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16. Internal Dimensions of Scaling Up

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Last updated: 16.08.02

Preparing for Scaling Up
Changes in Institutional Culture and Processes
Involvement of Volunteers
Leadership
Capacity
Documentation and Evaluation
Source: A Question of Scale

Preparing for Scaling Up
In most analyses of scaling up processes, emphasis is placed on the external, programmatic dimensions with much less attention paid to the internal, organisational questions which are perhaps equally important. Indeed, the reasons behind failure to scale up may lie more within the organisation, in terms of inappropriate leadership, management or structures, than outside. The little published literature there is on these concerns focuses on the experience of Northern, rather than Southern NGOs (see for example Hodson; Billis and MacKeith in Edwards and Hulme 1992).

This deficiency applies equally to analysis of the internal implications of scaling up for NGOs active in HIV/AIDS. Evidence from case studies presented at the Horizons/Alliance Seminar on scaling up indicates that very few organisations actually prepare their staff or internal processes for the demands of scaling up. The experience of KANCO is exceptional and instructive in this regard. Having made the shift from a voluntary to professional organisation, and having established an office in 1993-4, they rapidly expanded and successfully received a higher level of funds. However, they began to see some of the bigger programmes collapse, and therefore went through a period of institutional reflection to analyse what was happening within the institution. They developed a questionnaire for staff concerning the goals of the organisation, achievements and what people enjoyed in working for the organisation. This process informed a thorough strategic plan that laid the basis for a re-organisation. Among the new procedures introduced were job analysis and evaluation, new financial and personnel procedures, a staff appraisal system and more attention to sustainability.

Bob Grose, a representative of DFID at the time of the inception of the Healthy Highways Project in India targeting truck drivers and their partners, noted at the Horizons/Alliance seminar that scaling up is a type of transition and as such should be considered a project. Like any project, he argued, scaling up needs a clear plan, with objectives, indicators for achieving objectives and a plan of activities. Indeed, several participants in the Horizons/Alliance Seminar noted that because they did not consider the scaling up process as that, they lacked indicators for evaluating it. But Grose and other participants agreed that not all aspects can be planned in the real world, where one often has to respond to the sudden emergence of opportunities, needs or even threats.

Whether an organisation has the time to reflect on internal and external prerequisites for scaling up, however, partly depends on the nature of its funding. If the entire scaling up process is financed from a single donor, often its pace may be dictated by that particular donor’s demands. PSG in Zimbabwe has a policy of maintaining funding from five diverse donors, partly in order to ensure the requisite programme and institutional autonomy.

Changes in Institutional Culture and Processes
Institutional culture and structures are inevitably affected as organisations expand the scale of their activities. Changing roles of staff and board in the process of scaling up can be very threatening, and may lead to loss of staff. Decisions formerly made on the basis of trust and informality may give way to more formal structures and increased hierarchy (Hodson 1992) and involve different people (Horizons/Alliance Seminar). How managers help staff of their organisations to weather these dramatic changes is critical to the success of the scaling up. Staff may be used to a process of ownership and participation that is possible in a smaller organisation but may not be sustained as scaling up proceeds (Billis and MacKeith 1992). Expansion may also require an increased functional specialisation between parts of the organisation, increased capacity to raise resources (Edwards and Hulme 1992) and standardised delivery mechanisms to reduce unit costs (Edwards and Hulme 1996). Increased emphasis on professionalism and efficiency may come to replace the “value consensus” and mission goals that motivated the establishment of the NGO in the first place (Hodson 1992).

These processes may be particularly true of organisations addressing HIV/AIDS where staff’s personal commitment to the aims and particular approaches to HIV/AIDS which they feel are rare may inspire a particularly strong sense of staff ownership, and thus resistance to change. The greater diversity within the organisation and the increased proportion of professional staff as opposed to volunteers, as organisations expand into service-delivery organisations, for example, can sometimes limit the ability to work with affected communities.43 Both of these trends may jeopardise the former commitment of the organisation to providing labour-intensive personalised care.

43 This risk has been cited by Woolcock and Altman in the case of Australia (O’Malley et al 1996).

When, as is often the case, only certain programmes of an organisation are scaled up, there may be a sense of resentment and competition over resources from staff of other programmes. This was true of the experience of both SIAAP and Naz, for example. In the former case, the counselling programme expanded much more rapidly than the others did, and in the latter, the Healthy Highways initiative began to command a greater amount of resources and attention internally.

Involvement of Volunteers
Many of the organisations that expanded their HIV/AIDS activities did so through the explicit recruitment or increased involvement of volunteers. AMSED, for example, in Morocco saw this as a key strategy for reaching more people. Since volunteers usually come from the communities with which NGO are working, are aware of existing services and often know the community-members well, the clear benefit is the increased sense of community ownership over the project the involvement of volunteers brings. This was also the case for ASI, where volunteers with HIV/AIDS contributed both time and materials towards the building of a new clinic – a step that ASI sees as critical to the legitimacy of the effort. Similarly, PSG describes its programmes as almost entirely based on volunteers: “PSG’s prevention and mitigation activities share a common approach. They both work with community volunteers to deliver large-scale, economical, locally relevant services that increase community response capacity”. (Appendix A, Case study page 46). In Cambodia, volunteers in the Home-Care programme described above are “well-placed to facilitate links with other community activities, to ensure access and accessibility of Home Care Teams, and are a major source of referral of new patients to the Home Care Teams”. (Wilkinson et al 2000).

Often volunteers work as peer educators, who have been shown to be highly effective in a variety of settings in terms of fostering behavioural change, and also in generating demand for HIV related services such as voluntary counselling and HIV testing and management of sexually transmitted infections (Horizons 2000b).

Nevertheless, the contribution of volunteers may need to be formalised as the scaling up proceeds. ASI found that a critical step that improved their effectiveness was the recruitment of a manager to whom the volunteers report. The formalisation of the contributions of volunteers or donated commodities will mean that the costs associated with scaling up may be significantly different (and substantially larger) than the costs of running projects at current scales of activity. The costs, for example, of peer education programmes are often much higher than expected given the need for training, support, supervision and to provide them with resource material and compensation (Horizons 2000b).

Several organisations present at the Horizons/Alliance Seminar note that volunteers play a key role in collecting data useful for monitoring projects. However, the same organisations have also noted the problem of quality entailed in relying solely on volunteers to collect data. Clearly, also, the frequently high turnover of volunteers can be detrimental to institutional learning.44

44 Although, as noted by Jeff O’Malley at the Horizons/Alliance Seminar, turnover of volunteers is not necessarily a bad thing, particularly given the high risk of “burn-out” associated with such stressful work.

Leadership
Many innovative NGO efforts are led by charismatic, visionary leaders who pay relatively less attention to the establishment of participatory internal structures of governance (Edwards and Hulme 1992; Fowler 1991) and this has also been true of those active in HIV/AIDS (Sittitrai 1994). Yet the demands on leadership necessarily change as the organisation enlarges its scale of activity. The question is then raised as to whether the leader who pioneered the scaling up process is appropriate to lead the organisation through the next stage (question from Horizons/Alliance Seminar).

In order to sustain expansion of the organisation, it is imperative that consensus among staff is reached about the objectives and approaches to scaling up. Moreover, in order to scale up operations, managers increasingly have to delegate to lower levels of staff and to leaders within the beneficiary community. Are they willing to give a prominent role to subordinate staff members and for example, sex workers, in directing activities and will due credit be given to them? And is attention being paid to the need to develop a second generation of leadership given that the scaling up process is likely to take a long time? The leadership of any organisation undertaking scaling up is likely to feel tension between the often conflicting processes of achieving efficiency for operating at a larger scale, encouraging participatory processes within the beneficiary community and sustaining employee aspirations and motivations as the organisation undergoes change (Hodson 1992).

Capacity
Scaling up may necessitate the hiring of new categories of staff or enlisting new board members with diverse skills, or the retraining of existing personnel, which may be very costly. One key area that needs to be addressed is the avoidance of high staff turnover, given the need for institutional continuity during what is often a time-consuming scaling up process. This may be a particular problem for organisations that have relied on volunteers, or where salary levels are not sufficient to keep talented staff. While NGOs in most fields face difficulties in maintaining continuity and retaining skilled and experienced staff, those in HIV/AIDS face particular constraints since “the epidemic is so close to the people who are working in the epidemic” (Loughran 1995: 6) This has been the experience, for example, of the Cambodia home-care programme which has lost a number of key staff to HIV (Horizons/Alliance Seminar). Where an NGO loses key staff to HIV, it may take a long time for the programme to regain momentum.

There is also a need for staff to maintain good working relations with the often diverse organisations with which they will come into contact in the scaling up process, whether other NGOs or governmental bodies. Staff will need to document the processes and obstacles to scaling up and be able to communicate these lessons more broadly to stakeholders.

Once agreement has been reached on the objectives of scaling up, there needs to be careful attention paid to creating appropriate incentives for staff - or personnel of the organisations one is trying to influence (strategy 2) - to meet them. This is a particularly challenging task in sensitive areas such as HIV/AIDS where, because of the deep stigma associated with it, there is a need to instil changes in attitude and approach.45 An example of the difficulty of inspiring such attitudinal change is provided by the case of reproductive health in India. Following the International Conference on Population and Development the Indian government undertook a strong commitment to shifting the orientation of their population programmes from a vertical orientation to family planning to the wider and more comprehensive concept of reproductive health. Yet one of the main constraints to implementing this strategy is the difficulty of changing the approach of family planning cadres who are entrenched in ways of working that stress the goal of increasing contraceptive prevalence rates, rather than the process-oriented approach of eliciting and addressing often sensitive reproductive health problems (Health Watch 1998). As several participants in the Horizons/Alliance Seminar noted, however, the process itself of expansion - although it may require change in attitude and in ways of working - can be a morale boost for staff, in conferring a sense of greater visibility, prominence and effectiveness (PSG, ASI, KANCO).

45 Smith and Colvin 1999 has extensive analysis of this point as well in relation to adolescent services.

Documentation and Evaluation
Often overlooked in the haste to expand the scale of activities is the importance of building capacity to collect data as well as to document the experience of scaling up or the indicators used to evaluate it. Greater attention to documentation of the process of scaling up is important not only as a motivating factor for staff, but also provides the opportunity to share success with others, thereby widening perception of need, widening constituencies involved and even stimulating new action.