Lessons Learned From the Use of the Most Significant Change Technique for Adaptive Management of Complex Health Interventions

The Most Significant Change technique used in monitoring and evaluation has facilitated learning about the project scale-up and adaptive management of evidence-based family planning interventions across diverse project stakeholders in 11 countries in Asia and sub-Saharan Africa. Key Findings Project staff members in East Africa, Francophone West Africa, India, and Nigeria reported that using the Most Significant Change (MSC) technique had resulted in learning within and across countries to diffuse evidence-based interventions, as well as take concrete adaptive management actions. Collecting significant change stories allows various voices and perspectives across the health system, from the community level to policy makers, to be captured about the impacts of programs, thus enabling prompt corrective actions. Selection meeting discussions and responsive feedback about the significant change stories among various project stakeholders are critical for learning and collaboration. Key Implications The MSC technique could be an important learning and adaptive management tool for global health practitioners, policy makers, and researchers working on complex interventions. Although MSC makes use of a systematic and standard process, it is flexible in how the process is institutionalized to meet the needs and unique context of the implementation team. ABSTRACT Introduction: The Most Significant Change (MSC) technique is a complex-aware monitoring and evaluation tool, widely recognized for various adaptive management purposes. The documentation of practical examples using the MSC technique for an ongoing monitoring purpose is limited. We aim to fill the current gap by documenting and sharing the experience and lessons learned of The Challenge Initiative (TCI), which is scaling up evidence-based family planning (FP) and adolescent and youth sexual and reproductive health (AYSRH) interventions in 11 countries in Asia and sub-Saharan Africa. Methods: The qualitative assessment took place in early 2021 to document TCI’s use and adaptation of MSC and determine its added value in adaptive management, routine monitoring, and cross-learning efforts. Focus group discussions and key informant interviews were conducted virtually with staff members involved in collecting and selecting MSC stories. Results: TCI has had a positive experience with using MSC to facilitate adaptive management in multiple countries. The use of MSC has created learning opportunities that have helped diffuse evidence-based FP and AYSRH interventions both within and across countries. The responsive feedback step in the MSC process was viewed as indispensable to learning and collaboration. There are several necessary inputs to successful use of the method, including buy-in about the benefits, training on good interviewing techniques and qualitative research, and dedicated staff to manage the process. Conclusion: Our assessment results suggest that the MSC technique is an effective qualitative data collection tool to strengthen routine monitoring and adaptive management efforts that allows for flexibility in how project stakeholders implement the process. The MSC technique could be an important tool for global health practitioners, policy makers, and researchers working on complex interventions because they continually need to understand stakeholders’ needs and priorities, learn from lessons and evidence-based practices, and be agile about addressing potential challenges.