Gaining insight into why programs achieve scale or not is not sufficient for change at any level of society. Learning how programs successfully achieve scale (what some might call observational learning), imitating them (a form of flattery that many are loathe to practice unfortunately) and monitoring performance (through relevant program outputs and behavioral outcomes to feed back to planners what is working and what needs to be adapted to local circumstances) are the components of turning lessons learned into action (note I deliberately left out epidemiological endpoints. Waiting until then is waiting way too long).
The Bringing HIV Prevention to Scale report also examined how the successful national efforts of Brazil, Senegal, Thailand and Uganda scaled up their national HIV prevention activities. These countries have demonstrated that it is feasible to reduce the incidence and prevalence of HIV, slow down the rate of predicted increases in prevalence and keep HIV infection rates at low levels. The common characteristics seem to be:
- Adequate and Sustained Funding
- Visible Political Support
- Targeted, Evidence-Informed Action
- Use of Mass Media and Other Channels to Raise HIV Awareness
- Anti-Stigma Measures
- Involvement of Affected Communities and Diverse Sectors
The report also highlights that truly comprehensive HIV prevention programs need to focus on (1) preventing sexual transmission, (2) preventing blood-bourne transmission (including through blood transfusions and sharing injection equipment), (3) preventing mother-to-child transmission, and (4) social strategies and supportive policies. These authors also note that expanding access to key HIV prevention services including HIV counseling and testing, expanding condom distribution and use, and targeting of high risk and vulnerable groups - injection drug users, sex workers and men who have sex with men - are all necessary for scaled up programs to succeed.
Reading these reviews I have to ask if this problem of scale is really a call for better social marketing - creating and managing markets and resources more strategically? Or has the international health community gotten to the point where social marketing is being marginalized as a term reserved only for the promotion and distribution of subsidized commodities through commercial sector channels?
Then again, I guess we could be talking about marketing through social network sites and blogs? Those people call themselves 'social marketing experts' too.
About the image: This map shows the distribution of all people between ages of 15 and 49 with HIV.