In 2019, the article “The pitfalls of scaling up evidence-based interventions in health” was published. France Légaré, Scientific Director of the Université Laval branch of the Change Management axis of our unit, is a member of the writing team.
- Hervé Tchala Vignon Zomahoun
- Ali Ben Charif
- Adriana Freitas
- Mirjam Marjolein Garvelink
- Matthew Menear
- Michèle Dugas
- Rhéda Adekpedjou
- France Légaré
Zomahoun HTV, Ben Charif A, Freitas A, Garvelink MM, Menear M, Dugas M, Adekpedjou R, Légaré F. The pitfalls of scaling up evidence-based interventions in health. Glob Health Action. 2019;12(1):1670449. doi: 10.1080/16549716.2019.1670449. PMID: 31575331; PMCID: PMC6781190.
Context
Public policy makers are increasingly interested in scaling evidence-based interventions or innovations to reach larger populations. Although methodological frameworks have been developed, outcomes often fall short of expectations. This article aims to raise awareness of key pitfalls to anticipate when planning for scalability, drawing on experiences from both low- and middle-income countries and high-income countries.
Methods
The authors conducted a global literature review to identify common pitfalls encountered during the implementation of scaling plans. They synthesized the main challenges observed across various health contexts.
Results
Six major scaling-related pitfalls were identified:
- Pitfalls in estimating cost-effectiveness ratios: Difficult to establish under real-world conditions, making economies of scale uncertain.
- Pitfalls related to health inequalities: Certain populations are excluded and do not benefit from interventions.
- Pitfalls in amplifying negative effects: Adverse effects may increase with scaling.
- Pitfalls related to ethical issues: Informed consent becomes more complex at scale.
- Pitfalls of top-down approaches: Needs and preferences of end users may be overlooked.
- Pitfalls related to context: Interventions may not be adaptable to all settings.
Conclusion
Scaling evidence-based practices can improve health care in both low- and high-income countries. However, success requires anticipating and managing the identified pitfalls to ensure that the benefits of interventions are equitably distributed and contextually appropriate.