Table 1 Summary of the country projects and the process of developing and revising the ToC
| Â | Bangladesh | India | Uganda |
|---|---|---|---|
ToC development | Actors: Bangladesh FHS team, PIRU Coordinator, TRCL representatives Duration: 2–3 months Materials: Document review, team meetings, discussion with external collaborators and insights from other FHS members | Actors: India FHS team, PIRU Coordinator, facilitation by country coordinator Duration: 2–3 months Materials: Team meetings during project design and developing of annual plan and status update against the annual plan | Actors: Uganda FHS team, facilitation by EE, Suzanne Kiwanuka, MT and JK Duration: 9 months Materials: Stakeholder consultations during project design phase |
ToC revision | Actors: Bangladesh FHS team Duration: 1-day workshop Materials: data from household survey, interviews with village doctors, patients, project documents | Actors: India FHS team, facilitation by PIRU Coordinator Duration: 1-day workshop Materials: Findings from internal evaluation of implementation challenges; in-depth interviews with various stakeholders like non-governmental organisation, donor agencies and government workers and officials | Actors: Uganda FHS team, facilitation by AG and LP Duration: 2-day workshop Materials: PAR cycles allowed for periodic review of intervention; quarterly meetings at the sub-county and district levels and community engagement informed the ToC revision |
Key changes made | Revised intervention (dropped HealthBox, focused on telemedicine only); increased emphasis on inputs such as promotional activities by the telemedicine providers; identified new linkages, such as between (1) community and telemedicine use and (2) telemedicine use by the poor playing a role in reducing the delay in care-seeking | Constructs and relationships more specific, particularly to better recognise health and non-health factors influencing child health, as well as of historical and political contextual factors affecting the team’s intervention with feasible indicators | Richer representation of the complex nature of the project’s interventions (i.e. greater representation of feedback among intervention components and among stakeholders); assumptions better articulated in the revised ToCs |
Major contextual changes captured | Rapidly growing mobile phone subscriptions were assumed to facilitate access to and use of eHealth initiatives by the community and village doctors; however, use of eHealth services by the community and village doctors appears to be very limited | The local stakeholders in Sundarbans were not working solely on child health; rather, they employed an approach cutting across health, nutrition, livelihood and climate change | Changing in the channels of communicating messages to the communities, the content of the messages, as well as re-targeting actors responsible for various interventions at district level |