Fundamental concepts in measurement, evaluation and quality improvement


Tina Sahay

With the new Ontario Public Health Standards (OPHS) released in 2018, there has been a lot of talk about effective public health practice, and with that, new concepts and tools to get used to.  You may be hearing about the concept of theory of change and wondering what it is.  How does theory of change apply to programs and how can it help us to be more effective?  In this blog, P2I’s Tina Sahay provides an overview of the core concepts of theory of change and how it can be used in your organization.


I first heard about Theory of Change (TOC) when I worked on a development project in India back in the 1980s.  The tool really helped us to collectively sort through the complexity of a social development project and to land on some clear goals and a pathway for achieving them.  So, I’m pretty pleased to see this tool gaining momentum in Canada among non-profits and within the public sector.  I’m a strong advocate of using this approach to guide organizational and program strategy formation and hope that it will increasingly influence the way in which we approach the design and delivery of programs.   

So many initiatives in public health, and other sectors, many of them excellent, show little evidence of lasting impact.  Working toward effective practice is understandably an ongoing, often messy, and deeply challenging endeavor.  But why do we often feel we are falling short?  Is it that interventions are planned and implemented as fragmentary short-term projects, rather than holistic longer-term processes?  Is it that success is measured in terms of outputs rather than results?  Is it a lack of understanding of the actors and influencers who intentionally or unintentionally influence our achievement of outcomes?  Adopting a theory of change helps us to understand the conditions necessary to sort out our work together, to understand all the actors and influencers who shape or contribute to our achievement of outcomes and to measure and build on impact in an incremental and integrated way.

What is a theory of change?

Simply put, a theory of change approach provides a framework which encourages program staff and stakeholders to develop comprehensive descriptions and illustrations of how and why a desired change is expected to happen in a particular context.  A group brainstorms together what their long-term organizational or program goal is, and then identifies the conditions or outcomes that need to occur for this long-term goal to be achieved.  The outcomes are typically arranged graphically in what is called a causal framework or outcomes pathway, with more immediate outcomes preceding later ones.  Stakeholders are challenged to test their assumptions about the causal linkages between outcomes and are called upon to provide evidence to support the linkages.

I like to think of TOC as a roadmap in that it provides us with an understanding of the landscape (actors, influencers, context, system) that maybe we can’t control but which nonetheless influence our ability to reach our destination or long-term goal.  It shows all the routes (pathways) that might lead to change even if some of these are not related to our program. And it shows the distances (indicators) that we need to travel to get to our destination (long-term result).  We use a road map to help us plot the journey from where we are now to where we want to be – our strategies or interventions. 

There is a very good paper which illustrates the importance of the TOC concept.  It was written in 1995 by Carol Weiss of the Aspen Institute and is called – Nothing as Practical as Good Theory: Exploring Theory-Based Evaluation.  In that paper, Weiss says that program stakeholders are often unclear about how a change process will unfold and therefore place little attention to the early and mid-term changes that need to happen in order for a longer-term goal to be reached. The lack of clarity about the ‘mini-steps’ that must be taken to reach a long-term result not only makes the task of evaluating a complex initiative challenging, but reduces the likelihood that all of the important factors related to the long-term goal will be addressed.

Core elements

Theory of change is becoming a ‘buzzword’ thrown about by funders, evaluators, planners and consultants.  It can be frustrating if you are new to the concept to sift through its different approaches or to even know if it will be useful for your organization.  To complicate matters further, there is no single definition of TOC and no single approach to developing one.  My experience in consulting with organizations and programs to develop theories of change has led me to identify a few CORE elements that defines this approach. 

1. A clear understanding of the problem.  A clear analysis of the problem your organization or program is trying to address is at the core of a theory of change.  Clarity about where your population is at will help to focus your efforts and land on a long-term goal that everyone agrees upon.  While participants working to develop a theory of change may hold different views and perspectives about how to achieve a long-term goal, they should share a broad commitment to the long-term goal derived through a clear understanding of the problem at hand. 

2. Use a participatory approach.  Never develop a TOC by yourself.  The sole purpose of doing a TOC is to help program staff and stakeholders to check that programs are appropriate, debate them and enrich them to strengthen their design and implementation. For this reason, the theory of change process emphasizes the importance of dialogue with stakeholders, acknowledgment of multiple viewpoints and recognition of power relations, as well as political, social and environmental realities in the context.  TOC should be developed in a group to help organizations or teams see beyond their familiar frames and habits, understand the full complexity of the change they wish to see, and imagine new solutions in dialogue with others.   

3. Focus on what you want to achieve, not what you want to do.  Read any set of standards, strategic plans or other such planning documents and you’ll find that inevitably the focus is on what we should be doing in the next three, four or five years, instead of on what we are trying to bring about.  Starting with activities as a solution to a problem right off the bat begs the question, how do we know these activities are the right ones?  A theory of change forces us to think about results first.  What is it we want to achieve?  What pre-conditions are necessary to bring about these changes?  What evidence is there to support our assumptions?  Only when these questions are answered does a TOC ask us to then think about the activities necessary to bring about these results.    

4.  Consider the context.  A TOC, when done thoughtfully, gives us the big picture, including issues related to the environment or context that we can’t control.  It shows us all the different pathways that might lead to change, even if those pathways are not related to our program.  A TOC helps us to focus our efforts on the aspects of a problem, its causes and consequences, which are within our reach and capacity to influence and to identify those which are largely beyond our direct focus or which are far beyond the scope of our program.  While we may want to engage with partners to affect these external factors, we know not to expend excessive effort or resources toward this end — we’ll leave that up to our partners.   Considering the context in which we work helps us to take into account the complexity of our work and the possible barriers or enablers to achieving our outcomes. 

5. Be flexible when representing a TOC.  I always tell people there is no right or wrong way to represent a TOC – just lay it out in a way that is most meaningful to you.  The diagram below is what I call an ‘all-in-one model’, in that it includes not only the core elements found in most TOCs – impact statement, long-term outcomes, intermediate outcomes (pre-conditions), and assumptions, but it also incorporates indicators to measure change and interventions as needed along the causal pathway. 

To sum up, when done thoughtfully and without rush, a theory of change can be a useful tool to specify the range of conditions necessary to allow programs to deliver on desired results. A TOC helps organizations and program staff and stakeholders to check that programs are appropriate, debate them and enrich them to strengthen their design and implementation.  By developing a theory of change based on good theory, managers can be better assured that their programs are delivering the right activities for the desired results. And by creating a theory of change, programs are easier to sustain, bring to scale, and evaluate, since each step – from the ideas behind it, to the results it hopes to provide, to the resources needed – are clearly defined within the theory. 

As you embark on your theory of change, remember, there is no one way to do it.  Talk with your stakeholders about what suits your organizational culture, google away to learn about different approaches, and devote the necessary time to develop and revisit your theory as your program unfolds.  Debate, challenge one another, make decisions, and have fun brainstorming your program’s path to success!

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