“An NGO can achieve wider impacts in many ways including expanding its operations; introducing or developing technologies which spread; developing and using approaches which are then adopted by other NGOs and/or by government; influencing changes in government and donor policies and actions; and gaining and disseminating understanding about development.” 16

16 Drabek 1987 quoting from Robert Chambers, “Thinking about NGO Priorities” IDS Mimeo, 2 May 1987, p. 1

In looking at the HIV/AIDS epidemic specifically, it is evident that NGOs have operated in each of the above pathways to exert influence over the general thinking about and approaches to HIV/AIDS. The emphasis on and need for home care, for example, was initiated by NGOs, as was the emphasis on the ethical need to combine counselling with voluntary testing, and indeed the whole notion and promotion of ‘safe sex’ (O’Malley et al 1996). Similarly, it is largely due to successful NGO advocacy that an increasing number of donors now recognise the need to support and finance AIDS care and treatment, as well as prevention, which they were previously reluctant to do. It is also thanks to the efforts of NGOs that policy-makers have a greater understanding of the social determinants of the epidemic and its effects on communities and individuals. Yet, as stated above, much of this impact has been spontaneous, rather than a reflection of deliberate strategy.

Within the context of development thinking generally, a number of authors have recently addressed the question of deliberate strategies to increase scale and widen the impact of NGO activities. John Clark, for example, formerly of OXFAM but now working at the World Bank on NGOs, argues that there are essentially three pathways available to NGOs: project replication, building grassroots movements and influencing policy (Clark 1991; Clark in Edwards and Hulme 1992). Howes and Sattar (in Edwards and Hulme 1992) make the useful distinction between organisational or programme growth as opposed to achieving impact by means of transferring programmes to, or supporting other organisations. Myers, in an analysis of scaling up early childhood development programmes, develops a terminology characterising the pace and nature of expansion; he uses the term planned expansion to refer to the process of implementing a particular model in a number of geographic areas once it has been pilot tested; explosion to denote the sudden initiation of a large-scale programme or intervention without any policy or organisation preparation beforehand, and association to mean expanding programme size through common efforts and alliances among a group of organisations, each of whom develop similar programmes but tailor them to the needs of specific communities or populations.

Other authors have pointed out that it is not the content of services alone that can be replicated or expanded, but underlying approaches or ideas, and this is particularly relevant to work on HIV/AIDS. Robert Chambers, for example (in Edwards and Hulme 1992) refers to what he calls “self-spreading and self-improving strategies” whereby good practice (such as participatory approaches) is gradually extended through other organisations, in effect transforming their approach.17 Van Odenhoven and Wazir (1998) use the term “concept replication” to denote a similar process.

17 The book Who Changes? by Blackburn and Holland, inspired by Robert Chambers’ work, entails a series of case studies of increasing the scale of the practice of participatory rapid assessment precisely through this approach.

In the early 1990s, Edwards and Hulme, noting the lack of analyses of NGO efforts to scale up in developing countries, convened a number of workshops under the auspices of the University of Manchester and the Save the Children Fund. These brought together a diverse range of case studies of scaling up by both Northern and Southern NGOs, and include the presentation of a number of think-pieces on scaling up strategies more generally.18 In their efforts to synthesise the findings from these studies, they developed a three-fold conceptual framework: namely additive strategies which imply an increase in the size of a programme or organisation; multiplicative strategies – which do not necessarily imply growth but achieve impact through influence, networking, policy and legal reform or training; and diffusive approaches where spread tends to be informal and spontaneous.