Theory of Change in FETPs
Written by Rachel Mather - Epidemiologist at Field Epi in Action
What is a Theory of Change?
While ‘Theory of Change’ is increasingly visible across international development and health programs, the term is ambiguous. Theories of Change (ToC) are nebulous, and the meaning can be context specific. A ToC can be a belief, an approach, a workshop, a process, or a product.
Field Epidemiology in Action (FEiA) consider ToC as an approach to understanding how programs lead to a desired change through a logical sequence of intermediate outcomes. In this way ToC are like logic models – mapping how one step logically links to the next. The differentiation is that a solid ToC visibly acknowledges the complex realities through which change occurs. By bringing the existing systems and challenges to the fore, ToC can produce a more accurate understanding of the backdrop that a program is occurring in, so that all necessary steps that lead to the desired change can be identified.
The Theory of Change map describing the aims and processes of the advanced Field Epidemiology Training Program of Papua New Guinea (aFETPNG). The ToC was developed by key FETP stakeholders from both national and provincial levels of PNG in November 2018.
Developing a Theory of Change ‘Map’
How is this achieved, and how are ToC relevant to field epidemiology? While there are some generally agreed principles or approaches to field epidemiology training, there are more than 90 Field Epidemiology Training Programs (FETPs) building field epidemiology workforce capacity in around 200 countries and territories (TEPHINET 2023). The key aims and priorities of the FETP, and the necessary systems and processes for operationalisation, must be driven by the context in which it exists. Building a common understanding of these is where ToC are helpful.
FEiA have conducted ToC workshops in Papua New Guinea (November 2018), Solomon Islands (March 2021) and most recently, Vanuatu (June 2023) to support the establishment of FETPs. Bringing in stakeholders from across the health system, participants at each workshop worked together to discuss and consider:
The challenges that would impact the development and implementation of the FETP
The overarching change that the FETP should be aiming its efforts to contribute to
The intermediate outcomes, or preconditions, that must exist in order to achieve the overarching change
The assumptions that need to hold true in order for the outcomes to be achieved
The activities, or interventions, necessary to achieve the intermediate outcomes
Indicators of success, and the ceiling of accountability after which the FETP may contribute to but is not wholly responsible for
The resulting ToC ‘map’ describes how and why the FETP works, and what change the FETP is contributing to. The accompanying report goes into a lot more detail – not only in terms of the process, but the discussions of context that led to participants prioritising what they did, and key next steps required to create the change.
Participants of ToC workshops, such as these in Vanuatu, work together at every stage to develop the ToC, resulting in a map and theory that reflects the diverse perspectives and complex realities of any health system.
Further Development and Feedback on the ToC Map
So, what comes next? While some reports are merely filed, the ToC map and report provide a project management and evaluation framework for the FETP. This is cyclical; the ToC both provides initial directions for the FETP, while also serving as an anchor from which to measure progress of the FETP. If the context or aims of the FETP changes – such as following a new strategic plan or changes to the operational environment – the ToC needs to be revisited. For example, in December 2022 we facilitated a monitoring workshop with key FETP actors from Solomon Islands to evaluate progress towards the original ToC. While participants agreed the ToC remained valid, by revisiting it the group were to identify areas where the FETP had and had not progressed, which in turn informed the 2023 FETP operational plan.
Just last month, we facilitated a two-day Theory of Change workshop with 22 participants from across Vanuatu to support planning for its forthcoming FETP, with the aim to commence training in 2024. The subsequent ToC map and report have been circulated to the workshop participants for further input and feedback, to ensure it truly captures their perspectives and realities. Once its been finalised, we look forward to sharing the new Vanuatu FETP ToC.
If you’re interested in conducting a Theory of Change workshop for your FETP, contact FEiA at info@fieldepiinaction.com
About Field Epi in Action
We facilitate proven high impact intervention-based field epidemiology training, designed to develop work-ready graduates equipped with the necessary tools to support outbreak detection and response.