Most Significant Change (MSC) workshops were held in each case study state. MSC is an approach to monitoring and evaluation that involves assessing changes and impacts in response to a program from the perspective of (in this case) USAID HPN implementing partners, State Ministry of Health and other government staff, and other donor partners. In each state, participants shared stories of change and ultimately chose one story as MSC for three “domains of change” that were topic areas for the stories: 1) advocacy and accountability for health, 2) capacity for leadership and governance in healthcare, and 3) sustainability of health outcomes and systems. The selected MSC stories included a focus on sustainability at the community, health facility, and/or system level. Community structures were reactivated and strengthened, and traditional and religious leaders were trained on promotion of priority health behaviors leading to increased community ownership of health. At the facility level, behavior change interventions that addressed and reshaped provider attitudes, norms, and biases strengthened quality of care. At the system level, state structures for managing diseases such as malaria were reactivated and health officials’ capacity was strengthened in the areas of data management and use, planning, and coordination. In addition, drug revolving funds were established or strengthened in each state for sustainable availability of drugs and commodities. The workshop enabled participants to tell stories that reflected their views on the types of changes they believe are impactful and sustainable and can inform the development of sustainability frameworks and benchmarks.
