Scaling up in international health: what are the key issues?

Mangham, L. J.; Hanson, K.

doi:10.1093/heapol/czp066

Cited by 303Healthcare Systems and ReformsPublic health and occupational medicineHealthcare Systems and Practices

Scaling up in international health: what are the key issues?

Mangham, L. J., Hanson, K.·2010·Health Policy and Planning

DOI 10.1093/heapol/czp066

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Abstract

The term 'scaling up' is now widely used in the international health literature, though it lacks an agreed definition. We review what is meant by scaling up in the context of changes in international health and development over the last decade. We argue that the notion of scaling up is primarily used to describe the ambition or process of expanding the coverage of health interventions, though the term has also referred to increasing the financial, human and capital resources required to expand coverage. We discuss four pertinent issues in scaling up the coverage of health interventions: the costs of scaling up coverage; constraints to scaling up; equity and quality concerns; and key service delivery issues when scaling up. We then review recent progress in scaling up the coverage of health interventions. This includes a considerable increase in the volume of aid, accompanied by numerous new health initiatives and financing mechanisms. There have also been improvements in health outcomes and some examples of successful large-scale programmes. Finally, we reflect on the importance of obtaining a better understanding of how to deliver priority health interventions at scale, the current emphasis on health system strengthening and the challenges of sustaining scaling up in the prevailing global economic environment.

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Little is known about scaling-up initiatives in Indigenous contexts with diverse traditions, governance structures and relationships that influence readiness and capacity for community food actions.
“Little is known about scaling-up initiatives in Indigenous contexts with diverse traditions, governance structures and relationships that influence readiness and capacity for community food actions [23, 24].”
From Scale up of the learning circles: a participatory action approach to support local food systems in four diverse First Nations school communities within Canada (2024) · cites this paper as [24]
There are multiple implementation strategies that, in specific circumstances, can effectively address different barriers to implementation, as well as the same barrier.
“That is, there are multiple implementation strategies that, in specific circumstances can effectively address different barriers to implementation, as well as the same barrier (e.g., financing) [83–85].”
From “Scaling-out” evidence-based interventions to new populations or new health care delivery systems (2017) · cites this paper as [85]

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Self-citation
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“Little is known about scaling-up initiatives in Indigenous contexts with diverse traditions, governance structures and relationships that influence readiness and capacity for community food actions [23, 24].”
Background

Authors: Mangham, L. J., & Hanson, K.
Affiliations: London School of Hygiene & Tropical Medicine (GB)
Venue: Health Policy and Planning
Publisher: Oxford University Press (OUP)
Published: 2010-01-13
Volume: 25
Issue: 2
Pages: 85-96
ISSN: 0268-1080 (ISSN-L)
1460-2237
DOI: 10.1093/heapol/czp066
OpenAlex: W2127305651
Cited by: 303
References: 103
Citations by year: 2026: 3 · 2025: 23 · 2024: 31 · 2023: 21 · 2022: 9 · 2021: 22 · 2020: 13 · 2019: 22 · 2018: 21 · 2017: 20 · 2016: 13 · 2015: 20 · 2014: 18 · 2013: 18 · 2012: 25
FWCI: 4.92
Type: journal article
Language: en
Open access: closed
Locations: Health Policy and Planning (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
Social Sciences › Political Science and International Relations › Public health and occupational medicine
Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Practices
Keywords: scale-up, international health, health care financing, development aid, equity, health care delivery, health system strengthening, sustainability of health programs
MeSH terms: Delivery of Health Care, Female, Health Planning, Health Policy, Humans, International Cooperation, Male

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Scaling up in international health: what are the key issues?

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