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Lessons from Chile's Use of System‐Level Theory of Change to Implement a Policy Redesign Process to Address Health Inequities
Author(s) -
Solar Orielle,
Frenz Patricia
Publication year - 2017
Publication title -
new directions for evaluation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.374
H-Index - 40
eISSN - 1534-875X
pISSN - 1097-6736
DOI - 10.1002/ev.20246
Subject(s) - theory of change , transformative learning , process (computing) , health equity , social capital , social determinants of health , public relations , sociology , program evaluation , health policy , process management , political science , economic growth , health care , public administration , computer science , business , economics , social science , pedagogy , anthropology , operating system
To reduce health inequities, Chile´s Ministry of Health embarked on an ambitious process to implement policy redesign involving six public health programs that used a system‐level theory of change. The process brought together a large and diverse group of national and local actors from within and outside the health sector organized in a network of program nodes, who worked together on well‐defined tasks over the course of a year with high‐level political and technical support. The tasks were part of a coconstructed stepwise assessment methodology, based on understanding and testing program theory and uncovering theories of inequities, drawing on realistic evaluation approaches, the social determinants of health framework, and models of effective program coverage. Almost simultaneously, the program nodes proposed new program theories to address equities with an implementation strategy, which necessarily engaged other sectors and community actors. This chapter highlights some of the lessons to explain the success of Chile´s redesign process: (a) the diversity of knowledge and experiences across nodes enriched and enabled system‐level change, (b) the key distinction between theory of change and theory of inequities required to address inequities, and (c) the long‐lasting transformative capital for institutional change of training a network of agents for change.