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For the next step in developing your country’s IMCI program theory, you will need to figure out the order in which these outcomes were expected to occur, and create boxes for each one. To get things in the right logical order, ask:1.Which of the outcomes follow directly from the outputs that were identified in Deliverable 1? These are short-term, or immediate, and are the next step after outputs in the causal pathway.2.Which outcomes come next? How many of the preceding short-term outcomes contribute to each of these – once you start getting to this intermediate outcome stage in the causal pathway, it is typical that multiple activities contribute to achieving an outcome, so there may be arrows 4
from more than one preceding short-term outcome box going to one intermediate outcome box. There may be some logical ordering within the set of intermediate outcomes – some may need tohappen before others. You can have several steps of intermediate outcomes before getting to the long-term outcome, depending on the type of activity/intervention.3.What are the longer-term outcomes? Usually, there are only 2-3 of these in a program, and these are things that must be achieved if any change in the ultimate impact can be expected. Often, if a program achieves this level of outcome along the causal pathway, there is confidence that the impact will be achieved, even if it was not measured as part of the evaluation study. All of the preceding intermediate outcomes should contribute to at least one, or even all, of these longer-term outcomes on the causal pathway.4.Indicate where each indicator belongs in the table below: short-term, intermediate, or long-term.5.For the last row in the table: Impact of IMCI – how was it defined? Was mortality defined and measured in your country’s study? What about nutritional status? These are the expected IMCI impacts on health status, and should be the end boxes on the right hand side of the program theory – where all the activities’ causal pathways converge. If mortality or nutrition was not part of your country study, just put the overall IMCI goals of Reduced U5 Mortality and Improved Nutrition.Table 1. Process and Effects indicators in the IMCI MCE studyOutcomes used for process/implementation assessmentIndicatorHow measuredShort-termIntermediateLong-termOutcomes used for assessing effects of IMCIIndicatorHow measuredShort-termIntermediateLong-termImpact of IMCIIndicatorMeasured?How measuredAdditional questions that may help with the table above:1.Think about the distinct activities for your program. How would expect each activity to produce or contribute to the desired long-term outcomes of the IMCI? What intermediate outcomes need to be achieved along the way?2.How do you think the different activities together are expected to contribute to the long-term outcomes and impact of interest?