Factors influencing the scale-up of public health interventions in low- and middle-income countries: a qualitative, systematic literature review

The authors identified the following key messages:

• Scale-up is a complex process. Applying the multi-level perspective on transition to scale-up provides a useful framework with a specific focus on how public health interventions in LMICs could be embedded in a certain landscape, through changes in the way of organizing (structure), doing (practice) and thinking (culture).
• A systematic review of the literature found that resources, advocacy, the supply chain and policies and guidelines were the main factors influencing scale-up related to structure, while training and supervision, scale-up strategy, collaborations, and research and monitoring and evaluation and the social–cultural environment were factors influencing scale-up related to practice and culture, respectively. The interlinkages of the different factors influencing scale-up highlight the importance of a holistic approach to scale-up.
• For the scale-up of public health interventions in LMICs, an a priori development of a scale-up strategy is an essential step for success. This scale-up strategy provides a base for policymakers and programme managers on how changes in structure, practice and culture could be facilitated and how to manage and adapt the scale-up process within the existing landscape to ensure sustainable scale-up.