Background: Program coverage is likely to be an important determinant of the effectiveness of community\r\ninterventions to reduce neonatal mortality. Rigorous examination and documentation of methods to scale-up\r\ninterventions and measure coverage are scarce, however. To address this knowledge gap, this paper describes the\r\nprocess and measurement of scaling-up coverage of a community mobilisation intervention for maternal, child and\r\nneonatal health in rural Bangladesh and critiques this real-life experience in relation to available literature on\r\nscaling-up.\r\nMethods: Scale-up activities took place in nine unions in rural Bangladesh. Recruitment and training of those who\r\ndeliver the intervention, communication and engagement with the community and other stakeholders and active\r\ndissemination of intervention activities are described. Process evaluation and population survey data are presented\r\nand used to measure coverage and the success of scale-up.\r\nResults: The intervention was scaled-up from 162 women�s groups to 810, representing a five-fold increase in\r\npopulation coverage. The proportion of women of reproductive age and pregnant women who were engaged in\r\nthe intervention increased from 9% and 3%, respectively, to 23% and 29%.\r\nConclusions: Examination and documentation of how scaling-up was successfully initiated, led, managed and\r\nmonitored in rural Bangladesh provide a deeper knowledge base and valuable lessons.\r\nStrong operational capabilities and institutional knowledge of the implementing organisation were critical to the\r\nsuccess of scale-up. It was possible to increase community engagement with the intervention without financial\r\nincentives and without an increase in managerial staff. Monitoring and feedback systems that allow for periodic\r\nprogramme corrections and continued innovation are central to successful scale-up and require programmatic and\r\noperational flexibility.
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