Sols FETP: Theory of Change process
Solomon Islands has engaged with various forms of field epidemiology training for nearly 10 years, and in the past few years has explored its options to accelerate field epi capacity. This includes having two fellows complete Field Epidemiology Training Program of Papua New Guinea (FETPNG) in 2018, and 11 participants complete a postgraduate certificate in field epidemiology through Fiji National University (FNU) in 2019. Our high-level conversation with Solomon Islands about adopting its own Field Epidemiology Training Program (FETP) model occurred over about 18 months, starting in early 2018, with decision makers really wisely considering their priorities within the existing health system before committing to a model.
While delaying our plans to establish Solomon Islands FETP (Sols FETP), the emergence of COVID-19 served to highlight the imperative of our collaboration with the Solomon Islands Ministry of Health and Medical Services (MHMS) to build field epi capacity across the country’s nine Provinces.
Baseline: March 2021. The red dots are FETPNG graduates and the yellow are FNU graduates.
By December 2021 – more FETP grads across the country
At the outset, Sols FETP is largely modelled from FETPNG, which is not affiliated by an academic institution but wholly government owned and operated, and unique amongst FETPs for its inclusion of an intervention project. However we and our partners in Solomons were really keen to have the model adapted to Solomon Islands’ context to ensure its relevance and sustainability. Having spoken to our counterparts in PNG about the Theory of Change workshop we facilitated for the Advanced FETPNG program, they were keen to undertake a similar process to help map how Sols FETP can be integrated and adapted to the Solomon Islands health system.
We define Theory of Change as a process which describes how programs bring about specific outcomes through a logical sequence of intermediate outcomes. The subsequent product or process describes how and why a program works, and can be used to inform the development, monitoring and evaluation, and implementation of programs.
Sols FETP Theory of Change participants, from front row left: Nathan Jama Jr, Ambrose Gali, Cynthia Joshua, Deborah Davo, Freda Pitakaka, Samuel Manu, John Harara, Lorraine Satorara, Alison Ripiapu Sio. Back row: Simpson Qalo, Rolly Viga, Martin Gavira, Barbara Leinga, Rachel Mather (facilitator), Nixon Olofisau, Dr Rex Maukera, Dr Hugo Bugorgo. (Missing: Michael Lauri, Julie Atu, Suné Waletofea)
We ran the two-day Workshop in March, with 19 participants joining from across the country. 11 of the participants came from the National level, and most of these people have a direct role in the program, including the Director and faculty, and hopefully some people who will come to be in the Steering Committee. From the Provincial level we had Provincial Health Directors and Nursing Directors, which are the kinds of roles that are likely managers of fellows, as well as Surveillance Officers, which is the key role that will be recruited into the program. Some of the Surveillance Officers had previously completed the FNU training, but one came to be enrolled in the first cohort of Sols FETP. Eight of the participants were female; six came from the National level.
The workshop commenced with introductory presentations providing an overview of what FETPs are and how they have been standardised globally; the rationale to establish an FETP in Solomon Islands; and the experiences of a Solomon Islander graduate FETPNG. We also went over what a Theory of Change is, as an approach, a process and a product, and used the example of planning an expedition to the summit of Mt Popomanaseu, the highest peak in Solomon Islands. The remainder of the workshop was structured into a series of sessions which started with group work, whereby groups noted their discussion on post it notes, followed by feedback to the plenary to identify common themes and discuss these in more depth. These sessions built on the work of the previous session and asked participants to consider: 1) the challenges that were likely to present when developing and implementing Sols FETP; 2) the key outcomes for Sols FETP; 3) the intermediate outcomes (or preconditions) required to achieve the outcomes; 4) the assumptions that needed to hold true in order for the outcomes to be achieved; 5) interventions required to achieve the outcomes; and 6) indicators of success. Finally, as a plenary, the group considered where the ceiling of accountability should be. The ceiling of accountability recognises there are wider impacts from existing within complex systems and is the line beyond which the program is no longer wholly accountable for the outcome.
In our next blog post, we’ll share the Theory of Change that our participants came up with!