This book considers the topic of scaling up from a particular vantage point. The focus is on ways to increase the impact of health service innovations that have been tested in pilot or experimental projects so as to benefit more people and to foster policy and programme development on a lasting, sustainable basis. The book addresses a major failure in the global health and development field: namely, the failure to expand the many successful small-scale pilot or demonstration projects that have been organized around the world so as to benefit larger populations than those initially served. It presents a conceptual framework for thinking about scaling up as well as case-studies from Africa, Asia and Latin America where the potential for expansion was a concern from the very inception of pilot or experimental projects. The case-studies discuss family planning and related reproductive health service interventions as well as other innovations in primary health care. The case-studies presented in this book share a series of common values. They emphasize the imperative to build capacity within the public sector institutions to meet the health needs to the disadvantaged. They highlight the necessity of building a strong sense of both local and national ownership in the identification of priority health needs, the development and testing of local solutions, and the formulation of context-specific strategies for expanding small-scale successes. The book build s upon nearly 15 years of experience with the development and testing, in more than 25 countries around the world, of the Strategic Approach to Strengthening Reproductive Health Policies and Programmes.