2 Reaching a goal using the Theory of Change model

This section will take you through the Theory of Change model using a development example – the problem of high maternal mortality (deaths of women in childbirth) in sub-Saharan Africa. The specific challenges are that expectant mothers often do not have access to specialist obstetric care facilities and deliver their babies at home without specialist care or in facilities without trained staff or adequate equipment. Where adequate facilities do exist, women may be unaware of the benefits of using them. Access to specialist care during delivery can therefore relate both to availability and awareness.

Maternal mortality was addressed in Millennium Development Goal 5 (MDG5) (United Nations, n.d.) and is now part of Sustainable Development Goal 5: ‘Ensure healthy lives and promote wellbeing for all at all ages’. The MDG5 goal (which was not met) was to reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio. (This is the ratio of the number of maternal deaths during a given time period per 100,000 live births during the same time period.)

Note that it is important to recognise that what follows is a learning exercise rather than a Theory of Change process, which must, by definition, involve other stakeholders.

Now refer to the Theory of Change template in the DIY toolkit. Starting on the left-hand side of the template, you enter the problem you are trying to solve. In the example of maternal mortality, this is poor access to, or awareness of, obstetric care facilities, insufficient trained staff and inadequate equipment in healthcare facilities.

Moving to the right on the template, you would then identify the key audience. In this example, there are two key audiences. The first is women of childbearing age. The second is the health workers involved in childbirth, from traditional birth attendants through to midwives in healthcare facilities.

In the next box you should detail the entry point for reaching the key audiences. In this example, this is village health workers (who can reach women of childbearing age as well as traditional birth attendants) and district-level health officers (who are responsible for the training of healthcare facility staff as well as the provision of equipment).

Moving further to the right you should now enter the steps needed to bring about the change. In this example, these steps involve training of midwives and traditional birth attendants, improved equipment and facilities, and raising awareness among women of childbearing age to know when to seek assistance and deliver their baby in a healthcare facility.

Of the next three columns on the right, it is often the longer-term goal that is quite clear and implicit in the identified problem.

Activity 2

Timing: Allow around 5 minutes for this activity

Can you identify the longer-term goal in the example of maternal mortality?

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Discussion

The longer-term goal is to reduce maternal mortality.

You may have recognised that the longer-term goal is not necessarily the same as the direct output (or measurable effect) of the work. In this example, the measurable effects are increased awareness among women of childbearing age of the benefits of delivering their babies in a healthcare facility, improved knowledge and skills of midwives and traditional birth attendants, and improved provision of equipment and facilities.

The wider benefits, or outcomes of the intervention, are that more women have better-quality, specialist healthcare during childbirth. The logic is that if women are more aware of the benefits of delivering their babies in healthcare facilities, and if health workers are better trained and have better equipment, then more women receive specialist care, which contributes to a reduction in maternal mortality.

Activity 3

Timing: Allow around 15 minutes for this activity

Using the information in Section 2 and the template provided below, try to complete a Theory of Change for the example of maternal mortality. At this stage, don’t worry about completing the boxes headed ‘Key assumptions’ – you are going to work through these in Section 4. However, if you have any ideas about these now then do make some notes.

What is the problem you are trying to solve?Who is your key audience?What is your entry point for reaching your key audience?What steps are needed to bring about change?What is the measurable effect of your work?

 

 

 

 

What are the wider benefits of your work?What is the long-term change you see as your goal?
Measurable effect?

 

 

 

 

Wider benefits?
Measurable effect?

 

 

 

Wider benefits?
Key assumptionsKey assumptionsKey assumptionsKey assumptionsKey assumptionsKey assumptionsStakeholders

Discussion

Yours may not be exactly like the example here, but did you capture the key elements summarised in the Theory of Change below?

What is the problem you are trying to solve?

  

Poor access to, and awareness of, obstetric care, insufficient trained staff and inadequate equipment in health facilities.

 

Who is your key audience?

   

Women of childbearing age

 

Healthcare workers: traditional birth attendant (TBAs), midwives in healthcare facilities

 

What is your entry point for reaching your key audience?

 

Village health workers

 

District health officers

What steps are needed to bring about change?

 

Training of midwives and TBAs

 

Improved equipment and facilities

 

Raising awareness among women of childbearing age

 

What is the measurable effect of your work?

  

Increased awareness among women of child bearing age

 

What are the wider benefits of your work?

  

More women have better- quality, specialist healthcare during childbirth

  

What is the long-term change you see as your goal?

 

Reduced maternal mortality

Measurable effect?

 

Improved knowledge and skills of midwives and TBAs

 

Measurable effect?

 

Improved facilities and provision of equipment

 
Key assumptionsKey assumptionsKey assumptionsKey assumptionsKey assumptionsKey assumptionsStakeholders

1 The purpose and benefits of a Theory of Change model

3 The participatory process of identifying the Theory of Change for a programme or idea