costs in a significant manner • Sequencing: Local depts now being set up, sanitation and hygiene education being scaled

9. Lessons • Useful to prioritise high impact interventions for goals/targets • Do not concentrate actions in single depts, esp when capacity is weak • Have a sequencing plan for scaling up interventions and systems support • To guarantee scaling up, make sure to include intervention(s) in MDBS policy matrix and/or MTEF, in addition to annual sector plans and PRS • Strategic, not comprehensive planning