On July 30, 2017, SMART Africa investigators, Drs. Inge Petersen, and Arvin Bhana, and Ms. Erica Breuer from Alan J. Flisher Centre for Public Mental Health facilitated a half-day Theory of Change (ToC) pre-conference workshop. This event was held at Sheraton Hotel in Kampala, Uganda as part of the 2nd Annual Conference on Child Behavioral Health in sub-Saharan Africa.
The aim of the ToC workshop was to introduce participants to the concept of ToC and demonstrate how the concept could be developed and used in the planning of child and adolescent mental health services at the regional/district levels. Over 30 people representing NGOs, district level representatives from Masaka, Rakai, Kalungu and Lwengo, academicians, National Institute of Mental Health (NIMH) colleagues, and SMART Africa team members participated in the workshop.
ToC is an outcome-based approach that describes how an intervention leads to specific outcomes through a logical sequence of activities. Participants were introduced to key elements of the ToC including; impact, outcomes, assumptions, rationale, indicators of success, and intervention or key activities. Several key features of ToC were highlighted:
1) ToC uses principles of participation and empowerment to engage various stakeholders working together to bridge the gaps in the system,
2) ToC is comprised of several functions like strategic planning, monitoring and evaluation, description, and learning,
3) ToC allows its users to identify the pathways to and through care that includes mental health promotion/prevention, mental health awareness and literacy, screening, assessment, treatment, and follow-up,
4) ToC map may have different pathways depending on how the policy works in different contexts and setting of the intervention, and
5) ToC needs community ownership; hence the inclusion of key community stakeholders is key.
The workshop was delivered using a mixture of presentations, and participatory activities such as open plenary discussions, facilitated group work, report back sessions and visual mapping exercises in developing maps and pathways. ToC workshop was divided into five sessions accompanied by five group exercises. The sessions focused on five key issues, namely; challenges of child mental health, expected impact when addressing child mental health challenges, development of outcomes, identifying knowledge gaps and evidence-based interventions and developing indicators for evaluating progress. All the discussions were based on designing and implementing an intervention in the Masaka District of Uganda, where the SMART Africa-Uganda scale-up study is currently implemented.
With facilitators’ guidance, participants came up with three key tangible outputs; a ToC map, an outline of identified challenges and a set of suggested outcomes addressing child mental health challenges in Masaka. For more detailed information, please refer to ToC workshop notes.
Going forward, facilitators encouraged the participants to take back the ToC to develop it further, present it to their respective teams, and see how that represents everyone’s ideas on the team.