Using Most Significant Change Methodology to Evaluate Impact of a Health Innovation in Four Countries

The study aimed to understand the process and outcomes of scaling up FAM, specifically the Standard Days Method (SDM), in Guatemala, Mali, Rwanda, the Democratic Republic of Congo (DRC), and India. IRH used the ExpandNet/WHO model for scaling-up health innovations and the Most Significant Change (MSC) methodology as one of its evaluation components. The MSC technique is a participatory, qualitative method that involves collecting stories of significant change, systematic interpretation of the stories, and selection of the stories showing the most significant changes by a group of stakeholders. IRH implemented MSC in four of the five FAM Project countries, collecting stories from users, service providers, and program managers in public and private sector family planning (FP) programs. The implementation of MSC resulted in 155 significant change stories over 20 months, collected by 12 organizations and institutions. The MSC stories were analyzed to identify the most significant changes due to FAM integration. In the program manager domain, the most significant changes included increased availability of FAM in services, improved method integration into norms, reporting, training, and other health systems elements. In the provider domain, the most significant changes included increased provider knowledge and skills in FAM, improved provider-client communication, and increased provider confidence in providing FAM. In the user/beneficiary domain, the most significant changes included increased user knowledge and skills in FAM, improved user-provider communication, and increased user confidence in using FAM. Significant trends across domains included increased availability of FAM in services, improved provider and user knowledge and skills in FAM, and increased user confidence in using FAM. The implementation of MSC in the FAM Project countries provided valuable insights into the personal impact of SDM and LAM integration in the communities and programs where the methods were introduced. The results of the MSC implementation highlighted the importance of participatory, qualitative evaluation components in understanding the process and outcomes of scaling up health innovations in complex systems. The FAM Project aimed to increase access and use of FAM within a broad range of service delivery programs using systems-oriented scaling up approaches. The project was funded by the United States Agency for International Development (USAID) and was implemented by IRH in collaboration with local partners in the four countries. The project's results and lessons learned will inform the scale-up of FAM in other countries and contribute to the development of effective, easy-to-use fertility awareness-based methods of family planning. The Institute for Reproductive Health (IRH) is a leading technical resource and learning center committed to developing and increasing the availability of effective, easy-to-use fertility awareness-based methods (FAM) of family planning. IRH is part of the Georgetown University Medical Center, an internationally recognized academic medical center with a three-part mission of research, teaching, and patient care.