“Scaling up to meet the need is equivalent to when a large group of people must use a bus to undertake a crucial journey. If the bus is too small, or it goes too slowly, or it takes a wrong turn, or its mechanical problems are not fixed, or it is badly driven, it won’t reach its destination in time. Simply pouring in more fuel won’t resolve these problems. Government and other players in the countries involved must deal with all the issues if the journey is to succeed.”(Rivers, 2008)

‘Scaling up’has become a much-used term in global health in the 21st century for a number of reasons. There has been increasing awareness of global inequalities and the number of people without access to essential health services, and that to achieve the health-related Millennium Development Goals (MDGs) requires scaling up in the sense of both ‘big’and ‘urgent’. Scaling up was a key concept in the 2001 report of the Commission on Macroeconomics and Health. Since then, global health partnerships (such as the Global Fund and GAVI) have helped to significantly increase access to a range of interventions.