Theories of change (TOC) support program stakeholders’ understanding of program goals and outcomes and the strategies to achieve them. TOC map proposed pathways of change and illustrate the connections between planned activities and expected outcomes. They also clarify assumptions about why we believe our activities will contribute to the results we expect.
The COVID-19 pandemic disrupted multiple global health programs suddenly and rapidly. Countries have reassigned health care providers to focus on COVID-19, dedicated specific health facilities to care for patients who have it, and moved funds from one health area to another to cover related expenses. At the same time, many people, concerned about contracting the virus, have hesitated to seek needed care. As health systems adjust approaches and priorities and people shift their behaviors, we may need to revisit and revise program designs. We will also need to update our TOC to assess the validity of the change pathways and consider COVID-19’s implications on programs and health.
The following are 10 questions to ask when reviewing TOC in the context of the COVID-19 pandemic:
- Are the right people around the table to rethink the TOC? Since TOC aim to achieve common understanding of program goals and outcomes, consider the people who need to be involved in reviewing and revising the TOC, especially those based in other countries and intervention sites. Note: While circumstances limit opportunities for in-person meetings, it is critical to ensure virtual participation.
- How will COVID-19 affect the TOC?
- Are the outcomes for this program still relevant, attainable, and valid? Have program priorities shifted?
- Which pathways are most likely to be influenced by COVID-19?
- Will COVID-19 affect the timelines for the current project? How will the deadline for the project and its outcomes shift, and what are the implications/consequences, if any?
- Which assumptions about the program have been upended by COVID-19?
- How might COVID-19 affect other areas, like education and employment and how might they in turn influence program outcomes?
- Based on the revised pathways and outcomes, how will the indicators change?
- Does COVID-19 offer opportunities that were not considered before? Are new partnerships being formed to fill emerging gaps in health service delivery? For example, are private sector providers or other nongovernmental partners stepping in to offer services while the public sector grapples with COVID-19?
- Do you have to renegotiate your TOC and program strategy with key stakeholders and funders? Revising a TOC will help program teams scope and define the required changes in strategies due to COVID-19, and will ensure that the data collected on the program are relevant and responsive to the crisis.
Written by Natasha Kanagat, Deputy Director of JSI’s Center for Health Information, Monitoring, and Evaluation