Using Most Significant Change methodology to evaluate impact of scaling up of a health innovation in five countries

In a complex systems process to scale up a new family planning (FP) method, monitoring and evaluation efforts typically focus on measuring the availability of the new method in services and, sometimes, the extent of method integration into norms, reporting, training, and other health systems elements. When evaluating programs that involve a multi-year, multi-organizational process, how best to bring the individual perspective into the evaluation process is a challenge. To learn about values, meanings, and unanticipated effects and how involved stakeholders are affected, inductive methodologies play important roles. Most Significant Change (MSC), a participatory, story-based methodology, was adapted for use in evaluation of scale up of integrating the Standard Days Method (SDM) into FP programs in DR Congo, Guatemala, Mali, Rwanda, and India. Organizations involved in introducing SDM were trained on MSC, collected, analyzed, and selected top MSC stories at user/client, provider, and program manager/policy maker levels. Over 140 stories were collected by over 30 organizations, triaged, analyzed, and later shared with FP stakeholders. The use of MSC created an opportunity for those involved in a scale up process to learn about new method introduction from a personal perspective, appreciate how it is valued by different actors, and reinforce organizational and personal commitment to the scaling up process. Challenges within organizations using the MSC methodology will be discussed as well as findings of the cross-country analysis of MSC stories.