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Scaling & Sustainability

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Scaling and Sustainability

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In order to adapt Stepping Stones and to maintain fidelity to the original, you need to keep your programme to around 50 hours. Otherwise it is no longer Stepping Stones and will not achieve what was originally achieved.

Please do read our adaptation guidelines and FAQs to get more information about how you can make best use of our materials.

You can also access our work with the CUSP Collective on feminist scaling of our respective programmes. CUSP stands for the Community for Understanding Scaling Processes. Follow this link to access our thought-piece, webinar, blog – and more – on ethical, effective and sustainable scaling processes.

Scaling is hugely important for all of us seeking to develop wider access to a programme. There is also always the challenge  of how to increase the quantity of people involved in a programme without reducing the quality of the training they receive or its effectiveness in their lives. In the world of medication, this is referred to as maintaining the ‘duration’ and ‘dosage’ of a particular medication in order to achieve ‘fidelity’ of implementation, so that the effects of prescribing the medication in one community can be achieved for everyone in many communities.

In the context of a programme like Stepping Stones, ‘dosage’ would refer to the content of the sessions and the quality of their facilitation; and ‘duration’ would refer to the quantity of time: the number of hours of contact time with community members and the number of weeks taken to conduct the programme with community members.

The original Stepping Stones training programme was designed as 18 sessions of around 3 hours each, and we suggested that the programme might run over 9 weeks – ie with 2 sessions a week. This totalled about 54 hours. The sessions are carefully sequenced, like a staircase, and it is strongly recommended that each session be taken in order, since the later sessions contain content that can feel highly emotional.

By way of comparison the South African adaptation of Stepping Stones which was tested in a Randomised Control Trial, ran for about 50 hours. This was also carefully sequenced, over 14 rather than 18 sessions, with a few of the original exercises cut and a few others added in.

In order to adapt Stepping Stones and to maintain fidelity to the original, you need to keep your programme to around 50 hours. Otherwise it is no longer Stepping Stones and will not achieve what was originally achieved.

Some examples of going to scale

Some organisations using Stepping Stones have achieved scale-up successfully. Below are some examples:

Malawi: The Coalition of Women living with HIV and AIDS (COWLHA), with funding from the UN Trust Fund for Women, adapted Stepping Stones for use with women living with HIV and their partners in their communities. The programme was taken to scale across 144 communities in 12 districts. The evaluation report confirms that gender-based violence was reduced effectively in all these communities. A case study about this adaptation of Stepping Stones was highlighted in a UNAIDS/ATHENA publication. Click here to read it in full.

India: The Karnataka Health Promotion Project (KHPT) in India, under the guidance and leadership of Parinita Bhattacharjee, together with the University of Manitoba, with CIDA funding,  rolled out and expanded the use of Stepping Stones from one district in 2003 to 6 districts state-wide by 2007. Karnataka State has 2-3% general prevalence of HIV.

The Gambia: ActionAid, the Gambia Family Planning Association, the Medical Research Council and others partnered to adapt Stepping Stones and take it to scale in the Gambia. The adapted programme continued to be about 50 hours in length. Here the programme was scaled up to 20 villages of 500 participants each in 1 year – ie to 10,000 participants. In the Gambia, Stepping Stones was integrated into the rural development system and structures at national level. NGOs became part of multi-disciplinary teams making development plans. Stepping Stones was made available to any village with reproductive health problems.

Sustainability is another huge challenge for us all. Key messages from several Stepping Stones evaluations have highlighted the need to ensure that there is on-going follow-up work and involvement of organisations in communities where Stepping Stones workshops have taken place, so that communities can really begin to feel that the changes belong to and are owned by them rather than just being brought in by outsiders. Just doing a one-off workshop is never enough. This is a challenge – unfortunately there is often great pressure from donors to push on to roll out the programme in the next community, rather than to consolidate the changes that have taken place in a community through on-going support and follow-up. We have heard many stories where organisations have had to make highly skilled staff redundant once the project funding has come to an end. All the expertise built up within the training team over the project – and the great work that community members have done with their support – is then often lost. This can be a huge waste of scarce resources.

However, where on-going support has been provided, the results can be very encouraging. A key example is that of the village of Buwenda, the very first workshop where a Stepping Stones workshop took place. This was a community where Redd Barna was already supporting community members in various ways. Of particular benefit was the start-up seed funding that Redd Barna was able to provide to different peer groups which had formed during the workshop, so that they could embark on income-generating activities of their own creation after the workshop. Our impression is that the workshop provided the impetus for community members, especially the younger participants, to join together, form ideas for activities and work together to create further changes in their lives. The support of Redd Barna in enabling their dreams to become a reality is borne out in the Stepping Stones Revisited DVD, which can be ordered from us, and which can also be viewed here.

For further resources about scaling up and sustainability see below.


Resource Links