Will it fit? How will it scale?
The Halfway Point
Module 3 marks the halfway point in our journey of adaptation and scale up. In this module we look at how to anticipate the potential for “fit” (or suitable adaptation) of model activities into future target sites. We then look at how to set realistic scaling benchmarks to stay on track.
Adapting Activities to Fit
The Issue of Fit
Scaling up activities includes adapting activities from model sites to future target sites. Sometimes activities will not need to change much to work well at a new site. Other times, activities will need to adapt many aspects in order to work in a new context. It is up to the Implementing Partner, in partnership with the National Coordination Mechanism, to decide how an activity might change and whether it will work in the new context. This is the issue of fit.
There are many challenges to fit but two are of greatest significance:
- Fit-to-site: Can the model activity that was shown effective in its original site work in future target sites?
- Fit-to-partner-capacity: Do Implementing Partners at target sites have the capacity needed to implement the activity in the way it was intended?
If the National Coordination Mechanism finds that an activity will be difficult to fit-to-site or fit-to-partner-capacity, this presents a challenge. Luckily, many of these challenges can be met if they are anticipated ahead of time.
The Fit-to-Site Challenge
Every evidence-based INSPIRE activity has been proven effective in a particular site with its own environment. As we saw in the Environmental Assessment in Module 1, there are many factors that make each site unique. Globally, model activities often come from other parts of the world. In addition to local environmental differences, there may also be very big political, economic, and cultural differences between model sites and target sites. It can be helpful to have an understanding of differences among sites before selecting Implementing Partners and activities for scale up. These differences create new contexts for implementation.
Some of the elements of the model activity are essential to the success of the activity. We call these “core” elements. Other aspects may be more easily modified to fit the context and can be called “peripheral.” If the context of the intended target site(s) does not easily allow for the presence of core elements of the activity, this requires a solution.
The National Coordination Mechanism might consider how to change the context at the target site to be more accepting of the core elements. They may also try to adapt the activity to target sites, while ensuring fidelity to the elements that made the model activity effective. Tool 3A is helpful in identifying these needs, and gaining insight into how model and target sites differ.
The specific context and location where a model activity has demonstrated its effectiveness.
The contexts and locations where the government may wish to scale-up evidence-based model activities.
The elements or pieces of a model activity that are shown to be necessary to the activity’s success and should always be present during scale-up. Core elements may take different shapes in different contexts, but they must meet the same goals.
The elements of activities that can be easily adapted to fit the model activity to new sites and contexts. These elements are not considered core.
The Fit-to-Partner-Capacity Challenge
Fit-to-partner-capacity can point out gaps that might be addressed prior to selecting an Implementing Partner, or might highlight areas of needed strengthening. If a potential Implementing Partner at a target site is not organized to meet the needs of the model activity, this can pose a problem. Similarly, if the potential Implementing Partner does not have the same strengths and capacities that the implementers at the model site had, this can also make scale up difficult.
In some cases, the National Coordination Mechanism + Resource Team may have ideas on how to strengthen any weaknesses found in the Implementing Partner. If an Implementing Partner’s weaknesses cannot be addressed, it is still useful for the National Coordination Mechanism to be aware of them when overseeing and monitoring the implementation of activities. If capacity is severely lacking, however, this may require the National Coordination Mechanism to reconsider its decision to scale to the target site. Tool 3B provides a capacity assessment for Implementing Partners or potential partners, as well as a guide to identify actions for capacity-strengthening.
Setting Benchmarks for Scale
There are 2 main types of scale up:
- Vertical scale up, or institutionalization.
- Horizontal scale up, or expansion.
Successful, sustained scale up of an innovation requires attention to both vertical and horizontal scale up. The graphic below shows the relationship between these types of scale. We must take advantage of opportunities for both institutionalization and expansion as they arise. Horizontal scale without vertical scale will not be sustainable. Vertical scale without horizontal scale will not have the desired impact.
Horizontal scale without vertical scale will not be sustainable. Vertical scale without horizontal scale will not have the desired impact.
Both dimensions of scale can and should be monitored through benchmarks. Benchmarks are used to set intermediate expectations for progress towards reaching the ultimate action-plan goals. Benchmarks are concrete, incremental goals that should be met on the way towards meeting final results.
Horizontal scale up
The way of ensuring that an activity to end violence against children is distributed more broadly across geographic areas and populations.
Vertical scale up
The way of ensuring that an activity to end violence against children is integrated into a country’s policy, budgetary, administrative, training, and service-delivery systems.
Vertical Scale Up
Vertical scale up requires integrating an activity into laws, policies, budgets, work plans, and institutional structures such as training centers and health-information systems. To keep vertical scale up on track, the National Coordination Mechanism should establish benchmarks that will be used to track different elements of institutionalization, including the degree to which:
- National policies are supportive of the activity
- Social norms are shifting to accommodate the activity
- Activities are included in national, regional, or district-level budgets
- Routine training and supervision practices support the activity
- Service protocols reflect and advance the goals of the activity
Tool 3C will help the National Coordination Mechanism identify goals for vertical scale up and set benchmarks to measure progress and stay on track in working toward those results.
Horizontal Scale Up
Horizontal scale up means successfully getting an activity functioning in more sites or having it reach additional populations. This entails training more individuals to offer the intervention, creating more resources, and implementing activities to reach more people across the country.
For instance, an activity may be taken from a single pilot site where it was proven effective to a larger scale: an entire district, or region, or maybe the entire nation. Horizontal scale up may also expand the reach of an intervention by focusing on additional groups. Examples might be an activity designed for women being expanded to include adolescent girls, or an activity that was designed for urban children being expanded to reach rural children. Tool 3D will help the National Coordination Mechanism identify goals for horizontal scale up and set benchmarks to measure progress and stay on track in working toward those results.
Remember there is a risk that adaptations, especially when trying to reach new target populations, might have to be so extensive that the activity may lose fidelity to its core elements. It is always important to assess whether a new focus changes the activity too significantly to call it scale up.
3AContext of Implementation Analysis
3BPartner Capacity Assessment
3CBenchmarking and Tracking Vertical Scale Up
3DBenchmarking and Tracking Horizontal Scale Up
R1 Insights and Action
Pause and Reflect.
We are in the middle of the journey of adaptation and scale up, and we may have encountered some conditions we did not expect. And that is part of the excitement of the trip! This module asked you to think about two topics: fit and scale-up benchmarks.
Questions for consideration….
- If the model intervention environment differs significantly from local target sites, where the National Coordination Mechanism anticipates scaling an activity, have you discussed how you might meet some of these challenges?
- Do Implementing Partners who are already in place need any organizational strengthening? Does the National Coordination Mechanism + Resource Team have ideas about how they can facilitate this strengthening?
- Does the action plan make clear what the eventual scope of vertical scale up will be in terms of policies, curricula, budgets, and service protocols favorable to sustaining activities to end violence against children? If not, what can be done to demonstrate government commitment in these areas?
- Are the National Coordination Mechanism + Resource Team partners clear on where scale up will occur and at what pace? Does the benchmarking of horizontal scale up seem realistic? Will it be possible to institutionalize the activity into national systems and policies?
When discussing your reflections on this module, did the team have any interesting insights?
It is important to document your learning and the actions you will take, then check back to note when those actions have been completed.
Additional Resources on Assessing Fit
Castro, F.G., Barrera, M., and Martinez, CR. (2004). The Cultural Adaptation of Prevention Interventions: Resolving Tensions Between Fidelity and Fit. Prevention Science, 5 (1).
Cohen et al. (2008). Fidelity Versus Flexibility: Translating Evidence-Based Research into Practice. American Journal of Preventive Medicine, 35, (5S).