PERFORM2Scale Theory of Change

A complex diagram showing blue text boxes and arrows

The PERFORM2Scale Theory of Change describes a path of milestones/achievements which we hope will lead to changed policy and practice and hence to our objectives - improved service delivery and Universal Health Coverage. The upper level looks specifically at scale-up while the lower level looks at the management strengthening intervention, with sections colour coded to denote factors within our Spheres of Control, Influence and Interest. A PDF of the diagram and the underlying assumptions can be downloaded on the right.

Assumptions of the Theory of Change

(1a) Key stakeholders are convinced by the available evidence about the MSI and are initially willing to collaborate with the scale-up process

(1b) Key stakeholders are convinced by the available evidence about the MSI and remain willing to collaborate with the scale-up process

(2a) Attention of NSSG members not diverted by other priorities

(2b) Attention of RT members not diverted by other priorities

(3a) New knowledge on scale-up lessons is sufficiently well documented

(3b) New knowledge on scale-up lessons is sufficiently well disseminated

(4) Sufficient opportunities to apply scale-up knowledge available

(5) DHMTs willing to participate in the intervention even though no implementation funds are provided

(6a) Effective facilitation skills of CRT during MSI cycle

(6b) Effective facilitation skills of RT during MSI cycle

(6c) Work plan developed by DHMTs is feasible (related to time-frame, decision-authority, resources)

(6d) Work plan developed by DHMTs addresses real problems

(7a) DHMTs remain convinced of the value of the MSI

(7b) Sufficient support available from RT to support expansion of District Groups

(8a) DHMT members of District Group develop sufficient facilitation skills from working with new District Groups

(8b) Low turnover of RT members

(9a) DHMT remains key organisational structure at sub-national level

(9b) DHMT works as a team

(9c) Low turnover of DHMT members

(9d) DHMT decision-space does not decrease

(10) DHMTs involvement in this project, with the consequent opportunity costs, does not undermine (through possible diversion in project activities) health service delivery

(11) Service delivery plans remain in line with health care needs

(12a) New knowledge on MSI lessons is sufficiently well documented

(12b) New knowledge on MSI lessons is sufficiently well disseminated to relevant stakeholders