Despite consensus on actions to improve nutrition globally, less is known about how to operationalize the right mix of actions—nutrition-specific and nutrition-sensitive—equitably, at scale, in different contexts. This review draws on a large scaling-up literature search and 4 case studies of large-scale nutrition programs with proven impact to synthesize critical elements for impact at scale. Nine elements emerged as central:
- having a clear vision or goal for impact;
- intervention characteristics
- an enabling organizational context for scaling up
- establishing drivers such as catalysts, champions, systemwide ownership, and incentives
- choosing contextually relevant strategies and pathways for scaling up
- building operational and strategic capacities
- ensuring adequacy, stability, and flexibility of financing
- ensuring adequate governance structures and systems
- embedding mechanisms for monitoring, learning, and accountability.
Translating current political commitment to large-scale impact on nutrition will require robust attention to these elements.