Abstract
BackgroundGrand Challenges for international health and development initiatives have received substantial funding to tackle unsolved problems; however, evidence of their effectiveness in achieving change is lacking. A theory of change may provide a useful tool to track progress towards desired outcomes. The Saving Lives at Birth partnership aims to address inequities in maternal-newborn survival through the provision of strategic investments for the development, testing and transition-to-scale of ground-breaking prevention and treatment approaches with the potential to leapfrog conventional healthcare approaches in low resource settings. We aimed to develop a theory of change and impact framework with prioritised metrics to map the initiative’s contribution towards overall goals, and to measure progress towards improved outcomes around the time of birth.MethodsA theory of change and impact framework was developed retrospectively, drawing on expertise across the partnership and stakeholders. This included a document and literature review, and wide consultation, with feedback from stakeholders at all stages. Possible indicators were reviewed from global maternal-newborn health-related partner initiatives, priority indicator lists, and project indicators from current innovators. These indicators were scored across five domains to prioritise those most relevant and feasible for Saving Lives at Birth. These results informed the identification of the prioritised metrics for the initiative.ResultsThe pathway to scale through Saving Lives at Birth is articulated through a theory of change and impact framework, which also highlight the roles of different actors involved in the programme.A prioritised metrics toolkit, including ten core impact indicators and five additional process indicators, complement the theory of change. The retrospective nature of this development enabled structured reflection of the program mechanics, allowing for inclusion of learning from the first four rounds of the program to inform implementation of subsequent rounds.ConclusionsWhile theories of change are more traditionally developed before program implementation, retrospective development can still be a useful exercise for multi-round programs like Saving Lives at Birth, where outputs from the development can be used to strengthen subsequent rounds. However, identifying a uniform set of prioritised metrics for use across the portfolio proved more challenging. Lessons learnt from this exercise will be relevant to the development of pathways to change across other Grand Challenges and global health platforms.
Highlights
Grand Challenges for international health and development initiatives have received substantial funding to tackle unsolved problems; evidence of their effectiveness in achieving change is lacking
Grand Challenges for international heath and development initiatives have grown from the premise that science and technology, when applied appropriately can have transformational effects, and that engaging nontraditional potential innovators and problem solvers from around the world around critical problems is key in identifying more innovations that work
This paper reports on the development of a theory of change and impact framework, in addition to the development of prioritised metrics for Saving Lives at Birth following the end of the initial commitment from the partners
Summary
Grand Challenges for international health and development initiatives have received substantial funding to tackle unsolved problems; evidence of their effectiveness in achieving change is lacking. Grand Challenges for international heath and development initiatives have grown from the premise that science and technology, when applied appropriately can have transformational effects, and that engaging nontraditional potential innovators and problem solvers from around the world around critical problems is key in identifying more innovations that work These successful innovations have the potential to be scaled-up and lead to improvements in health and development status. A theory of change, which provides a comprehensive description of how and why a desired change is intended to happen, mapping out all the required steps in order to achieve long-term goals is a useful tool to track progress towards specific goals [1] It includes indicators for each stage of the pathway which create a holistic impact or outcomes framework including both process and outcome indicators [2], yet these have been rarely used within the Grand Challenge context
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