Working at scale

Hygiene Improvement at scale

The model HIP intends to adapt and test most vigorously is one developed by AED called SCALE. This model shifts the focus from health interventions to starting big by capitalizing on existing systems already engaged in hygiene activities.

Using a system-wide approach requires stepping back from routines and specific events to consider the larger context – the web of influences (social, economic, environmental and political) that affect the problem at hand.[1] Systems thinking is concerned with long-term patterns and trends of change and their causes. It also identifies differing spheres of responsibility within the system where change can occur and examines the implications of expected changes to ensure that change in one part of the system will not adversely affect another part of the system. Because systems resist change, feedback loops are necessary to balance negative and positive feedback to ensure proper flow of information throughout the system.[2]

HIP will utilize its systems approach to detail the processes involved in implementation at scale.The strength of working at scale is identifying the underlying web of reciprocal relationships within systems and locating leverage points within those systems where targeted action will yield maximum change. Economics, weather, culture, trade decisions, taxes and political parties all affect the lives of HIP’s target populations directly or indirectly and should be considered when hygiene improvement programs and interventions are planned.

Starting at scale, HIP intends to catalyze the many actors, efforts and sectors within the system, rather than focusing at the household level, to plan and act on a common goal simultaneously. The resulting synergy from all inputs drives the system to change. When all parts of the system reinforce the same improved behaviors, these behaviors become the social norm and are thus sustainable over time.

HIP defines starting at scale as more than population and/or geographic coverage: it is coordinated actions of many stakeholders working on a common goal to the social benefit of targeted groups. It is the convergence of skills, interventions, and availability of products and services at the same time, in the same places to benefit the same targeted communities. While our aim is to start at scale, HIP will consider strategic opportunities to complement existing country efforts that may grow into programming at scale.

Historically, the health sector has attempted to take small-scale efforts and double or triple them to move to scale.Small-scale processes by their very nature do not mimic large-scale processes; therefore, the assumption that a small-scale effort can be tripled and will automatically become at scale is based on the false premise that they do imitate each other.

Plans for implementation at scale will reflect what countries need as well as what hygiene improvement requires.They will bring stakeholders together to develop a common agenda and action plan for improving hygiene. In some cases, HIP will coordinate many small-scale efforts to form the effort at scale.

[1] SCALE, Academy for Educational Development 2004.

[2] Donatella Meadows, Whole Earth: Dancing with Systems, www.wholeearthmag.com/ArticleBin/447.html