• The World Health Organisation (WHO) has launched a new technical guide on developing evidence-informed theories of change (ToCs), a practical tool designed to help health actors better plan, monitor and evaluate their interventions. 

• This guide discusses how to use and incorporate evidence into the processes of developing and updating a theory of change (ToC) in the health sector.

• WHO expects that theories of change can anchor our collective efforts in outcomes and trigger real change in people’s lives.

What is the concept of theory of change?

• Theory of change (ToC) is a critical method for achieving goals, helping policies, programmes, and interventions to focus on outcomes (effects) rather than outputs, and strengthening the respective results chain. 

• It allows policymakers to plan, adapt and evaluate their interventions and engage stakeholders in defining, implementing and measuring the expected development change.

• Every public policy has some version of ToC or an equivalent of it. It has an explicit or implicit theory regarding how its actions will lead to outputs and the expected results. 

• Sometimes, this theory is not publicly displayed or even institutionally registered. However, it does exist, even if only in the minds of the policymakers involved in its design, and will be the backbone of future interventions.

• It is the bedrock of management strategies focusing on performance. 

• A ToC is a framework that allows for a comprehensive description of how and why a desired change is expected to occur in a particular context. 

• The framework involves identifying long-term goals and mapping out all the conditions that must be in place for those goals to be achieved. 

• In this sense, ToCs make explicit assumptions of how determined resources and activities are expected to lead to intended outcomes.

• By helping to articulate the vertical and horizontal logic of interventions, it helps  demonstrate the effects of work to team members and stakeholders.

Design of ToC

• ToCs can be used to support specific policies and programmes, as well as overarching institutional strategies, comprising bundles of interventions and activities. 

• A good ToC should be precise, rigorous, credible, and achievable.

• Generally, ToCs are built through a flexible, participatory, and dynamic process. 

• In this process, stakeholders continuously deepen their understanding of the local conditions for action, barriers, facilitators, risks and opportunities. 

• A well-developed ToC should guide a group of stakeholders through an easy-to-understand explanation of how an intervention or programme will help solve complex social problems to achieve common long-term goals. 

• As such, ToCs should be considered as living models that allow for multiple perspectives to be critically examined. 

• At each phase of the project, ToCs provide the opportunity to assess whether adjustments or improvements are in place to better achieve the desired outcomes.

• While ToCs are portrayed in countless formats and structures, they commonly depict a diagram, showing the connections between interventions and outcomes (causal pathways) while explicitly stating assumptions and related evidence. 

• This diagram usually represents a working model containing pre-conditions, expected results, rationales, assumptions, indicators, and other relevant elements.

Difference between theory of change and program logic models

• People often use the terms ‘theory of change’ and ‘program logic model’ interchangeably. However, there are important differences between the two concepts.

• A ToC is a diagram or written description of the strategies, actions, conditions and resources that facilitate change and achieve outcomes. It has ‘explanatory power’ in that it should explain why you think particular activities or actions will lead to particular outcomes.

• A program logic model is a simpler (often linear) visual representation of how a program is supposed to work. It shows the actions and the particular outcomes expected from them. It can be based on the same information used in a theory of change. However, it doesn't explain how or why the program will achieve the desired outcomes or bring about change.

Reasons to develop a theory of change

• Development challenges are complex, and are typically caused by many factors and layers that are embedded deeply in the way society functions. 

• For example, opening a legal aid clinic may not lead to more women accessing justice services unless issues of cultural sensitivities, needed legal reforms and childcare constraints are addressed as well.

• Theory of change (ToC) is an explicit process of thinking through and documenting how a program or intervention is supposed to work, why it will work, who it will benefit (and in what way) and the conditions required for success.

• A ToC can help a team systematically think through the many underlying and root causes of development challenges, and how they influence each other, when determining what should be addressed as a priority to achieve development change.

• A good ToC can provide you with a program rationale that is based on the best available research and practice evidence while also clarifying any assumptions made about achieving success.

• This can help in more effective program delivery and in assessing the merits of a particular program and its ability to achieve the outcomes you want to see. 

• It can also help to justify government or philanthropic spending and communicate intentions to the community.

• Another reason to develop a ToC is because of its usefulness in evaluation. 

• By explaining how you plan to get from program delivery to achieving outcomes, you will identify and begin to understand the set of conditions, activities and processes that contribute to change. You can interrogate and test that knowledge through evaluation.