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Expanding community action - 4 (lessons learned)
   Last updated: 29.06.02
4. Summary of lessons learned about scaling-up NGO/CBO work
This chapter provides a summary of the key lessons that the Alliance and its NGO/CBO partners have learned about scaling-up community action on HIV/AIDS:
  • Successful scale-up is not just about numbers. As well as increasing coverage, it also requires attention to the focus, quality, sustainability and impact of programmes. Each element is vital in its own right, but even more so in its symbiotic relationship to the others. For example, a programme is unlikely to have significant impact if it lacks coverage and quality.


  • NGOs/CBOs can select from the menu of scale-up strategies and develop a tailor made package to meet their specific needs and resources. The selection should consider the fact that while some strategies (such as building partnerships) may be cheaper, others (such as influencing policy) may have greater impact. Also, while some (such as de-centralising services) may be more sustainable, others (such as adapting models) may be of higher quality.


  • The ideal base for scale-up is a programme that has been successfully evaluated, responds to identified needs, could be used with different and / or larger communities, will have a concrete impact on the epidemic, and suits the mission, capacity and resources of the NGO/CBO.


  • Not all NGOs/CBOs should scale up. If groups are new, have limited current or potential capacity, or are experiencing internal or external instability, it is a wise and acceptable decision to say “no”. In such cases, these groups can make their most valuable contribution to HIV/AIDS by continuing and strengthening their existing efforts.


  • Organisations need to meet minimum requirements, including adequate internal commitment and capacity, before scaling up. The process should not be pursued if the threats outweigh the opportunities, as it may then endanger not only the success of scale-up efforts, but also existing programmes.


  • Key hindrances to scale-up such as weak leadership and staff burn out can lead to failure. They should be taken seriously and addressed from the start through practical steps such as training, staff meetings and internal counselling and support services.


  • Programming for scale-up should be evidence based and community led to maximise good practice learned from others and community knowledge and commitment. It must take into account issues such as the stage of the epidemic, possible target audiences and levels of stigma.


  • Scale-up benefits from systematic planning, starting with assessing the needs and resources of the organisation, community and environment, so that it is carried out effectively and strategically. However, it also benefits from flexibility to be able to adapt to changing opportunities and threats.


  • Scale-up should be comprehensive and multi-sectoral to ensure that the full range of needs is met and to benefit from the experience of different organisations. For example, if an NGO/CBO expands its participatory prevention work, it needs to ensure expanded condom supplies (for example from a social marketing company) and voluntary counselling and testing services (for example from another NGO).


  • On-going community participation – including the involvement of PLHA – is vital for maintaining the integrity, quality and sustainability of scale-up work.


  • Scale-up may involve short and long-term “trade offs” in areas such as quality of programme work and accountability to communities. NGOs/CBOs must be realistic about the potential repercussions of such work, and each one should to define its own “minimum standards” against which to assess whether compromises are acceptable.


  • Scale-up should not sacrifice attention to specific key populations for the sake of coverage. A comprehensive response to HIV/AIDS should combine specialist, possibly more expensive interventions with highly vulnerable groups, with broader, cheaper activities with the general population, and referral services to link the two.


  • Scale-up efforts may fail without a supportive political environment. Therefore, NGOs/CBOs must not expand their work in isolation, and need to collaborate with other stakeholders, especially government.


  • Monitoring and evaluation systems, which address focus, coverage, quality, sustainability and impact, should be put in place before scale-up so that successes and failures can be assessed from the start. Both quantitative and qualitative indicators that are agreed by all key players should be used, but formal, extensive evaluation of processes is not always necessary.


  • Assessing the sustainability of scale-up initiatives involves paying attention not only to programmatic and organisational issues, but also to their quality and impact at individual, community and societal levels. These are the most important indicators to show the effect of the work on the HIV/AIDS epidemic.


  • Scale-up is not a one-off, overnight event. It is a process that continues and is improved over time.


Source: Expanding community action on HIV/AIDS
This is an extract from Expanding community action on HIV/AIDS: NGO/CBO strategies for scaling-up, published by the International HIV/AIDS Alliance in 2001.

To view the whole report follow this link.

To download, complete with graphics, in pdf format (which requires Adobe Acrobat software to read it) follow this link (file size 998 Kbytes).