A promising approach to scale up health care improvements in low-and middle-income countries: the Wave-Sequence Spread Approach and the concept of the Slice of a System

F1000Res. 2014 May 2:3:100. doi: 10.12688/f1000research.3888.2. eCollection 2014.


There are several examples of successes in improving health care. However, many of these remain limited to the sites at which they were originally developed. There are fewer examples of successful spread of the improvement more widely inside or outside the health systems within which they were developed. This article discusses the wave-sequence approach to spread or scale up, which enables take up of the improvement in a systematic and sequential way, using "spread agents" - people who participated in the original demonstration sites. The paper also discusses the concept of the "slice" of a system which is useful for thinking about spread and considers a phenomenon related to the rate of adoption which we have observed in this wave-sequence approach.

Grants and funding

The Quality Assurance Project (QAP) was funded by the U.S. Agency for International Development (USAID), under Contract Number HRN-C-00-96-90013. The project is managed by University Research Co., LLC (URC). The USAID Health Care Improvement Project is funded by the American people through the United States Agency for International Development and its Bureau for Global Health. The project is managed by University Research Co., LLC (URC) under the terms of Contract Number GHN-I-03-07-00003-00.