A Results Framework Serves Both Program Design and Delivery Science

Abstract

Health programmers and researchers must collaborate despite different mandates and technical languages. A results framework is a simple model that both disciplines can use to understand complexity, clarify assumptions and hypotheses, design programs, and ask questions to inform action research. Typically, a health program's results framework has 3 tiers and 6 boxes: a base of 4 health service intermediate results (access, quality, demand, and environment), which lead to a midlevel strategic objective (use of life-saving intervention), which leads to the goal (improved health). A situation analysis directly informs intervention selection; more difficult is selecting strategies to deliver the interventions, especially in settings of health system weakness. We propose menus and submenus of strategies to achieve each intermediate result, illustrate the use of the results framework in a program design and in clarifying research questions, and begin to propose a research agenda for "delivery scientists" responsible for recommending optimal investments to maximize use of interventions by those who need them most.

Strengthening implementation and utilization of nutrition interventions through research: a framework and research agenda

“…The study in Peru found that, although implementation of the program at health centers in Peru was “less than optimal” overall, aspects of the implementation were nevertheless significant variables in the impact pathway to contribute to success. Overall, few studies tend to look systematically at delivery‐related factors, although they are recognized as being important to the adoption of practices and impact in nutrition programs …”

“…Results frameworks: These are one of the most common tools used in development to guide the design, monitoring, and evaluation of policies and programs, and their applicability in nutrition programs has been described by Marsh. 30 They help rationalize and make explicit the relations among inputs and the anticipated outputs, outcomes, and impacts, but they do not by themselves contain or reveal the underlying biological, behavioral, or social theory by which inputs are expected to produce the desired results. 2.…”

“…Overall, few studies tend to look systematically at delivery-related factors, although they are recognized as being important to the adoption of practices and impact in nutrition programs. 30 Research needs related to implementation, service delivery, and coverage. Our review reinforces that the current literature on IYCF BCC and MNP interventions does not yet include sufficient information on issues related to service delivery, quality, and coverage.…”

Expanding the Frontiers of Population Nutrition Research: New Questions, New Methods, and New Approaches

“…These include impact and process evaluations of large-scale programs and in demonstration or feasibility trials (154,215,216); formative or operations research to understand or address specific implementation issues or bottlenecks (217,218); retrospective "lessons learned" exercises (219-221); the development and application of tools to strengthen program design and/or implementation, such as log frames, program impact pathways, and program assessment methodologies (222)(223)(224); a large number of descriptive accounts of efforts to implement interventions, programs, or policies at organizational, local, and/or national levels (225)(226)(227)(228)(229)(230); and the development of new evaluation approaches sensitive to the needs and realities of implementation (35,231). This work often is driven by the needs of program implementers (and some funders) to strengthen the extent and quality of implementation and often involves collaboration between researchers and implementers.…”

Introduction to a Special Supplement: Evidence for the Implementation, Effects, and Impact of the Integrated Community Case Management Strategy to Treat Childhood Infection

“…9 In Stockholm (May 2009), ccm.org proposed a generic evaluation framework for iCCM (Figure 1). 9 On the basis of a results framework,10 the schema includes outcomes (boxes in top three rows) and processes (partitioned box at the bottom) to implement the strategy.…”