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Table 1 Summary of the country projects and the process of developing and revising the ToC

From: Using Theories of Change to inform implementation of health systems research and innovation: experiences of Future Health Systems consortium partners in Bangladesh, India and Uganda

  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
  1. Abbreviations: FHS Future Health Systems, PIRU Policy Influence Research Uptake, TRCL Telemedicine Reference Center Ltd., Bangladesh, PAR participatory action research