USING QUALITATIVE METHODS TO EXAMINE SCALE-UP: Application of the ExpandNet Framework and Most Significant Change methodology

Notas del editor

1. ExpandNet defines scaling up as efforts to increase the impact of health service innovations tested in pilot or experimental projects so as to benefit more people and to foster policy and program development on a lasting basis. This definition is more specific than when the term is used in a general sense to mean broadening the impact of existing or new practices.
2. ExpandNet is a global network of representatives from international organizations, non-governmental organizations, academic and research institutions, ministries of health and specific projects who seek to advance the science and practice of scaling up, share epxperience, determinants of successful scaling up and providing practical guidance.
3. In order to evaluate the process and outcomes of FAM scale-up, we have quantitative and qualitative tools in which to collect data. Monitoring and evaluation – availability of FAM Inclusion of FAM at national/subnational/organizational, at health facilities and provider capacity, as well as knowledge attitudes and practice (users). Stakeholder interviews – A qualitative method, in-depth interviews, will be used to collect information from stakeholders on the process and effect of SDM scale up. Interviews will be conducted with six different types of stakeholders, including: policy makers, representatives of technical assistance and donor agencies, representatives of private for profit provider networks, program managers, pharmacists and community leaders. Interview guides have been developed for each stakeholder and most significant change – M & E forms contain: Norms and policies Pre/in-service training Commodities procurement and logistics IE&C HMIS SDPs offering SDM No. of users
4. People often say that a FP method is ‘scaled up’ once it is found in the MOH’s FP norms and procedures and when providers have been trained in offering the method. But full scale integration of a new method (or any other kind of new service) touches on many systems elements in order to be sustained. As the slide shows, systems and services are interlinked. Political support and technical leadership provide the forward momentum.
5. The resource organization/team refers to the individuals and organizations that seek to promote and facilitate wider use of the innovation (which is the Standard Days Method (and the package of activities – IEC campaigns – TV or radio in Mali, training, etc.). The user organization refers to the institutions or organizations that seek to or are expected to adopt and implement the innovation. In the context of the environment – which are the conditions and institutions which are external to the user organization but fundamentally affect the prospects for scaling up. Types of scaling up – vertical – changes needed to be instituationalized through policy, legal, political or horizontal ( expanding to more geographic sites or servicing larger /differen populations). Influence the strategic choices that need to be made for dissemination and advocacy, organizational choices, costs/resource mobilization and monitoring and evaluation.
6. For IRH, we see many benefits of this particular model…
7. The most significant change (MSC) technique is a form of participatory monitoring and evaluation. It is participatory because many project stakeholders are involved both in deciding the sorts of change to be recorded and in analysing the data. It is a form of monitoring because it occurs throughout the programme cycle and provides information to help people manage the program. It contributes to evaluation because it provides data on impact and outcomes that can be used to help assess the performance of the programme as a whole. MSC has had several names since it was conceived with each emphasising a different aspect, e.g. 'Monitoring-without-indicators': MSC does not make use of pre-defined indicators, especially ones that have to be counted and measured; or the 'story approach': The answers to the central question about change are often in the form of stories of who did what, when and why - and the reasons why the event was important. MSC: Focus on questioning, Open questions, Context in (from the viewpoint of participants) About learning, Inductive, Dynamic, Outer edges of experience Quantitative: Focus on measurement, Closed questions, Project out, About ‘proving’, Deductive, Static, Central tendencies The process involves the collection of significant change stories, and the systematic selection of the most significant of these by panels of designated stakeholders or staff The designated stakeholders or staff are initially involved by searching for program impact Once changes (impact) have been identified, people sit down together and have in depth discussions about the value of these reported changes When the technique is implemented successfully, whole teams of people begin to focus on ongoing monitoring of program impact Learning occurs through discussion, and things we would like to do more of in the program, or areas where we need improvement can be identified and acted on Why stories: People tell stories naturally Stories can deal with complexity and context People remember stories Stories can carry hard messages /undiscussables But stories not known for accuracy/truth
8. What has happened? ( effect – and what has led – process).. Is there value in SDM? And How did it come about? There are two parts to the story: (1) Descriptive (describe change – before and after); and (2) Explanatory (why significant to them or community) The actual question is made up of a number of parts ‘ Looking back over the last year…’ – It refers to a specific time period. ‘… what do you think was...’ – It asks respondents to exercise their own judgment. ‘… the most significant…’ – It asks respondents to be selective, not to try to comment on everything, but to focus in and report on one thing. ‘… change…’ – It asks respondents to be more selective, to report a change rather than static aspects of the situation or something that was present previously. ‘… your involvement with the project?’ – Like the first part of the sentence, this establishes some boundaries. In this particular case we are focusing on the support provided through the project . This part can also be adjusted. It is then followed by further probing questions, always open ended (Could you describe that further? What was it about that change that was significant to you? Did anything else happen?) We will discuss story collecting – challenges and solutions - later in the day. Practicing story collection and thinking through how you will overcome challenges before actually collecting stories is critical.
9. The process involves the collection of significant change stories, and the systematic selection of the most significant of these by panels of designated stakeholders or staff The designated stakeholders or staff are initially involved by searching for program impact Once changes (impact) have been identified, people sit down together and have in depth discussions about the value of these reported changes When the technique is implemented successfully, whole teams of people begin to focus on ongoing monitoring of program impact Learning occurs through discussion, and things we would like to do more of in the program, or areas where we need improvement can be identified and acted on ( e.g. changes in lives of men and women since began using SDM); changes in attitudes toward family planning, changes in the sustainability of SDM introduction - integration/availability, transfer of ownership, perceived value of the SDM, politicial will, and changes in family planning services ( perception/value, quality of service).