The revised Theory of Change

Based on a review of the ‘Kuunika journey’ over the past five years, the original theory of change hypotheses (Annex 1), lessons learnt, challenges and consultations with key informants, the evaluator’s have drafted a new general theory of change for the Kuunika Project. This version of the theory of change is intended to inform dialogue on the next iteration of the project design.

Figure 7 below presents the evaluator’s proposed theory of change for the next iteration of the Kuunika Project. This theory of change builds on some Kuunika activities that have already commenced; however, it also references some activities that should be considered to advance progress towards intended results.

In this version of the theory of change, the project’s intended outcome and impact-level results are now articulated in terms of improved planning capabilities, improved core health services, and improved health outcomes, cost-effectiveness and impact. All these result areas are expected to be underpinned by sustainable institutional change.

Key task areas will encompass activities relating to:

● Improving or ‘re-vamping’ the digital health system architecture ● Enhancing data availability, accessibility and usability ● Building the capacity of application / system developers, data producers and users ● Building the foundations of sound digital health governance

In combination these task sets and activities are expected to produce strategic outputs relating to:

● New data use services - such as dashboards, tools and reporting services to support timely evidence-based decision-making at all system levels ● New developer and data user skills – with capacity to generate, access, use and interpret data at all system levels ● Sectoral change based on an inclusive digital health culture in which all target users can engage with innovation and access timely, quality data to inform policy, clinical / point of care and resource management decisions that will contribute to improved quality health care.

Together, these outputs are intended to provide pathways to the intended outcome and impact results. They will also contribute to a sustainable institutional environment that supports the objectives of successive Malawi Health Sector Strategic Plans.