Scaling up high-impact interventions: how is it done?

Int J Gynaecol Obstet. 2015 Jun;130 Suppl 2:S4-10. doi: 10.1016/j.ijgo.2015.03.010.


Building upon the World Health Organization's ExpandNet framework, 12 key principles of scale-up have emerged from the implementation of maternal and newborn health interventions. These principles are illustrated by three case studies of scale up of high-impact interventions: the Helping Babies Breathe initiative; pre-service midwifery education in Afghanistan; and advanced distribution of misoprostol for self-administration at home births to prevent postpartum hemorrhage. Program planners who seek to scale a maternal and/or newborn health intervention must ensure that: the necessary evidence and mechanisms for local ownership for the intervention are well-established; the intervention is as simple and cost-effective as possible; and the implementers and beneficiaries of the intervention are working in tandem to build institutional capacity at all levels and in consideration of all perspectives.

Keywords: Helping Babies Breathe; Maternal and newborn health; Midwifery; Misoprostol; Scale-up.

MeSH terms

  • Afghanistan
  • Female
  • Home Childbirth
  • Humans
  • Infant, Newborn
  • Midwifery / education*
  • Misoprostol / therapeutic use*
  • Oxytocics / therapeutic use*
  • Postpartum Hemorrhage / prevention & control*
  • Practice Guidelines as Topic
  • Pregnancy
  • Self Administration
  • World Health Organization


  • Oxytocics
  • Misoprostol