What are the barriers to scaling up health interventions in low and middle income countries? A qualitative study of academic leaders in implementation science

Interviews were conducted with fourteen key informants, all of whom are academic leaders in the field of implementation science, who were purposively selected for their expertise in scaling up in LMICs. Interviews were transcribed by hand and manually coded to look for emerging themes related to the two study aims. Barriers to scaling up, and unanswered research questions, were organized into six categories, representing different components of the scaling up process: attributes of the intervention; attributes of the implementers; scale-up approach; attributes of the adopting community; socio-political, fiscal, and cultural context; and research context.Factors impeding the success of scale-up that emerged from the key informant interviews, and which are areas for future investigation, include: complexity of the intervention and lack of technical consensus; limited human resource, leadership, management, and health systems capacity; poor application of proven diffusion techniques; lack of engagement of local implementers and of the adopting community; and inadequate integration of research into scale-up efforts.Key steps in expanding the evidence base on implementation in LMICs include studying how to: simplify interventions; train “scale-up leaders” and health workers dedicated to scale-up; reach and engage communities; match the best delivery strategy to the specific health problem and context; and raise the low profile of implementation science.Most developing countries are currently not on track to reach the health-related Millennium Development Goals (MDGs) [1,2]. A major reason for their slow progress is the “know-do gap”—the gap between what is known and what gets implemented in low and middle income countries (LMICs) [3].The burden of illness in developing countries could be reduced substantially if this gap was narrowed, i.e., if evidence-based tools and services were scaled up. Up to 70% of deaths of children under 5 years, for example, could be prevented