Scale up and Sustainability Flashcards
What is the difference in treatment gap in HIC and LMIC?
2 in 10 LMIC vs 1 in 3 HIC
What is scaling up and why is it important?
An increase in the number of those receiving services,
Ideally scientifically backed
Services should be sustainable
Because of the lack of Human Resources
What is the current research into scaling up in LMIC?
in the last 10 years only one- in chillie
Wha did the RCT in Chilie find with regard to scaling up?
At 3 months and 6 Months, it was preferable to TAU for women with depression
Subsequently expanded to India and Zimbabwe
What effect did the Chillie scaling up programme have on policy?
2001 to 2003 rolled out as a pilot funded by the National programme
National level by 2004.
160 000 treated for depression in 2008 and then 300000 by 2013.
How do you get an RCT to be implemented at a national level?
Put it into political or Finacial terms, easy-to-understand language.
Form strategic alliances: Primary Care and Ministries of Health (leadership of many)
Embed programme into an institution
Ring fence budget
What did the RCT of the friendship bench in Zimbabwe show?
That the intervention of training in behavioural activation and CBT training had marked effects on SSQ and PHQ 9 score even at 6 months.
100 000 individuals were seen in the Pilot
Scale-up then occurred
What were the challenges for the Zimbabwe study?
Core Competencies of Lay workers
Staff levels low
Poor referral system
Lack of supervision
Communication of providers
What were the challenges for the Zimbabwe study?
Core Competencies of Lay workers
Staff levels low
Poor referral system
Lack of supervision
Communication of providers
What are the Key Lessons of scaling?
Design with stakeholders
Keep in touch with stakeholders
Understand policymakers
Learn the language of policy makers
Give ownership to those who can make it possible.
What are the general lessons for scaling?
Never underestimate the media
Be patient
Scaling takes time and teamwork
