Background: Community Health Workers (CHWs) are an essential component of resilient and responsive health systems, within which they are a bridge between the community and formal health service to increase access to services. Although evidence shows that CHW programmes are effective in improving maternal and child health (MCH), greater clarity is required to understand what makes CHW programmes work, for whom and under what circumstances. This presentation draws lessons from using logic mapping as a tool to de-construct a multi-intervention CHW programme in Nigeria, which aimed to increase access to quality maternity services and improve MCH outcomes. The presentation should be of interest to policymakers and researchers interested in innovative approaches for evaluating and/or strengthening health systems. Methods: A logic map (LM) is a graphic way of organizing and displaying information about a strategy, programme or policy. A coherent LM is a thread of evidence-based logic that integrates programme planning, implementation, evaluation and programme reporting. We used logic mapping as part of a realist evaluation framework, to assess whether the CHW programme in Nigeria worked, for whom and under what circumstances. The evaluation methodology involved 3 steps: initial programme theory development, theory validation and theory refinement. We share reflections on using logic mapping for the first evaluation step. To achieve this, we used logic mapping to graphically de-construct stakeholder’s (i.e. policymakers, implementers and researchers) thinking of how the programme should work, by illustrating interrelations between actors, context, implementation process, outputs and outcomes. Data for developing the LM was collected using documents review, email discussions and a technical workshop (for researchers and implementers), to untangle relationships between programme elements, and develop initial working theories. Results: Logic mapping enabled stakeholders to collaboratively describe and link desired outputs and impacts to actual activities, to confirm that activities contribute towards achieving measurable final outcomes. Discussion/conclusions: Logic mapping provided stakeholders with a shared language for, and an approach to strengthen learning at local levels, to build health system responsiveness. However, we experienced two challenges with using LMs. First, the LM depicted linear/simplified relationships between inputs, activities and outputs, or between outputs and outcomes whereas in reality, interrelationships between and among inputs, activities and outputs, or between outputs and outcomes are more complex. Second, it was difficult to represent all relationships among programme elements in a single two-dimensional LM. Consequently, a series of (or nested) LMs were required to depict various components within the multi-intervention programme.
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)