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1. CLICK TO ADD TITLE The 5th Global Health Supply Chain Summit November 14 -16, 2012Kigali, Rwanda • AIDED model • A tool to scale up project • Rex Wong • Director of Hospital Strengthening, Global Health Leadership Institute, • Yale University [SPEAKERS NAMES] [DATE]

2. Background Many innovations are efficacious and cost-effective but fail to scale up for widespread use. Why and what can be done to address this failure of scale up?

3. Background Most commonly used global health scale up methodology: Pilot and Pray Pilot tested some intervention in a place and then hope for and look for a positive result and then are always somewhat surprised and disappointed when it doesn't scale.

4. What is AIDED Model? A practical, generalizable model for the spread of innovation.

5. Research Methods - 11 electronic databases through December 2010 - key documents from 20 global health organizations - 1,489 articles  75 met the criteria for inclusion - 27 experienced practitioners and policy makers - state-of-the-art methods of qualitative data analysis - 5 countries Systematic review of peer-reviewed and gray literature In-depth interviews Pressure testing

6. The AIDED model A I D E D Develop Build support and address resistance in the broader environment Engage Introduce, address resistance, translate, and integrate in the user group Assess Understand user group receptivity and environmentalcontext Devolve User groups release and spread the innovation via peer networks Innovate Design and package innovation to fit with user group receptivity

7. The AIDED model A E I D D ssess nnovate evelop ngage evolve

8. Assess Understand user groups’ receptivity to the innovation and the degree of support for the innovation in the political, regulatory, economic, socio-cultural, and technological environments User Groups

9. User groups vary in their receptivity User Groups User Groups User Groups User Groups User Groups

10. User groups exist within a context Economic, political, regulatory, socio-cultural, technological and informational environments User Groups

11. The AIDED model A E I D D ssess nnovate evelop ngage evolve

12. Innovate User Groups Design and package the innovation to fit with user groups and their environmental context, and to enable initial user groups to spread the innovation via social networks

13. The AIDED model A E I D D ssess nnovate evelop ngage evolve

14. Develop Overcoming resistance • Address turf issues – who stands to lose • Political engagement • Use of data of all kinds • Legislative and regulatory action • Incentives • Media campaigns • Community, national, international advocacy Build on sources of support and address resistance among stakeholders and opinion leaders; encourage policies, social norms, and infrastructure that will support take up of innovation

15. The AIDED model A E I D D ssess nnovate evelop ngage evolve

16. Engage Introduce and overcome resistance – Awareness Translate (for use by community) – Assimilation Integrate (i.e., put to use) – Application Use existing roles and resources within user groups to introduce, address resistance, translate, and integrate the innovation into each user group’s routine practices

17. Engage User Groups Integrate Translate Introduce via Boundary Spanner

18. The AIDED model A E I D D ssess nnovate evelop ngage evolve

19. Devolve Capitalize on existing social networks of index user groups to release and spread the innovation to new user groups

20. Devolve REPLICATION User Groups User Groups ADAPTATION User Groups FAILURE User Groups

21. Factors for success

22. Take home messages Start with communities that are receptive Ensure “fit” between the innovation and the community Developing support at all levels is essential Failure to scale up is largely a failure to engage properly Collaboration across sectors, professional groups and communities

23. Summary User group needs and receptivity, as well as economic, political, regulatory, socio-cultural and technological environmental conditions REPLICATED INNOVATION DESIGN AND PACKAGE ADAPTED INNOVATION Introduce FAILED INNOVATION

24. Acknowledgments http://bmjopen.bmj.com/content/2/4/e000987.full Research Team: Global Health Leadership Institute, Yale University Funding for AIDED development: Bill & Melinda Gates Foundation