Abstract
The decision to move from a successful project outcome to large-scale programme operations in the prevention of vitamin A deficiency involves detailed consideration of technical, managerial, and financial implications. The comparability of demographic, epidemiological, and service conditions at the project and programme levels must be considered in predicting long-term outcomes; the criteria for problem definition and response measurement must also be consistent. Design changes may be required as the scale is expanded; interventions managed by a single sector at the project level may require multiple-sector inputs at the programme level. Training, supervision, and management requirements are more diverse at the programme level, and operations research has an important role in ensuring consistent service performance under varied conditions. It is concluded that the development of effective software systems at the programme level is central to reproducing the technical effectiveness demonstrated at the project level.