Q5: How Could We Improve?

We established what we want to achieve, investigated what might be preventing our desired outcomes and generated potential solutions to those challenges. Now it is time to scale and implement our ideas.

But this is not the end. As we bring these ideas to the field, how can we continually improve them throughout their implementation? Improving immunization programmes requires a continual process of discovery, experimentation and learning. Many variables shape the success of a programme; some may be identified before implementing new ideas, but some will be identified during implementation. This calls for iteration.

Implementation is an opportunity for further learning and improvement. While disappointing, it is possible (and even likely) that our initial diagnoses were incorrect, or partially correct, and that our evaluations of prototyping were insufficient. Only by scaling and implementing our ideas can we see what works and what does not in the real world.

Q5a
Q5 | 5a

Plan for Iteration

What do we hope to learn during programme implementation? What are we going to measure? How will we measure it? An Adaptation Plan contains questions that we will return to during the iterative implementation of our ideas. These questions determine what we learn and what we change.

Adaptation Plans are ‘living’ documents. They should change from phase to phase. For example, we might identify unforeseen obstacles to success and we might change what we choose to measure.

Tool #22

 Adaptation Plan

Demand_For_HealthServices_FullWorkbook34

This tool outlines what we hope to learn by selectively deciding what to measure and track for the purposes of adapting an idea over time.

Q5b
Q5 | 5b

Evaluate Effectiveness

Whereas Planning happens on paper, Evaluation happens in the field. This step is comprised of two sequential parts: executing the means of verification chosen in the Adaptation Plan and analysing information as it is collated.

The methods used to execute the means of verification and analyse findings will vary significantly depending upon the chosen initiatives chosen for implementation.

Q5c
Q5 | 5c

Improve Ideas

The first involves efforts to improve the idea itself. Discovering that a particular risk is impeding an idea’s potential, or that the idea is not being received by users in the way we anticipated, requires returning to concept creation and design (Question 4). Once we have a new idea, we redeploy in a new phase of implementation and re-evaluate its performance. We can call this Idea Improvements.

The second involves making adjustments to how we measure and learn. Before we continue scaling up, we should revisit the initial Adaptation Plan: have we been asking the right questions? Are the indicators we chose proving helpful, or too challenging to meaningfully track? Are there others we should consider? What additional risks emerged that we did not anticipate? What risks did we anticipate that had no impact? We can call this Planning Improvements.