Abstract:
Scaling up an emergency obstetric and neonatal care (EmONC)
programme entails reaching a larger number of people in a
potentially broader geographical area.Multiple strategies requiring
simultaneous attention should be deployed. This paper provides a
framework for understanding the implementation, scale-up and
sustainability of such programmes. We reviewed the existing
literature and drew on our experience in scaling up the Essential
Steps in the Management of Obstetric Emergencies (ESMOE) programme
in South Africa.We explore the non-linear change process
and conditions to be met for taking an existing EmONC programme
to scale. Important concepts cutting across all components of a
programme are equity, quality and leadership. Conditions to be
met include appropriate awareness across the board and a policy
environment that leads to the following: commitment, health
systems-strengthening actions, allocation of resources (human,
financial and capital/material), dissemination and training, supportive
supervision and monitoring and evaluation.
