Health intervention pilots: thinking big before thinking small.

Pilots are a commonly deployed tool to support global health reform efforts. However, many pilots fail to be taken to scale due to critical flaws in pilot design and planning. Deploying pilots, which are not designed to be taken to scale, or not appropriate to answer the fundamental questions of scale, may distract from needed scale efforts or reduce resources available for reform. This article proposes four guidelines for planners to consider when designing a pilot. These guidelines can help ensure a pilot is both successful in achieving its internal targets and successfully implemented at scale.