About two decades ago, Jim Wolfensohn, then-President of the World Bank, visited Georgia, and noted a successful rural credit project, supported by the bank, which had improved lives for some 1,500 farmers. Upon his return, he asked the project team what they were doing to ensure the other 50,000 or so farmers in Georgia would reap similar benefits.
Wolfensohn did not like the response: “Oh, it’s such a good project, someone will pick it up and run with it; we have other projects under preparation.”
Scaling up nutrition: Addressing the challenge of multisectoral interventions
By: Chytanya Kompala, nutrition program officer, Eleanor Crook Foundation
Efforts to scale nutrition innovations over the past decades have often run into difficulty due to the multisectoral nature of nutrition interventions. Examples include initiatives to combat severe acute malnutrition, which threatens the survival of children around the world, contributing to roughly 1 million child deaths annually. Community management of acute malnutrition, a community-based approach to treat acute malnutrition using ready-to-use-therapeutic-food, was scaled up in the ‘90s. However, progress has stalled with currently less than 20% coverage globally.
Another example is vitamin A supplementation, or VAS, a proven intervention to reduce child mortality. It is simple and cost-effective, and it saves lives. Over the past decade, VAS has been rapidly scaled-up in many parts of the world by leveraging existing platforms to reach children, including polio vaccination campaigns. However, as the threat of polio has declined over time, VAS coverage has unfortunately declined.
Over the past decade, increasing attention has been paid to the scaling challenge in nutrition. For example, since 2010, the Scaling Up Nutrition Movement has brought together countries and institutions to support the scaling up of successful nutrition interventions to fight global malnutrition.
Also in 2010, the World Bank published a major study on scaling up nutrition, while in 2012, the International Food Policy Research Institute issued a policy brief series “Scaling up in agriculture, rural development, and nutrition,” which featured two examples of scaling up nutrition interventions. In 2015, Gillespie, Menon, and Kennedy published a synthesis article entitled “Scaling up impact on nutrition: What will it take?”, and in 2018 the Eleanor Crook Foundation, a foundation dedicated to supporting scaling nutrition interventions in developing countries, made sustainable scaling the centerpiece of its funding strategy. Despite these promising efforts, it remains that far too few nutrition interventions have successfully been delivered at scale. Much more needs to be done to ultimately achieve the nutrition outcomes these efforts are meant to support.
The recently launched Nutrition Scaling Working Group under the Scaling Up CoP, is designed to radically shift the focus within the nutrition sector toward finding truly scalable solutions to malnutrition.
Not long after, he started a new initiative at the bank to develop a systematic focus on scaling up successful development interventions. A couple of years later, Wolfensohn retired from the World Bank and his successor had different priorities.
This story reflects a couple of troublesome realities: first, development institutions pay too little attention to systematically scale up successful projects; and second, because of the pervasive inclination of new managers to do things differently from their predecessor, it is difficult to maintain a scaling focus in institutions.
Fortunately, after he left the World Bank, Wolfensohn pushed further ahead with his idea about scaling, by funding the Wolfensohn Center for Development at Brookings, which took up the challenge of scaling development impact. Based on a review of literature and practice the Brookings team concluded that the most important aspect is how to get the idea of scaling systematically integrated into development practice.
By working with various development organizations on scaling, we found that six key questions, if systematically addressed throughout the project cycle, could help effectively tackle the scaling agenda:
1. What’s the problem to be solved, and the vision and target of scale beyond the project’s lifespan?
2. What ideas, innovations, or interventions are to be scaled up?
3. What is the pathway to scale beyond the project: commercial, public, hybrid; horizontal, vertical, functional; expansion, replication, diffusion?
4. What to do about the enabling conditions — financial, institutional, political, environmental, etc. — that may drive or hinder the scaling process beyond the project?
5. How to sequence key steps along the scaling pathway?
6. How to ensure that monitoring and evaluation support learning for scaling up?
While we pursued the scaling agenda at Brookings, others in the development community also increasingly focused on how to scale. So, together with Larry Cooley of Management Systems International, we created the Scaling Up Community of Practice, dedicated to bringing together professionals interested in scaling up development impact. This CoP now consists of over 500 participants from over 200 organizations engaged in regular exchanges about how best to support scaling in education, health, agriculture, social enterprises, youth employment, and nutrition, in fragile states and through effective monitoring and evaluation.
What have we learned about key opportunities and challenges in scaling up?
First, as one of the results of increased attention to scaling there are now many analytical approaches to choose from, which can be adapted to the needs of any particular organization or project. But, second, the challenge remains how to move from a predominant focus on innovation to a balanced focus on innovation and impact at scale. Third, there is the question of how to ensure that we go beyond the one-off project approach to a scaling approach, i.e., to consider scaling from the beginning of project design and throughout implementation.
Fourth, there is the challenge of how to manage multiple tensions — between scale and quality; between flexible adaptation to local conditions versus maintaining fidelity to core aspects; and between bringing down costs, versus assuring impact. And fifth, one lesson from experience is that “scaling by subtraction” — simplifying interventions to their bare essentials — is more likely to succeed than adding “bells and whistles” in replication. However, in areas, such as nutrition, which require multisectoral approaches, complexity is often unavoidable.
But the biggest challenge is how to internalize, mainstream and sustain the scaling idea and approach in an organization. Two fundamental barriers remain, just the same barriers that plagued Wolfensohn at the World Bank: the pervasive focus on one-off projects with little or no incentive for staff in the institutions to think beyond the project’s life; and the fact that institutional memories are short, as new managers look for new ideas and initiatives rather than building on those of their predecessors.
What is the answer to this challenge? A relentlessly persistent focus on scaling by those who care about development impact at scale.
Take a closer look at what it takes to achieve scale in the nutrition sector.