The art of taking interventions to scale in global health: Lessons from scaling up a district health management strengthening intervention in Ghana, Malawi and Uganda

The scale-up of successfully tested health system strengthening interventions is essential to achieve Universal Health Coverage. It is widely acknowledged that there is a need to scale up such interventions in low- and middle-income countries to ensure equitable access to health care and sustainable impact on population health. How to scale up is, however, not straightforward, as there is no universally replicable approach. This thesis aims to understand how scale-up of health system strengthening interventions in low- and middle-income countries can be achieved to contribute to realizing Universal Health Coverage. The acquired insights are relevant and provide tangible recommendations for policy makers, funders, researchers and programme managers involved in the implementation and scale-up of health system strengthening interventions. Through learnings from scaling up a complex district-level health management strengthening intervention in Ghana, Malawi and Uganda, the thesis proposes different ways in which the scale-up of complex health system strengthening interventions can potentially be achieved and sustained.