Examples from our case studies to illustrate Nonadoption, Abandonment and failure of Scale-up, Spread, and Sustainability

1A. What is the nature of the condition or illness? In Case A, follow-up consultations after cancer surgery and routine consultations for young adults with diabetes were fairly predictable and consistent; the few unpredictable eventualities were low-risk. In contrast, diabetes in pregnancy is a volatile condition and if poorly controlled can lead to fetal malformations or death. The physician felt strongly accountable to the unborn child so “erred on the side of caution”, inviting very few women to try the service. Similarly, heart failure was typically an unpredictable condition whose effects varied from patient to patient (and in the same patient over time).