Theories of Change in Global Health

Global health interventions aim to improve health in communities. Underlying each intervention is a theory of change that addresses a specific constraint--such as poverty, limited access to clinical care, or weak governance--within the complex system that shapes global health. Theories of change can help explain broad global improvements such as those in life expectancy and child mortality. They can also be used to develop interventions for communities facing serious health problems. As global health problems are complex, different definitions of underlying constraints are often championed by different disciplines. Economists generally favor approaches that address poverty or economic instability; physicians advocate for improved health systems; engineers favor investment in technology; charities emphasize the importance of aid. However, monodisciplinary approaches ignore the complex systems that generate global health problems and omit a consideration of the strengths and weaknesses of potential interventions. In Theories of Change in Global Health, Stephen Luby and Sabina Faiz Rashid critically evaluate fifteen common theories of change that underlay global health interventions. Through case studies and examples of interventions across contexts, Luby and Rashid develop a framework of the conditions under which different theories of change have been successful and the conditions which predispose a particular theory of change to failure. As they argue, no single theory of change is a panacea. By spotlighting the often-implicit theory of change and underlying problem definition, this book aims to improve the specificity, depth, and effectiveness of interdisciplinary conversations around optimal strategies towards global health improvement. It also provides critical guidance about which theories of change are most promising and encourages stakeholders to broaden the range of possible interventions under consideration.

Stephen Luby is the Lucy Becker Professor of Medicine and Senior Fellow at the Woods Institute for the Environment and the Freeman Spogli Institute for International Studies at Stanford University. He previously served on the faculty of the Aga Khan University in Karachi, Pakistan, and as the Bangladesh Country Director for the US Centers for Disease Control and Prevention. Dr. Luby is an American physician who has conducted research at the interface between the environment and health in lower income countries since the early 1990s. Sabina Faiz Rashid is Professor, Mushtaque Chowdhury Chair in Health and Poverty, and former Dean at BRAC James P Grant School of Public Health at BRAC University in Dhaka, Bangladesh. She is also the Director of the Centre of Excellence for Gender, Sexual and Reproductive Health and Rights. She is a critical medical anthropologist with over two decades of research experience examining how structural, political, social, and economic factors, combined with gender and poverty, adversely impact the lives and health of disadvantaged populations.

- Introduction - Part I Improving Public Services - 1: Healthcare System Strengthening - 2: External Health Aid - 3: Adopting Healthy Regulations - 4: Improving Governance - Part II Key Technical Approaches - 5: Knowledge Dissemination - 6: Behavior Change - 7: Technology - Part III Economic Strategies - 8: Economic Growth - 9: Cash Transfer - 10: Modifying Prices - 11: Social Entrepreneurship - Part IV Stimulating Global Health Action - 12: Advocacy - 13: Global Health Initiatives - 14: Response to Crisis - 15: Strategic Research - Conclusion