'Scaling-up is a craft not a science': Catalysing scale-up of health innovations in Ethiopia, India and Nigeria.

Donors and other development partners commonly introduce innovative practices and technologies to improve health in low and middle income countries. Yet many innovations that are effective in improving health and survival are slow to be translated into policy and implemented at scale. Understanding the factors influencing scale-up is important. We conducted a qualitative study involving 150 semi-structured interviews with government, development partners, civil society organisations and externally funded implementers, professional associations and academic institutions in 2012/13 to explore scale-up of innovative interventions targeting mothers and newborns in Ethiopia, the Indian state of Uttar Pradesh and the six states of northeast Nigeria, which are settings with high burdens of maternal and neonatal mortality. Interviews were analysed using a common analytic framework developed for cross-country comparison and themes were coded using Nvivo. We found that programme implementers across the three settings require multiple steps to catalyse scale-up. Advocating for government to adopt and finance health innovations requires: designing scalable innovations; embedding scale-up in programme design and allocating time and resources; building implementer capacity to catalyse scale-up; adopting effective approaches to advocacy; presenting strong evidence to support government decision making; involving government in programme design; invoking policy champions and networks; strengthening harmonisation among external programmes; aligning innovations with health systems and priorities. Other steps include: supporting government to develop policies and programmes and strengthening health systems and staff; promoting community uptake by involving media, community leaders, mobilisation teams and role models. We conclude that scale-up has no magic bullet solution - implementers must embrace multiple activities, and require substantial support from donors and governments in doing so.

The work of a woman is to give birth to children: cultural constructions of infertility in Nigeria.

Infertility is a condition loaded with meaning spanning across biomedical, psychological, social, economic, cultural and religious spheres. Given its disruptive power over women's lives, it provides a unique lens through which issues of kinship, gender, sexuality, cosmology and religion can be examined. The paper presents the results of an ethnographic study of infertility in Central Nigeria. Explanatory models of infertility were variegated, encompassing biomedical, folk and religious elements. Like other ethnographic studies of help seeking for infertility in Nigeria, among this group resort was made to biomedical treatments, traditional healers and religious healing with no one system being hegemonic. The findings of this study accord with studies of infertility in other cultural groups indicating the disruptive influence of missing motherhood.