This development strategy prescribes a structured development of not only the content of an intervention, but also of the system (or technology) and the service (including the long term implementation).
I'm thinking here of Matteo Renzi in Italy, who has proposed the very kind of deep structural governance reforms -- new constitutional and electoral arrangements that will enable the forging of majority consensus and enable the long term implementation of policies that Europe as a whole needs.
It should be noted that we use the term enactment to replace the commonly used term implementation [ 8, 9, 12], as the activities in the preparation phase and the final appropriation phase should also be considered as part of the implementation process.
However, the subsequent breakdown of the NGO-health coalitionegativelyly impacted on the long-term implementation of the policy, which lacked financial resources and clear policy guidance from the Ministry of Health.
If s/he observes positive outcomes during the implementation stage, s/he finally commits to the long-term implementation of the innovation.
In Phase II, or the exploratory trial, the optimum intervention is developed, based on the information gathered in Phase I. Phase III consists of the definitive randomized controlled trial, and Phase IV the long-term implementation of the intervention.
Using primary care office staff on the one hand facilitated the long-term implementation of multifaceted interventions after the clinical trial had stopped.
However, both versions cover the same methodological steps of development, piloting and evaluation of a complex intervention, and the long-term implementation after the complex intervention has demonstrated its effectiveness.
Successful scaling-up of a health intervention is based on two prerequisites: first is the development of an effective delivery and management system at various levels and second is the longer-term implementation of the intervention based on a good knowledge of costs and sound financing strategies.
