As Facilitator, Transfer of the Constellation's secretariat I am reflecting a lot on scaling up the Transfer of the approach. I would like to launch a discussion on

What are effective models to go to scale with AIDS/ Malaria Competence?

I have heard several success stories of Red Cross (Togo), NCA (Thailand), Red Cross (PNG), CNLS (Rwanda), Group Pivot (Mali) etc, but I am wondering if there is a flexible blueprint for scaling up? What are the key components of rolling out the approach effectively at scale? My critical success factors so far:
- Host with capacity and commitment. One (or more) nationally present organizations that have the infrastructure, capacity, access to communities and commitment to implementing the approach;
- Start small, think big. While the testing phase can focus on some pockets of communities, the 2-3 year vision should focus on a significant part of the population (>20%).
- A solid transfer of the approach through at least 1 or 2 learning events that include experiential learning in the field. Cascading transfer to lower (district) levels can be possible with a focus on experiential learning.
- Mentoring and accompaniment of the new SALT teams by experienced coaches through regular support visits that link to international experiences.
- Consistent community support (ideally through existing infrastructure). This support can be rolled out by volunteers or community people, but needs to be consistent over time.
- SALT team budget. A modest budget for the national and/or provincial SALT teams to operate. This would cover logistics, refreshments, remuneration (if necessary) and documentation costs
- A rigid monitoring and documentation system that consolidates community progress and learning
- Map and stimulate horizontal transfer. When thinking scale, we cannot be everywher. We have to rely on natural transfer between communities. A pro-active strategy to analyze, map and stimulate this transfer is crucial;
- Regular consolidation of learning through Knowledge Fairs and Knowledge Assets. The important thing here is the focus on 'flow' of knowledge to the people who need it instead of 'collection' of knowledge that nobody will use.
- Leadership. Ensure leadership support of the organization and often the institution responsible for the National AIDS Response in the country
- Linking. Before implementation, establish strong links between service providers and the program. Don't assume the 'Linking' will happen naturally. Make sure the potential for complementing other work is exploited. Linking this to the community action plans at scale will boost effectiveness of local responses. Experience shows that funding for Competence appraoch is easier to access when combined in proposals with service delivery. Think inclusive and non-vertical!
- Think process, not workshops. One or two workshops won't have the desired effect. Support visits, mentoring of teams and consistent community visits are quintessential.
- Have funding support for at least 2 years. This can range from National funding to Global Fund. Global Fund intervenionist mechanisms and rigid outcome indicators might be difficult to match, but we have seen good and creative experiences of using Global Fund money for rolling out Competence. I will start a topic on lessons learnt on Global Fund soon!

So what did I miss for a succesful scaling out of AIDS or Malaria Competence?

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There was a “Scaling Up Poverty Reduction Conference” in Shanghai in May 2004 and while it was being looked at from an agency perspective, I believe some (but probably not all) of the key messages are relevant.
You can read the lessons at: http://info.worldbank.org/etools/reducingpoverty/docs/shanghailesso...


Get the policies right,
….and get the politics behind the policies right too

Foster commitment, continuity, stability and consistency
Follow an early win with phased changes that meet needs
Go for local solutions
Turn adversity into opportunity
Be open to outside help and ideas
Develop a culture of learning and experimentation
Stimulate competition to encourage adaptation, innovation and better service
Treat people as clients
Get the focus on clients right
And keep the focus on clients
Transparency leads to increased accountability to clients and empowers them
Get the implementation right – the devil is in the detail
Foster a culture of continuous learning
.. of calculated risk taking
Use early warning management systems
Invest in building peoples capacity
Decentralise structures and systems to scale up delivery of services
Share lessons on what is working
Cost sharing or full pricing keeps the provider honest and sustainable, and the client empowered
Get leadership and political commitment
.. then get external support
Simplify funding procedures
Invest in human and institutional capacity
Track the efficiency of funds use
Support good learning processes
Encourage partnerships to gain alignment and reduce transaction costs
Have cost effective and practical impact evaluations
Use seed money to leverage local funds

I did intend to produce a knowledge asset but other priorities took over. Can anyone point to examples of scaling up that have worked whatever the topic? They need not be global scale but perhaps district scale or organisation wide.

Geoff
Voici la traduction du message de Gaston. N'hésitez pas à répondre en français. A la fin de cette discussion, nous ferons un résumé que nous traduirons également en français.

En tant que Facilitateur Transfert de la Constellation je réfléchis beaucoup au passage à l’échelle de l’approche de la Compétence face au sida. J’aimerais lancer une discussion sur

Quels sont les modèles efficaces pour passer à l’échelle avec la Compétence face au sida/malaria ?

J’ai entendu plusieurs bonnes pratiques de la Croix Rouge (Togo), NCA (Thaïlande), Red Cross (PNG), CNLS (Rwanda), Groupe Pivot (Mali), etc. Je me demande s’il existe un modèle standard mais flexible pour passer à l’échelle ? Quelles sont les composantes clés pour mettre en œuvre l’approche à l’échelle d’un pays ?
Selon moi, les facteurs suivants mènent à la réussite :
- Organisation hôte compétente et engagée. Une (ou plusieurs) organisation présente au niveau national qui a l’infrastructure, la capacité, l’accès aux communautés et l’engagement de mettre en œuvre l’approche.
- Commencer petit et penser grand. Alors que la phase pilot peut se focaliser sur un petit nombre de communautés, la vision à 2-3 ans doit être de s’étendre à une partie significative de la population (>20%).
- Un transfert solide de l’approche grâce à un ou deux évènement qui inclus un apprentissage expérientiel sur le terrain. Transférer ensuite l’approche à d’autres niveaux (ex. district) est possible par un apprentissage expérientiel.
- Mentoring et accompagnement des nouvelles équipes SALT par des coaches expérimentés pendant des visites de soutien, qui font le lien avec des expériences internationales.
- Soutien communautaire régulier (idéalement par des infrastructures existantes). Ce soutien peut être fourni par des volontaires ou des gens de la communauté mais doit être régulier.
- Budget pour l’équipe SALT : un budget modeste pour les équipes provinciales et nationales afin de pouvoir mettre en oeuvre. Ceci couvre la logistique, les boissons, rémunération (si nécessaire) et des frais de documentation.
- Un system stricte de suivi et de documentation qui consolide le progrès communautaire et l’apprentissage
- Identifier et stimuler le transfert horizontal. Quand nous passons à l’échelle, nous ne pouvons pas être partout. Nous devons nous reposer sur le transfert naturel de communauté à communauté. Une stratégie pro-actice pour analyser, identifier et stimuler ce transfert est cruciale.
- Consolidation régulière des leçons apprises par des festivals du savoir et des perles du savoir. Ce qui est important ici est de se focaliser sur le transfert du savoir aux gens qui en ont besoin au lieu de ‘collectionner’ le savoir que personne n’utilise.
- Leadership. Assurer vous du soutien des leaders de l’organisation et de l’institution responsable de la Réponse Nationale contre le SIDA dans le pays.
- Lien. Avant la mise en œuvre, établissez des liens étroits avec des fournisseurs de services. Ne partez pas du principe que le lien se fera de façon naturelle. Ne manquez aucune opportunité où vous pouvez complémenter le travail d’autrui. Lier ceci au plan d’action communautaire à large échelle stimulera l’efficience des réponses locales. L’expérience nous montre que le financement pour l’approche de la Compétence est plus facile à obtenir quand il est combiné avec la fourniture de services. Pensez de manière inclusive et non verticale !
-Pensez processus, non pas ateliers. Un ou deux ateliers ne produisent pas l’effet désiré. Des visites de soutien, le mentoring des équipes et des visites de communautés régulières sont essentiels.
- Ayez un soutien financier pour au moins deux ans. Des fonds Nationaux, du Fonds Mondiale ou autre. Les mécanismes interventionnistes du Fonds Mondial et les indicateurs rigides paraissent difficiles à atteindre, mais nous avons des bonnes expériences créatives d’utilisation de fonds du Fonds Mondial pour mettre en œuvre la Compétence. Je lancerai un sujet sur le Fond Mondial très bientôt !

Donc, qu’ai-je oublié pour une mise en œuvre réussie de la Compétence face au sida ou face à la malaria ?
Hi Gaston,

When I think of other models that went to scaled, I think of the Global 'Red Cross' and the Buddhist teachings and practice of Thich Nhat Hanh. Both spread on a global scale with thousands of people involved. The Red Cross is the biggest organisation of volunteers on our planet. Thich Naht Hahn has thousands of followers around the globe, with small sanghas in almost every country.

Two points that I think are important:
- Community-to-community transfer: If we want competence to spread faster than the virus, communities need to transfer their experience and competence to others. This can be done through existing channels of transfer, for instance religious networks, or tribes, etc. But I do believe that facilitators can stimulate this transfer (by organising exchange visits, peer assists, knowledge fairs, mapping the transfer, etc.)
- Inspiration: People are passionate about the Red Cross or Thich Naht Hahn because they get something out of it. They get inspired, it makes them happy... I believe that SALT is an essential element in the spread of Competence, as it inspires people, they feel better human beings, live at peace and in harmony,...

What do other think?

Laurence
I perfectly agree that you are insisting that workshop do not help as much as process suport, whihc has much mor continuity. Indeed workshops can only be a starting point of process which need regular comunications in a follow-up. How ever, this is exactly the most difficult to secure ! Sophie
Yes, Sophie. workshops (or learning events how we call them) are great to stimulate interest and enthusiasm and have people be introduced to the key concepts. But this is not about knowledge, it's about attitudes and skills. And those are difficult if not impossible to transfer during one event. The Transfer of Training, as discussed in another forum topic will be significantly reduced.

We developed an online course with distant support to tailor to those situation where it's not possible to offer a full process due to financial or other reasons. It's called Blended Learning.

Message reçu de Sangaré Alfousseyni, du Mali

Merci laurence

le passage à l'échelle au Mali a commencé en 2003 avec l'initiative un cercle une ONG qui s'est brutalement arrêtée pour des raisons d'incompréhension. Les acteurs Etat qui accompagnaient cette initiative n'ont pas dans leur grande majorité participé à l'élaboration. Ils ne comrenaient pas du tout le bien fondé de cette affaire (leçon: il faut une participation large dès le début)

Les capacités de facilitation doivent être l dès le départ. Plusieurs ONG et même pas tous les partenaires techniques et même Groupe Pivot qui étaient l'organisme de facilitation n'avaient les outils de la démarche. On s'est jeté dans l'initiative en comptant sur l'improvisation (leçon : il faut d'abord avoir une masse critique de facilitateurs bien formés et bien engagés)

Les appuis financiers étaient très irréguliers et les procédures de mise à disposition des fonds étaient catastrophiques le premier trimestre de financement a servi toute la première année créant des démotivations et des démobilisations des ONG (leçon bien réfléchir au financement et à la mise à disposition des fonds)

Il faut la transparence dans la gestion (ONG et communautés). Cette transparence n'est pas toujours là. Les ONG ont beaucoup de problèmes à ce niveau.

Pour le roud 8 financé par le Fonds mondial, on avait plus d'autonomie mais le programme s'est arrêté brutalement alors que les choses étaient bien parties.(leçon il faut des fonds souverains pour bien conduire à l'échelle)

Translation:

 

Message received from Alfousseyni Sangare, Mali

 

Thank you Laurence

 

Scaling up in Mali began in 2003 with the initiative of an NGO circle stopped abruptly for reasons of misunderstanding. Most of state actors that accompanied this initiative were not involved in the development phase. They did not understand the merits of the project (Lesson: we need a broad participation from the beginning)

 

Facilitation skills should be there from the start. Several NGOs, not even all the technical partners, not even the Pivot Group who were the facilitating organization had the tools of the process. We took the initiative relying on improvisation (Lesson: we must first have a critical mass of well trained and involved facilitators)

 

Financial support was very irregular and procedures for provision of funds were disastrous. The first quarter funding was used throughout the first year, creating disincentives and demobilizations of NGOs (Lesson: think carefully about the financing and provision of funds)

 

There must be transparency in the management (NGOs and communities). It is not always there. NGOs have a lot of problems at this level.

 

With Round 8 of the Global Fund, we had more autonomy, but the program came abruptly to an end even though things were well under way. (Lesson: funds from the country must be found to scale up)

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