YOU ARE HERE:
1. Introduction to A Question of Scale?
   Last updated: 16.08.02
 
It is estimated that there are currently over 36 million people living with HIV/AIDS globally and in 1999, 5.3 million individuals were newly infected with the virus.1 (UNAIDS/WHO AIDS Epidemic Update, December 2000)The organisations currently addressing this rapid and devastating spread of the pandemic clearly are not operating at sufficient scale or with enough impact to stem its progress. The areas of the globe where 95 per cent of those living with HIV reside, and which is experiencing the fastest and most relentless growth of the epidemic, are broadly defined as developing countries. These are the very countries that are least able to afford to ensure broad and equitable access to the new anti-retroviral therapies against HIV/AIDS and treatments for opportunistic infections, or to provide care and support for those with HIV. Thus there is an urgent moral dimension to the struggle to enlarge the scale of HIV/AIDS activities.

AIDS activities initiated by non-governmental organisations (NGOs) have been highly influential on thinking and strategies found within the HIV/AIDS sector. Yet despite their proliferation, NGOs often experience particular difficulties in increasing the scale of their activities to reach larger numbers of people, to have an impact at levels higher than the “community” and to address the broader social determinants of HIV/AIDS. Much of the pioneering contribution of NGOs active in HIV/AIDS to wider public debate and approaches in the sector has been spontaneous, as has often been the case in development, rather than a result of planned and deliberate strategy.

Perceiving the urgent need for NGOs to expand the scale of their activities in the face of an escalating epidemic, Horizons and the International HIV/AIDS Alliance launched an initiative to examine the nature of the challenge to scale up in the context of HIV/AIDS internationally. This publication was prepared as part of this initiative and addresses the specific challenge of deliberately increasing the scale of HIV/AIDS prevention, care and support programmes in developing countries. It asks whether there are lessons from the broader literature on development which are of relevance to HIV/AIDS. An initial draft of this publication was presented to an international seminar convened as part of this project at which 12 NGOs from around the world presented their own experience of scaling up.2 Examples of increasing the scale of NGO activities in HIV/AIDS given here draw primarily on these case studies, presentations and comments at the seminar and relevant available published documentation. While the focus of the publication is on the activities of non-governmental organisations, it recognises that increasingly NGOs are engaging in partnerships with governments, academic institutions and other organisations in their quest to widen the impact of their activities.

2 Horizons/Alliance Seminar on Scaling Up, Windsor, England, September 1-5, 2000. (Hereafter referred to as Horizons/Alliance Seminar) See Appendix A for a complete description of these case studies. Note that the authors of each case-study and his/her organisation have reviewed the edited text for content and accuracy. Appendix D is a list of participants at the seminar.

The publication consists of three main sections. The first provides a background to and definitions of the term “scaling up” and describes contrasting perspectives to defining this term within the field of HIV/AIDS. In section two, drawing on the existing broader experience of scaling up development programmes, a typology of these processes relevant to HIV/AIDS is proposed. Substantial attention is paid to some of the risks inherent in the scaling up process, as cautionary tales for those interested in embarking on it. The publication also analyses the varied obstacles to scaling up programmes, both in general and how the sensitive nature of HIV/AIDS and diversity of contexts complicate the process. The third section examines the institutional implications of scaling up and the many internal dimensions that must be taken into consideration to prepare for scaling up. The publication concludes with some discussion of the relevance of the arguments made here for both donors and AIDS-support organisations.

Source: A Question of Scale
This is an extract from A Question of Scale: The challenge of expanding the impact of non-governmental organisations’ HIV/AIDS efforts in developing countries,
by Jocelyn DeJong, published by the Horizons Project of the Population Council with the International HIV/AIDS Alliance in 2001. To view the whole report follow this link.

To download, complete with graphics, in pdf format (which requires Adobe Acrobat software to read it) follow this link (file size 1.43 Mbytes).